How to watch Trump and Biden debate the pandemic

As Joe Biden and Donald Trump face each other in the first presidential debate tonight, they’ll undoubtedly be asked about the still-raging coronavirus pandemic and its economic impacts. Case counts are ticking up, and in the politically important Midwest, including swing-state Wisconsin, the numbers appear to be heading in the wrong direction.

Biden has excoriated Trump’s response to the pandemic, calling it “a life-and-death betrayal of the American people.” While Trump has the hard job of defending a COVID-19 record that many view dimly, he’s found a few statistics and policies he could try to use to paint a somewhat rosier picture of his administration’s pandemic response. He will also likely try to attack Biden on the former vice president’s own record in responding to an earlier influenza outbreak.

Here’s a framework for watching the candidates debate COVID-19.

How bad has the pandemic in the United States been, relatively? 

200,000 Americans have died from this virus.

It’s a staggering number that’s hard to wrap your head around. But behind every COVID-19 death is a family and community that will never again be the same.

There’s a devastating human toll to this pandemic — and we can’t forget that.

— Joe Biden (@JoeBiden) September 22, 2020

The United States has had more than 7 million documented COVID-19 cases, the most in the world. More than 205,000 people have died from the coronavirus, a higher figure than in any other country. For a politician trying to present a picture of success, these numbers are terrible. There is, however, one statistic that looks a little better for Trump: the case-fatality rate–the number of COVID-19 deaths divided by the number of infections. In a ranking of case-fatality rates, the United States isn’t number one–it doesn’t even crack the global top 10.

But by another epidemiological metric, per capita death rate, or the number of deaths per 100,000 people, the United States isn’t doing so well. By this measure, the country—which has had close to 63 deaths per 100,000 people–ranks sixth, according to Johns Hopkins University, better than Spain and several South American countries but worse than wealthy European and Asian countries like Italy, Germany, France, Japan, and South Korea.

Clearly Trump much prefers talking about the case-fatality rate. As FactCheck.org points out, he frequently boasts that the number has gone down 85 percent since April.

In an interview with Trump that aired in early August, Axios reporter Jonathan Swan tried to steer the conversation towards deaths in the broader population. The president wasn’t having it.

Jonathan Swan:
Oh, you’re doing death as a proportion of cases. I’m talking about death as a proportion of population. That’s where the U.S. is really bad, much worse than South Korea, Germany, et cetera.

President Donald J. Trump:
You can’t do that.

The case-fatality rate in the United States has been influenced, experts say, by the greater number of tests being conducted now and also by the population of people that have been getting sick lately. The Centers for Disease Control and Prevention noted that over the summer COVID-19 infections were most common among younger people, rather than the older, more vulnerable people more likely to die from the disease.

In March, Trump said that if deaths in the United States stay under 200,000, the administration will have been doing a good job. They’ve climbed past that number now, and Biden has strong ammunition ahead of the first debate: per capita, the United States has suffered many times the deaths seen in many developed countries. Still, you put your best foot forward, and for Trump, the case-fatality rate—even though many public health experts call it an “unreliable and misleading metric”—is that foot.

 Trump says we’ll have some “great” COVID-19 vaccines. How great?

Great News on Vaccines!

— Donald J. Trump (@realDonaldTrump) July 15, 2020

Despite repeatedly downplaying the severity of the pandemic, Trump has frequently raced to announce good news about COVID-19 therapeutics and vaccines, often running well ahead of scientific evidence.

Case in point: hydroxychloroquine, the anti-malaria drug that Trump promoted relentlessly for months. The president even said he took the dubious medicine himself—after the Food and Drug Administration began issuing warnings about it, and after a prominent study found that it not only was ineffective, but that it was also associated with cardiac arrest.

The Food and Drug Administration eventually pulled its authorization for hydroxychloroquine. But Trump was undeterred. “Hydroxy has tremendous support, but politically, it’s toxic because I supported it,” Trump told reporters in August. “If they would have said, ‘Do not use hydroxychloroquine under any circumstances,’ they would have come out, and they would’ve said, ‘It’s a great—it’s a great thing.’”

Now experts are worried Trump could pressure the Food and Drug Administration to authorize a coronavirus vaccine ahead of the election, before the scientific community is confident a vaccine candidate is safe and effective.

The deep state, or whoever, over at the FDA is making it very difficult for drug companies to get people in order to test the vaccines and therapeutics. Obviously, they are hoping to delay the answer until after November 3rd. Must focus on speed, and saving lives! @SteveFDA

— Donald J. Trump (@realDonaldTrump) August 22, 2020

In an effort to ease concern, the Food and Drug Administration recently floated the idea of strengthening the ongoing vaccine trials to better ensure they can determine that the inoculations protect against serious coronavirus cases, a move that would likely make it impossible for Trump to announce before the election that one of the vaccine candidates was ready for public distribution. But Trump has been critical of the idea.

When I said I trust vaccines, and I trust the scientists, but I don't trust Donald Trump — this is what I meant: https://t.co/oBDXcFUAek

— Joe Biden (@JoeBiden) September 16, 2020

Biden has to walk a tightrope in criticizing Trump’s push for a vaccine. Indeed, an independent safety monitoring board could decide a vaccine candidate has met the threshold for safety and effectiveness earlier than anticipated during clinical trials; a vaccine that arrives ahead of schedule is not necessarily a bad vaccine, and Biden won’t want to encourage anti-vaccine sentiment. Biden has said, he trusts vaccines and scientists, just not Trump, an argument he may return to during the debate.

As vice president, Biden faced a pandemic, too. Trump has brought it up before. Will he again? 

Sleepy Joe Biden was in charge of the H1N1 Swine Flu epidemic which killed thousands of people. The response was one of the worst on record. Our response is one of the best, with fast action of border closings & a 78% Approval Rating, the highest on record. His was lowest!

— Donald J. Trump (@realDonaldTrump) March 13, 2020

Remember the swine flu pandemic in 2009? Early in the Obama administration, reports out of Mexico that H1N1 influenza was circulating, led to a massive government effort to stop what could have morphed into a major public health threat. Between April 2009 and April 2010, H1N1 infected 60 million people in the United States and killed more than 12,000, the Centers for Disease Control and Prevention estimates.

While the Obama administration quickly began developing a flu vaccine for H1N1, the supply remained inadequate through the peak of the fall flu season, meaning many people never benefited. Trump has seized on Biden and the Obama administration’s record to try to contrast it with his own response to COVID-19. Independent fact checkers have called many of Trump’s attacks false.

Despite the Obama administration’s early concerns that a health catastrophe might be brewing, one never materialized; the pandemic began easing in late fall of 2009. In the end, the 2009 pandemic killed fewer people than the seasonal influenza frequently does. But Biden made at least one misstep at the time, calling for people not to ride subways or get on planes. Other administration figures had to walk back the vice president’s words.

Biden’s role in the H1N1 response gives Trump the slightest of openings. We’ll have to watch the debate to see whether or not he barges through it.