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Former Federal Health, Science And Economic Officials On Government Epidemic Response


Last Friday, there were 1,264 confirmed cases of COVID-19 in the United States. Today there are more than 15,000 confirmed cases.


The rhythms of daily life have come to a screeching halt, like here in California, where I am.


GAVIN NEWSOM: There is a recognition of our interdependence that requires of this moment that we direct a statewide order for people to stay at home.

CHANG: That is California Gov. Gavin Newsom last night ordering residents to stay at home.

KELLY: Despite the drastic measures being taken in California and around the country over the past week, coronavirus continues to spread. And as predicted, hospitals are becoming overwhelmed. The head of Massachusetts General Hospital is asking for people with 3D printers to print masks to try to alleviate shortages.

CHANG: In Indiana, people are sewing homemade masks and dropping them off for health care workers.

KELLY: And hospital systems across the country are warning there are not enough ICU beds to take care of the coming wave of critically ill patients.

CHANG: We're now going to spend the next several minutes talking through where the U.S. is in its ability to deal with the growing pandemic. And to do that, I'm joined now by three people who have played key roles in federal government - Dr. Margaret Hamburg, who was FDA commissioner under President Obama, Douglas Holtz-Eakin, who was chief economist for President George W. Bush and economics policy adviser for the John McCain campaign in 2008 - he joins us via Skype - and Tara O'Toole, who served as undersecretary of science and technology at the Department of Homeland Security.

Welcome to all three of you.


TARA O'TOOLE: Thank you.


CHANG: Tara, I'm going to start with you. It looks like, you know, the national stockpile, which are supplies held in reserve for emergencies - it looks like at this point, the national stockpile isn't big enough to meet the anticipated need. And I want to play you something that President Trump said at yesterday's briefing.


PRESIDENT DONALD TRUMP: You know, we're not a shipping clerk. The governors are supposed to be - as with testing, the governors are supposed to be doing it.

CHANG: But then former Homeland Security Secretary Jay Johnson took issue with that. This was from an interview on NPR this morning.


JAY JOHNSON: The president is actually, in many respects, the shipping clerk in chief here. And it's up to the president and the Congress to ensure that we have what we need on the front lines.

CHANG: So, Tara, who do you think is right about this? Is the president the shipping clerk?

O'TOOLE: I wouldn't say the president is the shipping clerk, but the federal government certainly plays a key role in ensuring that frontline health care workers have the gear that they need in emergencies like this. The strategic national stockpile was started more than 20 years ago by President Clinton initially to respond to chemical, biological and nuclear events, but it's expanded since then to include stuff for hurricanes, for Zika outbreaks and much else. But it was always intended to be a source of supplies that would bridge the - from the time of the emergency to when the private sector could come back online and use its supply chains...

CHANG: Right.

O'TOOLE: ...To fill the need.

CHANG: Well, let's talk about that - bridging this gap between the public and private sector. I mean, one measure that could potentially be helpful is the Defense Production Act. The president signed it more than two days ago. This helps the federal government access supplies from the private sector in times of crisis. Do you think that this act, the Defense Production Act, should have been activated much sooner?

O'TOOLE: That's a hard question to answer. We should have been much more prepared across many areas of the response sooner. I think what we have to do now, rather than point fingers, is get to business dealing with this crisis. My top worry is fast turnaround testing in the hospitals. It's taking most hospitals two to three days to get results back, and that is really slowing them down.

CHANG: Right. And we are going to talk more about testing in just a moment. But, Douglas Holtz-Eakin, I want to turn to you. You know, this crisis has been compared to 9/11 and the 2008 financial crisis combined. You advised President George W. Bush after 9/11. First of all, do you agree with that comparison that we're dealing with something on that level - both 9/11 and 2008 financial crisis combined, something of unprecedented magnitude?

HOLTZ-EAKIN: This is certainly bigger than either the financial crisis or the economic fallout of 9/11. There's no question about that. And it's very different in character from the 2008 crisis because this isn't a self-inflicted wound, as the financial crisis was. This is much closer to 9/11 in that there's been an attack on the United States - not terrorism but a virus. And it's had dramatic consequences for the safety of our citizens. And that's the first response, so the public health response is the top priority. And doing that well is analogous to taking on the threat of global terrorism. And then there's the second response, which is - can you insulate the economy from the consequences of that to the extent possible? And how quickly can you get back to normal life?

CHANG: Well, let's talk about that.

HOLTZ-EAKIN: And in both cases, we knew very little about that. I mean, if you go back to 9/11...

CHANG: Do you think so far - if I could just jump in, do you think that...


CHANG: ...So far, the federal government is taking the right steps to insulate the economy and keep it going?

HOLTZ-EAKIN: I think the short answer is no. This is not my portfolio, but the top economic response is to actually do the public health response right. More aggressive testing, you know, knowing the epidemiology better allows you to shorten the amount of time that you have to address that, and that makes it easier to get back to normal. It lowers the economic cost. I think it's pretty clear that we haven't done a great job on that so far. We need to do better. Now you see the Congress debating the very large response that they are trying to put together.

CHANG: Right - more than a trillion dollars.

HOLTZ-EAKIN: We will see. The proof is in the pudding. When they come out of that room with a deal on Sunday and vote on Monday, which is what I expect, what does that look like? And there, I think there are some key things that have to be present. We have to keep small and medium businesses open and their employees on the payroll to minimize the devastation. That's the key. We don't want to lose the businesses, but we certainly don't want the people to get laid off. They need that paycheck. And the more we do that, the easier it will be to recover afterwards.

CHANG: Let me ask you this. Other economists have cautioned that until you contain the spread of the virus, that any sort of economic measures are only going to amount to a rescue, that it won't lead to a recovery and that companies are going to continue coming back for more money. Is that a fair assessment - that you first need to contain the spread of the virus before you can get into recovery mode economically?

HOLTZ-EAKIN: I think that is a fair assessment. Again, I think this is like 9/11 where - if you recall, afterwards, there was never the sense that we were - we knew we were secure. There was deep suspicion about the next attack. And we spent millions and billions of dollars to secure the airlines, to make every office building safe, to inspect every container that came into the United States. And the economic toll it took was a very, very, slow, slow growth that people were very unhappy with. There was a lot of discontent at the time. I think if we don't take on the virus effectively, we're going to be in roughly the same position.

CHANG: OK. Margaret Hamburg, I want to turn to you. You know, South Korea has fared better than most places during the spread of this virus in part because they have had widespread testing available. So let me ask you. If we had seen the level of testing here in the U.S. that we saw - that we are seeing in South Korea, would we in the U.S. be living in a slightly different world with less social distancing, avoiding lockdowns like the one I'm living under in California right now? What do you think?

HAMBURG: Well, it's, of course, hard to speculate, but I think almost certainly, we would be much better off. We have lost critical time in understanding the nature and scope of this outbreak here. We've lost critical time in identifying who is, in fact, infected and needs to be isolated, who's been exposed to those infected. And it has certainly complicated our ability to provide appropriate medical care and treatment to these patients. So I think it is really troubling how we - as one of the most advanced nations in the world, if not the premier nation in the world in terms of our ability to harness science and technology - to do a whole range of things, including make really good diagnostics. And we're...

CHANG: Right.

HAMBURG: ...Not talking...

CHANG: Well, last week...

HAMBURG: ...About the most complex science and technology here.

CHANG: Last week, when you talked to my co-host Ari Shapiro, the administration had just announced a major increase in testing, like drive-throughs and online sites where people could triage their own symptoms. To what extent has that happened?

HAMBURG: Well, we're seeing progress in terms of new diagnostics that are going through what's called the emergency use authorization process at FDA, but we're not seeing all of those diagnostics in the field. Access to testing kits has increased. We're also seeing, unfortunately, shortages of some of the reagents necessary to make use of those diagnostics and also the nasal pharyngeal swabs necessary to do some of these tests. So, you know, we are not where we want to be. We're not...

CHANG: Right.

HAMBURG: ...Where we need to be. And we're certainly not where we could be, I think, with, unfortunately...


HAMBURG: ...Better preparedness and a better...

CHANG: We...

HAMBURG: ...And more coordinated effort.

CHANG: ...Will have to leave it there. That is Dr. Margaret Hamburg, FDA commissioner under President Obama, Douglas Holtz-Eakin, who was chief economist for President George W. Bush, and Tara O'Toole, who served as undersecretary of science and technology at the Department of Homeland Security.

Thank you to all of you.

HAMBURG: Thank you.

HOLTZ-EAKIN: Thank you.

O'TOOLE: Thank you. Transcript provided by NPR, Copyright NPR.