We reached out to the Trump campaign and the White House to ask for more information about Trump's assertion but didn’t receive a response.

This article was published on Thursday, October 15, 2020 in Kaiser Health News.

By Victoria Knight

On Monday, President Donald Trump claimed that the World Health Organization (WHO) “admitted” he was correct that using lockdowns to control the spread of COVID-19 was more damaging than the illness.

In a post on Twitter, Trump wrote: “The World Health Organization just admitted that I was right. Lockdowns are killing countries all over the world. The cure cannot be worse than the problem itself. Open up your states, Democrat governors. Open up New York. A long battle, but they finally did the right thing!”

He reiterated his statement later that night during a campaign rally, saying, “But the World Health Organization, did you see what happened? They just came out a little while ago, and they admitted that Donald Trump was right. The lockdowns are doing tremendous damage to these Democrat-run states, where they’re locked out, sealed up. Suicide rates, drug rates, alcoholism, deaths by so many different forms. You can’t do that.”

Together, the tweet and these comments got considerable attention on social media.

But did the WHO change its stance on lockdowns or concede anything to Trump, as he said it did? Briefly, no.

Since May, Trump has been vocal about asking states to reopen businesses, schools, religious services and other social activities. He also took credit for locking down the U.S. in the early stages of the pandemic, however. And his administration largely delegated lockdown decisions to governors and local governments.

Yet those lockdowns — marked by stay-at-home orders and other restrictions — have been less stringent than those implemented in other countries, said Brooke Nichols, an assistant professor of global health at Boston University.

The “definition has differed country by country and state by state. I would argue that the U.S. has never had an actual enforced lockdown like there have been in some Asian countries and in Italy last spring,” Nichols wrote in an email.

We reached out to the Trump campaign and the White House to ask for more information about Trump’s assertion but didn’t receive a response.

A Clip Doesn’t Tell the Full Story

Although the Trump team didn’t get back to us, we noticed that the Trump War Room Twitter account responded to Trump’s tweet with a link to a video, appearing to back up the president’s claim.

The video is a clip from an Oct. 8 interview with Dr. David Nabarro, a special envoy on COVID-19 for the WHO, by Scottish journalist Andrew Neil. The segment was televised by the British news outlet Spectator TV.

In response to a question about the economic consequences of lockdowns, Nabarro said: “We in the World Health Organization do not advocate lockdowns as the primary means of control of this virus. The only time we believe a lockdown is justified is to buy you time to reorganize, regroup, rebalance your resources; protect your health workers who are exhausted. But by and large, we’d rather not do it.” Nabarro then went on to describe potential economic consequences, including effects on the tourism industry and farmers or the worsening of world poverty.

We checked with Nabarro to find out if the clip accurately reflected the points he raised during a nearly 20-minute interview. He responded, by email: “My comments were taken totally out of context. The WHO position is consistent.”

That context Nabarro mentioned covered a range of topics, such as the estimate that about 90% of the world’s population is still vulnerable to COVID-19, that lockdowns are only an effective pandemic response in extreme circumstances and what Nabarro means when he talks about finding the “middle path.”

“We’re saying we really do have to learn how to coexist with this virus in a way that doesn’t require constant closing down of economies, but at the same time in a way that is not associated with high levels of suffering and death,” Nabarro said in the interview.

To achieve that via the middle-path approach, robust defenses against the virus must be put in place, said Nabarro, including having well-organized public health services, such as testing, contact tracing and isolation. It also involves communities adhering to public health guidelines such as wearing masks, physical distancing and practicing good hygiene.

So, it’s really not accurate for the president to imply that the WHO has or has not supported lockdowns, said Lawrence Gostin, a global health law professor at Georgetown University. It’s not as simple as an either-or choice.

“No one is saying that lockdowns should never be used, just that they shouldn’t be used as a primary or only method,” Gostin wrote in an email.

And Josh Michaud, associate director of global health policy at KFF, said both the WHO and public health experts have acknowledged there are economic consequences to lockdowns. (KHN is an editorially independent program of KFF.)

“Strict lockdowns are best used sparingly and in a time-limited fashion because they can cause negative health and economic consequences,” said Michaud. “That is why Nabarro said lockdowns are not recommended as the ‘primary’ control measure. Critics like to frame lockdowns as being recommended as the only measure, when in reality that is not the case.”

Has the WHO Flipped on Its Stance on Lockdowns?

And what about Trump’s assertion that the WHO had changed its position and admitted he was right?

A member of the WHO media office told us in a statement, “Our position on lockdowns and other severe movement restrictions has been consistent since the beginning. We recognize that they are costly to societies, economies and individuals, but may need to be used if COVID-19 transmission is out of control.”

“WHO has never advocated for national lockdowns as a primary means for controlling the virus. Dr. Nabarro was repeating our advice to governments to ‘do it all,’” the spokesperson said.

To test this premise, we looked at statements by WHO leaders over the course of the pandemic. In the multiple media briefings we reviewed from February onward, the WHO appeared consistent in its messaging about what lockdowns should be deployed for: to give governments time to respond to a high number of COVID-19 cases and get a reprieve for health care workers. Although WHO leaders in February supported the shutting down of the city of Wuhan, China, the presumed source of the COVID-19 outbreak, they have also acknowledged that lockdowns can have serious economic effects, and that robust testing, contact tracing and physical distancing are usually preferable to completely locking down.

There is also no evidence the WHO “admitted” Trump was right about lockdowns.

Our Ruling

Trump tweeted on Monday and then said later that night at a campaign rally that the WHO admitted he was right about lockdowns.

We found no evidence the WHO made this admission. And, based on a review of WHO communications, we found its messaging on the topic has been consistent since the pandemic’s early days.

Trump also appears to have relied on a brief video clip of a wide-ranging interview with WHO special envoy Dr. David Nabarro that didn’t give an accurate portrayal of how Nabarro characterized the use of this intervention.

We rate this statement False.

Latino case rates were only 64% higher by mid-September, while  positivity rate among Blacks was 60% higher than that of whites in late July, but the disparity had waned by mid-September.

This article was published on Thursday, October 15, 2020 in Kaiser Health News.

By Anna Almendrala

Los Angeles County officials attribute a dramatic decline in COVID-19 death and case rates among Blacks and Latinos over the past two months to aggressive workplace health enforcement and the opening of tip lines to report violations.

Now, officials intend to cement those gains by creating workplace councils among employees trained to look for COVID-19 prevention violations and correct or report them — without fear of being fired or punished.

Cal/OSHA, the state’s workplace safety and health authority, is overwhelmed with complaints and tips about COVID-19 violations, and the county’s health investigators — there were officially 346 of them as of last Friday — can’t possibly keep tabs on all of Los Angeles’ more than 240,000 businesses, labor advocates say.

The councils could help keep Los Angeles from backsliding on its progress in mitigating cases and racial disparities in the fall as more businesses are likely to reopen, said Tia Koonse, a researcher with the UCLA Labor Center and co-author of an assessment of the workplace council proposal. The L.A. County Board of Supervisors is expected to approve an ordinance this month requiring businesses to permit employees to form the councils, which would troubleshoot compliance issues and report to the health department when necessary.

Critics, including many business leaders, say the measure will create more red tape at the worst possible time for the economy. But labor groups and some businesses say it is crucial to fighting the pandemic. Workers around the country have been sacked or reprimanded for complaining about COVID-related safety violations, and laws protecting them are spotty.

"Workers have a right to be in a safe space and shouldn’t face any retaliation" for noting poor practices, said Barbara Ferrer, director of the L.A. County Public Health Department. Low-wage workers have been "tremendously disadvantaged" by having to work outside the home in contact with other people, often without sufficient protection, she said.

During the upsurge of COVID cases that followed Memorial Day weekend family gatherings and business openings, Latinos in Los Angeles were dying at a rate more than four times higher than that of whites, while Blacks were twice as likely as whites to die of the disease. Two months later, death rates among Blacks and Latinos had fallen by more than half and were approaching the rate for whites, according to age-adjusted data from the county health department.

While four times as many Latinos as whites were reported COVID-positive in late July, the Latino case rates were only 64% higher by mid-September. The positivity rate among Blacks was 60% higher than that of whites in late July, but the disparity had waned by mid-September.

Experts can’t be certain that any one policy is responsible for the decline in deaths among Blacks and Latinos in Los Angeles — and state and county rates have declined for the entire population in recent weeks. But Ferrer attributed the progress to her department’s focus on workplace enforcement of health orders, which include rules about physical distancing, providing face coverings for workers and requiring face coverings for customers.

"If you’re in violation, at this point we can either issue citations, or there are cases where we just close the place down because the violations are egregious," she said.

The sharp racial disparities that characterized the pandemic from the beginning are under even more scrutiny now that California has become the first state to make "health equity" a factor in its decisions to allow expanded reopening.

Large counties may not advance toward full reopening until their most disadvantaged neighborhoods, and not just the county as a whole, meet or are lower than the targeted levels of disease. The criteria prod local governments to invest more in testing, contact tracing and education in poor neighborhoods with high levels of the disease.

Ferrer’s focus on workplaces crystallized during a crackdown on Los Angeles Apparel, a clothing factory that had pivoted to face mask manufacturing during the pandemic. Despite the ready inventory of masks, an outbreak at the factory resulted in at least 300 cases — and four deaths.

The health department, acting on a tip from community health centers flooded with sick Los Angeles Apparel workers, shut down the factory on June 27. That action highlighted the need to bring the government and labor unions together to fight the pandemic, said Jim Mangia, CEO of St. John’s Well Child & Family Center, a chain of community health centers in South L.A.

"At St. John’s, almost all of our patients are the working poor," Mangia said. "They were getting infected at work and bringing it home to their families, and I think intervening at the workplace is what really made all the difference."

Early in the pandemic, Ferrer had also set up an anonymous complaint line for employees who want to report workplace violations. It gets about 2,000 calls a week, she said. As of Oct. 10, the department’s website lists 132 workplaces that have had three or more confirmed COVID-19 cases, with a total of 2,191 positives. Another table dated Oct. 7 lists 124 citations — mostly to gyms and places of worship — for failing to comply with a health officer order.

"Fortunately, we’re not like Cal/OSHA, in the sense that it doesn’t take us months to complete an investigation," Ferrer said. "We’re able to move more swiftly under the health officer orders to actually make sure that we’re protecting workers."

Public health councils are the next phase in Ferrer’s plan to keep workers safe. The plan stemmed from the response of Overhill Farms, a frozen-food factory in Vernon, California, after an outbreak of more than 20 cases and one death. The factory and its temporary job agency were hit with more than $200,000 in proposed penalties from Cal/OSHA in September, but before the fines landed, the factory leadership was already responding by beginning to hold meetings with workers to improve safety there.

"They found that the workers helped them bring down infection rates and helped solve problems," said Roxana Tynan, executive director of the Los Angeles Alliance for a New Economy, a worker advocacy organization.

While it’s not exactly a feel-good story about corporate beneficence, the turnaround at Overhill Farms added credence to the benefits of workplace councils, said Koonse of UCLA.

No company would have to spend more than 0.44% of its payroll cost on the health councils, she estimated.

Still, the idea has gotten a mixed reception from businesses. In an Aug. 24 statement, CEO Tracy Hernandez of the L.A. County Business Federation wrote that the proposal would add “burdensome and convoluted programs that will further hinder an employer’s ability to meet demands, get back on their feet, and adequately serve their employees and customers.”

But Jim Amen, president of the eight-store Super A Foods grocery chain, said businesses should welcome the councils as a way to keep lines of communication open. Such practices have kept infection rates low at his stores, even without a mandate, Amen said.

"All I know is, for Super A, our employees are heavily involved in everything we do," Amen said.

Labor groups see the councils as a crucial way for workers to raise concerns without fear of retaliation.

"In low-wage industries like the garment industry, workers coming together gets them fired," said Marissa Nuncio, director of the Garment Worker Center, a nonprofit that mainly serves immigrants from Mexico and Central America.

While disparities are narrowing in L.A. County, some shops are still unsafe and potential whistleblowers aren’t confident their reports to the county’s tip line are being acted on, she said.

"We continue to get calls from our members who are sick, have COVID and are hospitalized," Nuncio said. "And the most obvious location for them to have been infected is in their workplace, because so many precautions are not being taken."

Throughout the pandemic, people who never had the coronavirus have been reporting a host of seemingly unrelated symptoms.

This article was published on Thursday, October 15, 2020 in Kaiser Health News.

By Aneri Pattani

In late March, shortly after New York state closed nonessential businesses and asked people to stay home, Ashley Laderer began waking each morning with a throbbing headache.

"The pressure was so intense it felt like my head was going to explode," recalled the 27-year-old freelance writer from Long Island.

She tried spending less time on the computer and taking over-the-counter pain medication, but the pounding kept breaking through — a constant drumbeat to accompany her equally incessant worries about COVID-19.

"Every day I lived in fear that I was going to get it and I was going to infect my whole family," she said.

After a month and a half, Laderer decided to visit a neurologist, who ordered an MRI. But the doctor found no physical cause. The scan was clear.

Then he asked: Are you under a lot of stress?

Throughout the pandemic, people who never had the coronavirus have been reporting a host of seemingly unrelated symptoms: excruciating headaches, episodes of hair loss, upset stomach for weeks on end, sudden outbreaks of shingles and flare-ups of autoimmune disorders. The disparate symptoms, often in otherwise healthy individuals, have puzzled doctors and patients alike, sometimes resulting in a series of visits to specialists with few answers. But it turns out there's a common thread among many of these conditions, one that has been months in the making: chronic stress.

Although people often underestimate the influence of the mind on the body, a growing catalog of research shows that high levels of stress over an extended time can drastically alter physical function and affect nearly every organ system.

Now, at least eight months into the pandemic, alongside a divisive election cycle and racial unrest, those effects are showing up in a variety of symptoms.

"The mental health component of COVID is starting to come like a tsunami," said Dr. Jennifer Love, a California-based psychiatrist and co-author of an upcoming book on how to heal from chronic stress.

Nationwide, surveys have found increasing rates of depression, anxiety and suicidal thoughts during the pandemic. But many medical experts said it's too soon to measure the related physical symptoms, since they generally appear months after the stress begins.

Still, some early research, such as a small Chinese study and an online survey of more than 500 people in Turkey, points to an uptick.

In the U.S., data from FAIR Health, a nonprofit database that provides cost information to the health industry and consumers, showed slight to moderate increases in the percentage of medical claims related to conditions triggered or exacerbated by stress, like multiple sclerosis and shingles. The portion of claims for the autoimmune disease lupus, for example, showed one of the biggest increases — 12% this year — compared with the same period last year (January to August).

Express Scripts, a major pharmacy benefit manager, reported that prescriptions for anti-insomnia medications increased 15% early in the pandemic.

Perhaps the strongest indicator comes from doctors reporting a growing number of patients with physical symptoms for which they can't determine a cause.

Dr. Shilpi Khetarpal, a dermatologist at the Cleveland Clinic, used to see about five patients a week with stress-related hair loss. Since mid-June, that number has jumped to 20 or 25. Mostly women, ages 20 to 80, are reporting hair coming out in fistfuls, Khetarpal said.

In Houston, at least a dozen patients have told fertility specialist Dr. Rashmi Kudesia they're having irregular menstrual cycles, changes in cervical discharge and breast tenderness, despite normal hormone levels.

Stress is also the culprit dentists are pointing to for the rapid increase in patients with teeth grinding, teeth fractures and TMJ.

"We, as humans, like to have the idea that we are in control of our minds and that stress isn't a big deal," Love said. "But it's simply not true."

How Mental Stress Becomes Physical

Stress causes physical changes in the body that can affect nearly every organ system.

Although symptoms of chronic stress are often dismissed as being in one's head, the pain is very real, said Kate Harkness, a professor of psychology and psychiatry at Queen's University in Ontario.

When the body feels unsafe — whether it's a physical threat of attack or a psychological fear of losing a job or catching a disease — the brain signals adrenal glands to pump stress hormones. Adrenaline and cortisol flood the body, activating the fight-or-flight response. They also disrupt bodily functions that aren't necessary for immediate survival, like digestion and reproduction.

When the danger is over, the hormones return to normal levels. But during times of chronic stress, like a pandemic, the body keeps pumping out stress hormones until it tires itself out. This leads to increased inflammation throughout the body and brain, and a poorly functioning immune system.

Studies link chronic stress to heart disease, muscle tension, gastrointestinal issues and even physical shrinking of the hippocampus, an area of the brain associated with memory and learning. As the immune system acts up, some people can even develop new allergic reactions, Harkness said.

The good news is that many of these symptoms are reversible. But it's important to recognize them early, especially when it comes to the brain, said Barbara Sahakian, a professor of clinical neuropsychology at the University of Cambridge.

"The brain is plastic, so we can to some extent modify it," Sahakian said. "But we don't know if there's a cliff beyond which you can't reverse a change. So the sooner you catch something, the better."

The Day-to-Day Impact

In some ways, mental health awareness has increased during the pandemic. TV shows are flush with ads for therapy and meditation apps, like Talkspace and Calm, and companies are announcing mental health days off for staff.

But those spurts of attention fail to reveal the full impact of poor mental health on people's daily lives.

For Alex Kostka, pandemic-related stress has brought on mood swings, nightmares and jaw pain.

He'd been working at a Whole Foods coffee bar in New York City for only about a month before the pandemic hit, suddenly anointing him an essential worker. As deaths in the city soared, Kostka continued riding the subway to work, interacting with co-workers in the store and working longer hours for just a $2-per-hour wage increase. (Months later, he'd get a $500 bonus.) It left the 28-year-old feeling constantly unsafe and helpless.

"It was hard not to break down on the subway the minute I got on it," Kostka said.

Soon he began waking in the middle of the night with pain from clenching his jaw so tightly. Often his teeth grinding and chomping were loud enough to wake his girlfriend.

Kostka tried Talkspace, but found texting about his troubles felt impersonal. By the end of the summer, he decided to start using the seven free counseling sessions offered by his employer. That's helped, he said. But as the sessions run out, he worries the symptoms might return if he's unable to find a new therapist covered by his insurance.

"Eventually, I will be able to leave this behind me, but it will take time," Kostka said. "I'm still very much a work in progress."

How to Mitigate Chronic Stress

When it comes to chronic stress, seeing a doctor for stomach pain, headaches or skin rashes may address those physical symptoms. But the root cause is mental, medical experts say.

That means the solution will often involve stress-management techniques. And there's plenty we can do to feel better:

Exercise. Even low- to moderate-intensity physical activity can help counteract stress-induced inflammation in the body. It can also increase neuronal connections in the brain.

Meditation and mindfulness. Research shows this can lead to positive, structural and functional changes in the brain.

Fostering social connections. Talking to family and friends, even virtually, or staring into a pet's eyes can release a hormone that may counteract inflammation.

Learning something new. Whether it's a formal class or taking up a casual hobby, learning supports brain plasticity, the ability to change and adapt as a result of experience, which can be protective against depression and other mental illness.

"We shouldn't think of this stressful situation as a negative sentence for the brain," said Harkness, the psychology professor in Ontario. "Because stress changes the brain, that means positive stuff can change the brain, too. And there is plenty we can do to help ourselves feel better in the face of adversity."

Aneri Pattani: apattani@kff.org, @aneripattani

We decided to examine both the Trump and Biden plans to curb the pandemic and investigate whether Pence was on target in his charge that the Biden plan is rooted in Trump's ideas.

This article was published on Wednesday, October 14, 2020 in Kaiser Health News, in partnership with PolitiFact.

During last week's vice presidential debate, moderator Susan Page, USA Today's Washington bureau chief, asked Vice President Mike Pence about the U.S. COVID-19 death toll. Pence replied by touting the Trump administration's actions to combat the pandemic, such as restrictions on travel from China, steps to expand testing and efforts to accelerate the production of a vaccine.

Pence also took a jab at Democratic presidential nominee Joe Biden, a strong critic of the Trump pandemic response. "The reality is, when you look at the Biden plan, it reads an awful lot like what President Trump and I and our task force have been doing every step of the way," said Pence. "And, quite frankly, when I look at their plan," he added, "it looks a little bit like plagiarism, which is something Joe Biden knows a little bit about."

(Pence's gibe about plagiarism is likely a reference to Biden copying phrases from a British politician's speeches during his first run for president in 1987, an issue that caused him to drop out of the race. In 2019, the Biden campaign acknowledged it had inadvertently lifted language in its climate and education plans without attributing the sources.)

Because COVID-19 continues to spread throughout the United States, with nearly 8 million cases and upward of 215,000 deaths, we decided to examine both the Trump and Biden plans to curb the pandemic and investigate whether Pence was on target in his charge that the Biden plan is rooted in Trump's ideas.

We reached out to both presidential campaigns for their candidates' COVID-19 plans. The Trump campaign did not respond to our request, but we looked at a campaign website timeline of administration actions on COVID-19, as well as a coronavirus fact sheet from the White House. The Biden campaign sent us a link to Biden's COVID-19 plan.

At first glance, there are obvious similarities. Both declare goals like vaccine development and expanding public availability of COVID-19 tests.

"Most pandemic response plans should be at their core fairly similar, if they're well executed," said Nicolette Louissaint, executive director of Healthcare Ready, a nonprofit organization focused on strengthening the U.S. health care supply chain.

But public health experts also pointed to significant philosophical differences in how the plans are put into action.

"You ought to think about it as two groups of people trying to make a car," said Dr. Georges Benjamin, executive director of the American Public Health Association. "They have to have four wheels, probably have to have a bumper, have some doors," he said. It is how you build the car from that point forward that determines what the end product looks like.

What Trump Has Done

As Pence pointed out, the Trump administration has focused its efforts to combat COVID-19 along a couple of lines.

The administration formed the White House coronavirus task force in January and issued travel restrictions for some people traveling from China and other countries in February. Federal social distancing guidelines were issued in March and expired on April 30. The administration launched Operation Warp Speed in April, with the goal of producing and delivering 300 million doses of a coronavirus vaccine beginning in January 2021. A more detailed logistics plan to distribute a vaccine was issued later. Trump activated the Defense Production Act for certain protective equipment and ventilators. His administration also has talked about efforts to expand COVID-19 testing in partnership with the private sector, as well as initiatives to help cover costs for COVID-19 treatments and make tests free of charge.

Importantly, the administration also shifted significant decision-making responsibility to states, leaving the development of testing plans, procurement of personal protective equipment and decrees on stay-at-home orders and mask mandates to the discretion of the governor or local governments. Despite that, Trump still urged states to reopen beginning in May, though in many areas cases of COVID-19 remained high.

What Biden Proposes to Do

Biden's plan would set out strong national standards for testing, contact tracing and social distancing — words that echo the Trump plan. It proposes working with states on mask mandates, establishing a "supply commander" in charge of shoring up PPE, aggressively using the Defense Production Act and accelerating vaccine development.

It also outlines plans to extend more fiscal relief, provide enhanced health insurance coverage, eliminate cost sharing for COVID treatments, reestablish a team on the National Security Council to address pandemic response and to maintain membership inthe World Health Organization. Trump announced earlier this summer that the U.S. would begin procedures to withdraw from the WHO, effective as of July 6, 2021.

Biden has said he would follow scientific advice if indicators pointed to a need to dial up social distancing guidelines in light of another wave of COVID-19 cases.

What's the Same, What's Different

Sources:

The Boston Globe, "On the Campaign Trail, Trump and Biden Operate in Different Circles on COVID-19," Oct. 6, 2020

Department of Health and Human Services, "From the Factory to the Frontlines — The Operation Warp Speed Strategy for Distributing a COVID-19 Vaccine," accessed Oct. 12, 2020

Department of Health and Human Services, "Trump Administration Will Deploy 150 Million Rapid Tests in 2020," Aug. 27, 2020

DonaldJTrump.com, "Trump Campaign Announces President Trump's 2nd Term Agenda: Fighting for You!" accessed Oct. 8, 2020

DonaldJTrump.com, "Timeline: The Trump Administration's Decisive Actions to Combat the Coronavirus," accessed Oct. 9, 2020

Email exchange with Joe Biden for President campaign staffer, Oct. 7, 2020

Email interview with Dr. Rachel Vreeman, director of the Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai, Oct. 8, 2020

JoeBiden.com, "The Biden Plan to Combat Coronavirus (COVID-19) and Prepare for Future Global Health Threats," accessed Oct. 8, 2020

KFF, "Comparing Trump and Biden on COVID-19," Sept. 11, 2020

Phone interview with Brooke Nichols, assistant professor of global health at Boston University, Oct. 9, 2020

Phone interview with Josh Michaud, associate director for global health policy at KFF (Kaiser Family Foundation), Oct. 8, 2020

Phone interview with Joseph Antos, Wilson H. Taylor resident scholar in health care and retirement policy at the American Enterprise Institute, Oct. 8, 2020

Phone interview with Dr. Georges Benjamin, executive director of the American Public Health Association, Oct. 8, 2020

Phone interview with Dr. Leana Wen, public health professor at George Washington University, Oct. 8, 2020

Phone interview with Nicolette Louissaint, executive director and president of Healthcare Ready, Oct. 9, 2020

Rev.com, "Kamala Harris & Mike Pence 2020 Vice Presidential Debate Transcript," Oct. 7, 2020

Tableau, "COVID-19 at the White House — Public Reports," accessed Oct. 12, 2020

Tradeoffs Podcast, "Season 1: Episode 71, Biden and COVID-19," Sept. 24, 2020

Tradeoffs Podcast, "All the President's … Health Policies: Where Do the Candidates Stand on Health Policy?" Sept. 24, 2020

The White House, "President Trump's Historic Coronavirus Response," Aug. 10, 2020

The White House, "Coronavirus Guidelines," March 16, 2020

The Washington Post, "Echoes of Biden's 1987 Plagiarism Scandal Continue to Reverberate," June 5, 2019

The Washington Post, "Joe Biden's Campaign Acknowledges Lifting Language From Other Groups for Its Policy Plans," June 4, 2019

Dr. Rachel Vreeman, director of the Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai, noted in an email that a key likeness is that the two plans "sometimes used similar words, such as testing, PPE and vaccines."

But "the overall philosophy from the start, from the White House and from Trump, has been to let states and local governments deal with this problem," said Josh Michaud, associate director for global health policy at KFF. "Biden would have a much more forceful role for the federal government in setting strategy and guidelines in regards to the public health response." (KHN is an editorially independent program of KFF.)

Even Pence pointed out this philosophical difference during the debate, saying that Democrats want to exert government control while Trump and Republicans left health choices up to individual Americans.

Vreeman and others pointed to another contrast — that the Trump administration has yet to issue a comprehensive COVID-19 response plan.

"What plan? I would really love it if someone could show me a plan. A press release is not a plan," said Dr. Leana Wen, a public health professor at George Washington University.

Wen is right that the Trump administration has not issued a detailed plan, such as Biden's document. The Trump administration has, however, offered a road map for how vaccines would be distributed.

Behavior Matters, Too

Another major distinction emerged in the way the candidates have communicated the threat of the coronavirus to the public and reacted to public health guidelines, such as those issued by the Centers for Disease Control and Prevention.

During most public outings and campaign rallies, Trump has chosen not to wear a mask — even after he tested positive and was treated for COVID-19. He has been known to mock others, including reporters and Biden, for wearing masks. And, Trump and members of his administration have not adhered to social distancing guidelines at official events. The White House indoor reception and outdoor Rose Garden event held to mark the nomination of Amy Coney Barrett to the Supreme Court – at each one, few attendees followed these precautions – have been associated with the transmission of at least 11 cases of coronavirus, according to a website tracking the cases from public reports. There are also multiple reported cases among White House and Trump campaign staff members.

Throughout the pandemic, Trump has downplayed the threat of COVID-19, touted unproven treatments for the disease such as bleach, hydroxychloroquine or UV light, questioned the effectiveness of face masks and criticized or contradicted public health officials' statements about the pandemic.

In comparison, Biden has worn masks during his public campaign events and has encouraged Americans to do so as well. His events strictly adhere to public health guidelines, including wearing masks, social distancing and limiting the number of attendees.

The two candidates' approaches to listening to scientists are also different.

"Biden has said he is going to look at science and value the best scientists," said Benjamin. "The Trump administration has not walked the talk; they have said one thing and done something else. If you go on the Trump administration website, you see guidelines that they didn't follow themselves."

In the end, the Biden campaign has the distinction of being able to learn from the Trump administration's early missteps, said the experts.

There's also a reality check: if Biden wins and attempts to implement his COVID-19 plan, it's important to consider that no matter how well thought out it looks on paper, he may not be able to accomplish everything.

"There's a lot of words in this plan," said Joseph Antos, a resident scholar in health care policy at the American Enterprise Institute. "But until you're in the job, a lot of this doesn't really matter."

Our Ruling

Pence claimed the Biden plan to address COVID-19 was similar to the Trump administration's plan "every step of the way."

A cursory, side-by-side look at the Trump administration's COVID-19 actions — no actual comprehensive plan has been released — and the Biden plan indicates some big picture overlap on securing a vaccine and ramping up testing. But that's where the similarities end.

Biden's plan includes proposed actions the Trump administration has not pursued. It also is focused on federal rather than state authority, a significant distinction Pence himself pointed out during the debate.

Additionally, the candidates' behaviors toward COVID-19 and views on science have been diametrically opposed, with Trump eschewing the use of face masks and social distancing, and Biden closely adhering to both.

Pence's statement ignores critical facts and realities, making it inaccurate and ridiculous.

We rate it Pants On Fire.

Victoria Knight: vknight@kff.org, @victoriaregisk