The Mike Pence show

On May 8, 2018, Trump fired Rear Adm. Tim Ziemer, who was serving on the National Security Council as the Director of Global Health Security. In that position, Ziemer was responsible for coordinating responses to global health emergencies and potential pandemics. Ziemer was praised as "one of the most quietly effective leaders in public health" — his work on malaria during the Obama administration was credited for saving millions of lives. 

Instead of replacing Ziemer, Trump eliminated the position. Dr. Luciana Borio, the National Security Council director for medical and biodefense preparedness, left the same month and was not replaced. 

So when the coronavirus began spreading globally, there was no one in the White House to coordinate the response. As the outbreak grew more severe, Trump reportedly ruled out appointing someone new to help manage the crisis, "worrying that bringing in a person from outside the administration might be seen as a failure — and wondering whether such a person would be loyal to him."

Instead, Trump put Vice President Mike Pence in charge. 

Before Pence's appointment, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, was scheduled to appear on all five Sunday political talk shows. But Fauci was ordered to cancel, and Pence made the rounds in his place.

On CNN's State of the Union, Pence was shown a clip of Donald Trump Jr. from an appearance Friday on Fox News. Trump Jr. said that Democrats hoped millions of people would die from the coronavirus:

KILMEADE: Are you surprised the way they've been handling the coronavirus situation, meaning Democrats?

TRUMP JR.: Not at all. I mean, we've seen -- like you said, we've seen this play out for four years. Anything that they can use to try to hurt Trump, they will...But for them to try to take a pandemic and seemingly hope that it comes here, and kills millions of people so that they could end Donald Trump's streak of winning, is a new level of sickness.

"Can we agree that neither Democrats nor Republicans want Americans to get the coronavirus and die from it?" CNN host Jake Tapper asked Pence.

Pence did not agree and defended Trump Jr. According to Pence, Trump Jr.'s remarks were "understandable" because there has been "some very strong rhetoric directed at the president." The only comments about the coronavirus that were unacceptably political, Pence said, were criticisms of Trump made by "some of the predictable voices in the public debate on the left."

Pence repeated the claim on Meet the Press and was pressed to provide evidence:

PENCE: There has been a lot of irresponsible rhetoric among Democrats and commentators on the left.

NBC'S CHUCK TODD: Who? Who is this? Name some names, sir. Because it just feels like gaslighting. Please name some names. We are all big people here.

Pence was only able to provide one example: a column in the New York Times by Gail Collins with the headline, "Let's call it the Trumpvirus." Asked whether Collins represents the Democratic Party, Pence said it was "important" for Republicans to push back against "outrageous and irresponsible rhetoric on the other side."

This is why Pence was put in charge. Pence has no expertise in public health and, as Governor of Indiana, contributed to the spread of an HIV outbreak by refusing to approve a needle exchange program for several months. But Pence has been tasked with fighting the coronavirus in the political arena and making sure the virus doesn't infect Trump's reelection chances. 

Testing fate

Trump has consistently used the low number of confirmed cases in the United States as proof that his administration's response is working. (As of Sunday, there were 76 confirmed cases in the United States.)

But the low number of confirmed cases is a reflection of the small number of tests in the United States. China has the capacity to perform 1.6 million tests per week. As of February 29, only 472 tests have been conducted in the United States. 

On Fox Business, Pence tried to obfuscate the issue:

PENCE: We've actually done a fair amount of testing.


PENCE: Look, we've actually screened 47,000 people coming through designated airports in the country and done testing at airports. 

Screening, however, is not testing. It usually involves someone just asking the traveler a few questions. Carriers of the coronavirus can be asymptomatic. 

So what is the problem? Science Magazine reports the "rollout of a CDC-designed test kit to state and local labs has become a fiasco because it contained a faulty reagent." Meanwhile, no "commercial or state labs have the approval to use their own tests." There were other tests available through the World Health Organization, but the administration opted not to use them. 

In Washington State, the coronavirus has already killed one man with no known exposure to the disease. Researchers now believe the coronavirus "has been spreading in the state for close to six weeks" and "150 to 1,500 people 'have either been infected and recovered or currently are infected now.'" These cases, however, have not been detected. 

This situation will be changing rapidly. On Saturday, the FDA announced a new policy, "giving laboratories and hospitals around the country the go-ahead" to conduct their own tests. Pence said that 15,000 testing kits are en route to medical professionals, and the government just signed an agreement with a commercial vendor to produce 50,000 more. 

So this week is likely to produce a spike in new confirmed coronavirus cases. Trump's emphasis on the low numbers of confirmed cases, without mentioning the testing issues, is likely to spark confusion. The new cases will not necessarily be an indication that the coronavirus is rapidly spreading in the United States. But it will reflect a more accurate understanding of the current scope of the outbreak.

The cost of a broken system

Even once tests become available, people with symptoms may not want to get tested, fearing massive medical bills. This is the danger of a system with millions of people who are uninsured or underinsured. 

Osmel Martinez Azcue returned to Miami from a business trip to China and developed flu-like symptoms. Concerned he may have contracted the coronavirus, he went to the hospital, where he was placed in a closed-off room. The hospital staff said he would need a CT scan to identify the coronavirus. But Azcue was concerned about his insurance coverage and asked to be tested for the standard flu first. He tested positive and was released. 

Then he received a bill for $3,270. Under his insurance policy, he will be responsible for $1400. 

Azcue has a so-called "junk" insurance plan that was made more broadly available when Trump rolled back some Obamacare regulations in 2018. In order to receive any reimbursement, he is required to "three years of medical records to prove that the flu he got didn’t relate to a preexisting condition." 

Azcue's situation illustrates that the existence of these junk plans, and a large pool of uninsured Americans, puts everyone at risk — even people who are happy with their current plan. For millions, there are significant incentives to avoid diagnosis and treatment of the coronavirus. 

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