The resistance some states have shown to implementing aggressive coronavirus responses has led public health experts to call for President Trump to issue nationwide stay-at-home guidance.
Across the country, mayors have battled their governors over how broadly business-closure orders should be implemented. In some cases, it appears that governors will only implement statewide orders when they feel they have the White House’s full backing in doing so.
A nationwide stay-at-home order would be helpful for both medical and political reasons, experts said. Already, there has been plenty of evidence that Trump’s initial moves to play down the outbreak affected some governors’ responses, while local officials who’ve acted with urgency told TPM that an order from Trump would make their measures more effective.
From a public health standpoint, the patchwork of official clamp-downs across the country will hamper efforts to contain the virus, public health experts told TPM.
While cracking down early on non-essential activity may be politically difficult for state officials facing pushback from their business sectors, “if the President orders it, they don’t have that local fight,” said Gary Slutkin, an epidemiologist who formerly led the World Health Organization’s Intervention Development. “Plus, we as a country have the opportunity to cooperate on stopping all further transmission now.”
In a statement to TPM, the White House defended President Trump’s “ unprecedented approach to communicating and working with our Nation’s Governors to guarantee they have the resources they need and the ability to make the best on-the-ground decisions.”
“As both the President and Vice President have said, this is a locally executed, state managed, federally supported response to a global pandemic that this Administration is fully committed to,” White House spokesperson Judd Deere said. “Every level of government needs to deliver solutions and that is what we are doing in partnership.”
‘It Would Be So Much More Helpful’
The White House’s current 30-day nationwide guidelines only tell older people, those with underlying conditions, those who are sick, or those with exposure to a positive COVID-19 case to stay at home.
More than two-dozen states have issued state-wide stay-at-home orders for all their residents, while a handful of states have told only high-risk individuals to stay home, and several more have taken no statewide action.
Local officials told TPM that, regardless of what kind authority the President has to issue a national stay-at-home order, even just having him encourage Americans nationwide to stay home would make it easier for local and state officials to carry out their shelter-in-place order.
Oklahoma City Mayor David Holt (R) said that when he ordered his city’s bars and restaurants to close on March 17, he didn’t receive much pushback because, the day before, the White House said it backed local governments taking that action if need be.
“The measures I take are obviously significantly less effective if my neighboring cities don’t take the same measures,” Holt said, especially as only half of the Oklahoma City metropolitan area is covered by his ordinances.
“It does create a patchwork of regulations that lessens the safety of the public,” he said. Only on Wednesday did Oklahoma Gov. Kevin Stitt (R) issue a state-wide stay-at-home order for vulnerable populations, though last week — at Holt’s and another mayor’s suggestion — the governor implemented that order on a regional level.
“If it’s the advice of CDC and Dr. Fauci and all of those people we see on television, I don’t get any serious pushback, but it’s harder if we’re going further than what seems to be recommended by the national experts,” Holt said.
Elsewhere in the country, it’s clear governors will only go as far as the political cover they’re getting from Trump has extended.
Despite having a large population of retirees, and the influx of spring breakers to the state last month, Florida Gov. Ron DeSantis (R) only issued a state-wide stay-at-home order on Wednesday.
Explaining the move, DeSantis cited specifically the changes in the President’s “demeanor” in the “the last couple of days.” Previously, while DeSantis was still resisting the order, he said he wasn’t inclined to issue it because the White House task force had not recommended it. Hours after he signed the state-wide guidance, he also signed an order barring local officials from going further than what his order laid out.
In places like Arizona and Missouri, leaders of blue cities have expressed frustration that their Republican governors haven’t matched, or have even undermined, their local efforts to stop the virus’ spread.
On the other side of the spectrum is Ohio, where Republican Gov. Mike DeWine issued a stay-at-home order on March 23, and has worked closely with the seven Democratic mayors of the state’s biggest cities to “sing from the same songbook,” Dayton Mayor Nan Whaley (D) told TPM.
“I imagine if DeWine was a Democrat, how much trouble we’d have in this state,” Whaley said, while praising DeWine’s ability to show ”restraint” in dealing with the President.
”It would be so much more helpful if [the White House] would do a national stay at home [order] and message accordingly,” she said.
‘You Can’t Really Know What You Can’t Test’
The reason for a nationwide stay-at-home order is not just to boost the effectiveness of local orders in places that have seen an outbreak, according to public health experts. It’s to arrest the spread in places with relatively few or perhaps no confirmed cases yet, according to Thomas Tsai, an assistant professor of health policy and management at the Harvard Global Health Institute, who said nowhere in the country is it currently too early for aggressive action.
“If we look at the data, this is clearly going to be a pandemic that affects every single state and a majority of counties, and it will likely affect every county,” he said. The virus has shown the ability to spread rapidly among people not even yet showing symptoms — a fact that led Georgia Gov. Brian Kemp (R) to finally announce a state-wide order Wednesday, while admitting he wasn’t aware of that aspect of the outbreak until 24 hours prior to the reversal.
“Without a widespread social distancing effort, the odds of containing the pandemic are low,” Tsai added.
There is plenty of evidence — both from other countries and within the U.S. — that states and localities that shut businesses down when there were relatively few cases were able to contain the virus more effectively than those that waited for a spike, said Sluktin, the former WHO epidemiologist.
“For any individual city, you can’t know what you really have until you can test,” Sluktin, who now leads the public health anti-violence program Cure Violence, said. “If you have transmission stop over there, then it’s rising over here.””
A White House official told TPM that the federal system allows for solutions to be identified locally and for best practices to be scaled up nationally, with federal resources helping to fill in the gaps.
But Slutkin warned that the White House is just delaying, and extending, the inevitable.
“The time of the pain of the country will be shortened substantially by everybody at once having to stay at home, so that we stop as much transmission as possible from person to another person,” he said.