How not to lead or manage a health crisis

Trump’s response to the health crisis is problematic. He has botched the four steps of a crisis response that Joshua M Sharfstein identified in his excellent book: The Public Health Crisis Survival Guide.[i]

The four steps are:

  1. Identifying the crisis,
  2. Managing the crisis,
  3. Addressing communications and the politics of it and lastly,
  4. Developing a long-lasting change as a result.

Although the final step is in the future, the failures on the first three steps do not bode well for long lasting change.

Identifying a crisis.

Everything starts with identifying a crisis since that determines how well you manage it. Trump failed to identify the crisis despite the evidence that it existed. Trump did pretty much everything wrong. His belief that the decision to limit direct flights was enough meant that he confused a symbolic act for meaningful action. Had he listened to the early warnings provided by his experts, the WHO, and China, he would have instituted screening and testing on flights from China as well as considering that the disease had likely spread elsewhere. Moreover, his administration was limited in its ability to identify the outbreak because in 2018 he disbanded the NSC post designated with preparing for and coordinating the national response to a pandemic.[ii]


Trump’s failure to recognize the crisis goes to something deeper within his administration which is fatal for any organisation—the failure of critical upwards communications.[1] Trump is clear that he does not like to hear bad news.[iii] No one pointed out the worst case scenario to argue for immediate, decisive action that even if unpopular, was necessary to prevent a larger crisis. Instead, everything he has done has been reactive and reflective of his interests. He has managed it not as a public health crisis but as a market crisis where he worried about market liquidity before worrying about speeding up the testing process. What has stirred him to act is not the mounting evidence of infections and deaths but that the markets have reacted badly to his efforts to his efforts to dispel the idea that a crisis is coming.

Even though he recognizes the crisis and has declared a national emergency, it is too late. The virus is already deeply entrenched across the United States. By the time testing indicates the outbreak’s scale and scope many more will have died.

Managing a crisis

Trump is a living textbook in how *not* to manage a crisis. When he declared a national emergency on 13 March 2020, the virus was already entrenched so he is only reacting to the issue. What will happen next is that hospitals will be inundated with positive tests. In turn, hospitals will be overwhelmed with known cases and that will have a knock-on effect on other treatments as patients will have to be prioritised. When coronavirus patients start to overwhelm the system and other treatments are displaced, the public will become alarmed about the scarcity of urgent care and treatment. At that point, the second wave of institutional problems will emerge. The government appears unprepared for that crisis. In a sense, their failure to manage the first wave of the crisis means they appear unable to identify the emerging second wave.

Communication has been a failure on every level except by experts.

Trump has failed abysmally in communicating during this crisis. He downplayed its significance until forced to act by the markets. He has contradicted government and outside experts. He has made this crisis about himself rather than focusing on the experts in promoting the message they have. The public have not had clear and consistent messages from the government about the virus, the risks, or the scale and scope. The failure to provide effective communication to the public is not surprising in an administration proud of attacking the press as the enemy or as purveyors of “fake news” yet, it is a scandal that the communication has been this poor during a national emergency. He has compounded the issue by declaring certain meeting notes as classified as national security which limits the ability for experts to have a clear understanding of what the government wants done.[iv]

All the crisis communications texts suggest that you are transparent as much as possible with what your responses. Again, this has not been the case with Trump. his speeches have not reassured people they’ve added to the fears, because he’s not reassuring them by providing them with a coherent and consistent message is conflicting message about how much the testing will be covered by the payments, whether the testing is covered or treatment is covered. The public are concerned about this. He says the testing is ready when it’s not. He says they have an excellent response when it’s not. And it’s clear that it’s not this isn’t a matter for debate, it is clear as an objective fact that there are not enough tests that he did not contain this virus. It is not and was contained and that that is not going to go down in a short period of time and it’s not approaching zero. And it’s not that they’ve done an excellent, wonderful job. In fact, it’s been the opposite of a wonderful, excellent job. Where he could miscommunicate or mismanage the message, he has done so because he has prioritised political over public health.

Can there be a long-lasting change?

Given Trump’s focus on the short-term issues, it’s unlikely that long lasting change will come except as a negative example. As Sharfstein argues change only comes after accepting responsibility which may also involve accepting some blame for the crisis. Trump and his administration seem institutionally incapable of accepting responsibility or blame. We have learned for three years that it is someone else’s problem. A crisis of this order is not someone else’s fault. The only person able to deal with a national emergency is the national leader. Trump has failed to lead which means that long lasting change can only occur once he stops being the leader because his approach has been to avoid bad news and shift blame both of which keep stop a person and an organisation from learning. We will have to wait for a future President and Congress to put into place structures to prevent this poor of response and leadership from happening again.

The best lesson to take from Trump’s crisis response is to avoid following Trump’s example.





[iii] “In the case of Alex Azar, he did go to the president in January. He did push past resistance from the president’s political aides to warn the president the new coronavirus could be a major problem. There were aides around Trump – Kellyanne Conway had some skepticism at times that this was something that needed to be a presidential priority.

But at the same time, Secretary Azar has not always given the president the worst-case scenario of what could happen. My understanding is he did not push to do aggressive additional testing in recent weeks, and that’s partly because more testing might have led to more cases being discovered of coronavirus outbreak, and the president had made clear – the lower the numbers on coronavirus, the better for the president, the better for his potential reelection this fall.”


[iv] Sharfstein provides a brief overview of crisis communication which the CDC follows, and each one Trump has failed.

  1. Be first
  2. Be right
  3. Be credible
  4. Express Empathy
  5. Promote Action
  6. Show respect

About lawrence serewicz

An American living and working in the UK trying to understand the American idea and explain it to others. The views in this blog are my own for better or worse.
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