US media examines country’s failures over first 70 days of coronavirus outbreak (2)

“The genesis of this group was around border control and repatriation,” said a senior official involved in the meetings. “It wasn’t a comprehensive, whole-of-government group to run everything.”

The State Department agenda dominated those early discussions, according to participants. Officials began making plans to charter aircraft to evacuate 6,000 Americans stranded in Wuhan. They also debated language for travel advisories that State could issue to discourage other travel in and out of China.

Trump has, with some justification, pointed to the China-related restriction as evidence that he had responded aggressively and early to the outbreak. It was among the few intervention options throughout the crisis that played to the instincts of the president, who often seems fixated on erecting borders and keeping foreigners out of the country.

Pottinger was by then pushing for another travel ban, this time restricting the flow of travelers from Italy and other nations in the European Union that were rapidly emerging as major new nodes of the outbreak. Pottinger’s proposal was endorsed by key health-care officials, including Fauci, who argued that it was critical to close off any path the virus might take into the country.

This time, the plan met with resistance from Treasury Secretary Steven Mnuchin and others who worried about the impact on the U.S. economy. It was an early sign of tension in an area that would split the administration, pitting those who prioritized public health against those determined to avoid any disruption in an election year to the run of expansion and employment growth.

Those backing the economy prevailed with the president. And it was more than a month before the administration issued a belated and confusing ban on flights into the United States from Europe. Hundreds of thousands of people crossed the Atlantic during that interval.

A wall of resistance

While fights over air travel played out in the White House, public health officials began to panic over a startling shortage of critical medical equipment including protective masks for doctors and nurses, as well as a rapidly shrinking pool of money needed to pay for such things.

By early February, the administration was quickly draining a $105 million congressional fund to respond to infectious disease outbreaks. The coronavirus threat to the United States still seemed distant if not entirely hypothetical to much of the public. But to health officials charged with stockpiling supplies for worst-case-scenarios, disaster appeared increasingly inevitable.

A national stockpile of N95 protective masks, gowns, gloves and other supplies was already woefully inadequate after years of underfunding. The prospects for replenishing that store were suddenly threatened by the unfolding crisis in China, which disrupted offshore supply chains.

Much of the manufacturing of such equipment had long since migrated to China, where factories were now shuttered because workers were on order to stay in their households.

In late January and early February, leaders at HHS sent two letters to the White House Office of Management and Budget asking to use its transfer authority to shift $136 million of department funds into pools that could be tapped for combating the coronavirus. Azar and his aides also began raising the need for a multibillion-dollar supplemental budget request to send to Congress.

Yet White House budget hawks argued that appropriating too much money at once when there were only a few U.S. cases would be viewed as alarmist.

Joe Grogan, head of the Domestic Policy Council, clashed with health officials over preparedness. He mistrusted how the money would be used and questioned how health officials had used previous preparedness funds.

Azar then spoke to Russell Vought, the acting director of the White House Office of Management and Budget, during Trump’s State of the Union speech on Feb. 4. Vought seemed amenable, and told Azar to submit a proposal.

Azar did so the next day, drafting a supplemental request for more than $4 billion, a sum that OMB officials and others at the White House greeted as an outrage. Azar arrived at the White House that day for a tense meeting in the Situation Room that erupted in a shouting match, according to three people familiar with the incident.

A deputy in the budget office accused Azar of preemptively lobbying Congress for a gigantic sum that White House officials had no interest in granting. Azar bristled at the criticism and defended the need for an emergency infusion. But his standing with White House officials, already shaky before the coronavirus crisis began, was damaged further.

White House officials relented to a degree weeks later as the feared coronavirus surge in the United States began to materialize. The OMB team whittled Azar’s demands down to $2.5 billion, money that would be available only in the current fiscal year. Congress ignored that figure, approving an $8 billion supplemental bill that Trump signed into law March 6.

But again, delays proved costly. The disputes meant that the United States missed a narrow window to stockpile ventilators, masks and other protective gear before the administration was bidding against many other desperate nations, and state officials fed up with federal failures began scouring for supplies themselves.

In late March, the administration ordered 10,000 ventilators — far short of what public health officials and governors said was needed. And many will not arrive until the summer or fall, when models expect the pandemic to be receding.

“It’s actually kind of a joke,” said one administration official involved in deliberations about the belated purchase.

Inconclusive tests

Although viruses travel unseen, public health officials have developed elaborate ways of mapping and tracking their movements. Stemming an outbreak or slowing a pandemic in many ways comes down to the ability to quickly divide the population into those who are infected and those who are not.

Doing so, however, hinges on having an accurate test to diagnose patients and deploy it rapidly to labs across the country. The time it took to accomplish that in the United States may have been more costly to American efforts than any other failing.

“If you had the testing, you could say, ‘Oh my god, there’s circulating virus in Seattle, let’s jump on it. There’s circulating virus in Chicago, let’s jump on it,’ ” said a senior administration official involved in battling the outbreak. “We didn’t have that visibility.”

Among the costliest errors was a misplaced assessment by top health officials that the outbreak would probably be limited in scale inside the United States — as had been the case with every other infection for decades — and that the CDC could be trusted on its own to develop a coronavirus diagnostic test.

The CDC, launched in the 1940s to contain an outbreak of malaria in the southern United States, had taken the lead on the development of diagnostic tests in major outbreaks including Ebola, zika and H1N1. But the CDC was not built to mass-produce tests.

The CDC’s success had fostered an institutional arrogance, a sense that even in the face of a potential crisis there was no pressing need to involve private labs, academic institutions, hospitals and global health organizations also capable of developing tests.

Yet some were concerned that the CDC test would not be enough. Stephen Hahn, the FDA commissioner, sought authority in early February to begin calling private diagnostic and pharmaceutical companies to enlist their help.

FDA leaders were split on whether it would be bad optics for Hahn to be personally calling companies he regulated. When FDA officials consulted leaders at HHS, they understood it as a direction to stand down.

At that point, Azar, the HHS secretary, seemed committed to a plan he was pursuing that would keep his agency at the center of the response effort: securing a test from the CDC and then building a national coronavirus surveillance system by relying on an existing network of labs used to track the ordinary flu.

In task force meetings, Azar and Redfield pushed for $100 million to fund the plan, but were shot down because of the cost, according to a document outlining the testing strategy obtained by The Washington Post.

Relying so heavily on the CDC would have been problematic even if it had succeeded in quickly developing an effective test that could be distributed across the country. The scale of the epidemic, and the need for mass testing far beyond the capabilities of the flu network, would have overwhelmed the plan, which didn’t envision engaging commercial lab companies for up to six months.

The effort collapsed when the CDC failed its basic assignment to create a working test and the task force rejected Azar’s plan.

On Feb. 6, when the World Health Organization reported that it was shipping 250,000 test kits to labs around the world, the CDC began distributing 90 kits to a smattering of state-run health labs.

Almost immediately, the state facilities encountered problems. The results were inconclusive in trial runs at more than half the labs, meaning they couldn’t be relied upon to diagnose actual patients. The CDC issued a stopgap measure, instructing labs to send tests to its headquarters in Atlanta, a practice that would delay results for days.

The scarcity of effective tests led officials to impose constraints on when and how to use them, and delayed surveillance testing. Initial guidelines were so restrictive that states were discouraged from testing patients exhibiting symptoms unless they had traveled to China and come into contact with a confirmed case, when the pathogen had by that point almost certainly spread more broadly into the general population.

The limits left top officials largely blind to the true dimensions of the outbreak.

In a meeting in the Situation Room in mid-February, Fauci and Redfield told White House officials that there was no evidence yet of worrisome person-to-person transmission in the United States. In hindsight, it appears almost certain that the virus was taking hold in communities at that point. But even the country’s top experts had little meaningful data about the domestic dimensions of the threat. Fauci later conceded that as they learned more their views changed.

At the same time, as the president’s subordinates were growing increasingly alarmed, Trump continued to exhibit little concern. On Feb. 10, he held a political rally in New Hampshire attended by thousands where he declared that “by April, you know, in theory, when it gets a little warmer, it miraculously goes away.”

The New Hampshire rally was one of eight that Trump held after he had been told by Azar about the coronavirus, a period when he also went to his golf courses six times.

A day earlier, on Feb. 9, a group of governors in town for a black-tie gala at the White House secured a private meeting with Fauci and Redfield. The briefing rattled many of the governors, bearing little resemblance to the words of the president. “The doctors and the scientists, they were telling us then exactly what they are saying now,” Maryland Gov. Larry Hogan (R) said.

That month, federal medical and public health officials were emailing increasingly dire forecasts among themselves, with one Veterans Affairs medical adviser warning, ‘We are flying blind,’” according to emails obtained by the watchdog group American Oversight.

Later in February, U.S. officials discovered indications that the CDC laboratory was failing to meet basic quality-control standards. On a Feb. 27 conference call with a range of health officials, a senior FDA official lashed out at the CDC for its repeated lapses.

Jeffrey Shuren, the FDA’s director for devices and radiological health, told the CDC that if it were subjected to the same scrutiny as a privately run lab, “I would shut you down.”

On Feb. 29, a Washington state man became the first American to die of a coronavirus infection. That same day, the FDA released guidance, signaling that private labs were free to proceed in developing their own diagnostics.

Another four-week stretch had been squandered.

Life and death

One week later, on March 6, Trump toured the facilities at the CDC wearing a red “Keep America Great” hat. He boasted that the CDC tests were nearly perfect and that “anybody who wants a test will get a test,” a promise that nearly a month later remains unmet.

He also professed to have a keen medical mind. “I like this stuff. I really get it,” he said. “People here are surprised that I understand it. Every one of these doctors said, ‘How do you know so much about this?’”

In reality, many of the failures to stem the coronavirus outbreak in the United States were either a result of, or exacerbated by, his leadership.

For weeks, he had barely uttered a word about the crisis that didn’t downplay its severity or propagate demonstrably false information. He dismissed the warnings of intelligence officials and top public health officials in his administration.

At times, he voiced far more authentic concern about the trajectory of the stock market than the spread of the virus in the United States, railing at the chairman of the Federal Reserve and others with an intensity that he never seemed to exhibit about the possible human toll of the outbreak.

In March, as state after state imposed sweeping new restrictions on their citizens’ daily lives to protect them — triggering severe shudders in the economy — Trump second-guessed the lockdowns.

The common flu kills tens of thousands each year and “nothing is shut down, life & the economy go on,” he tweeted March 9. A day later, he pledged that the virus would “go away. Just stay calm.”

Two days later, Trump finally ordered the halt to incoming travel from Europe that his deputy national security adviser had been advocating for weeks. But Trump botched the Oval Office announcement so badly that White House officials spent days trying to correct erroneous statements that triggered a stampede by U.S. citizens overseas to get home.

“There was some coming to grips with the problem and the true nature of it — the 13th of March is when I saw him really turn the corner. It took a while to realize you’re at war,” Sen. Lindsey O. Graham (R-S.C.) said. “That’s when he took decisive action that set in motion some real payoffs.”

Trump spent many weeks shuffling responsibility for leading his administration’s response to the crisis, putting Azar in charge of the task force at first, relying on Pottinger, the deputy national security adviser, for brief periods, before finally putting Vice President Pence in the role toward the end of February.

Other officials have emerged during the crisis to help right the United States’ course, and at times, the statements of the president. But even as Fauci, Azar and others sought to assert themselves, Trump was behind the scenes turning to others with no credentials, experience or discernible insight in navigating a pandemic.

Foremost among them was his adviser and son-in-law, Jared Kushner. A team reporting to Kushner commandeered space on the seventh floor of the HHS building to pursue a series of inchoate initiatives.

One plan involved having Google create a website to direct those with symptoms to testing facilities that were supposed to spring up in Walmart parking lots across the country, but which never materialized. Another centered on an idea advanced by Oracle chairman Larry Ellison to use software to monitor the unproven use of anti-malaria drugs against the coronavirus pathogen.

So far, the plans have failed to come close to delivering on the promises made when they were touted in White House news conferences. The Kushner initiatives have, however, often interrupted the work of those under immense pressure to manage the U.S. response.

Current and former officials said that Kadlec, Fauci, Redfield and others have repeatedly had to divert their attentions from core operations to contend with ill-conceived requests from the White House they don’t believe they can ignore. And Azar, who once ran the response, has since been sidelined, with his agency disempowered in decision-making and his performance pilloried by a range of White House officials, including Kushner.

“Right now Fauci is trying to roll out the most ambitious clinical trial ever implemented” to hasten the development of a vaccine, said a former senior administration official in frequent touch with former colleagues. And yet, the nation’s top health officials “are getting calls from the White House or Jared’s team asking, ‘Wouldn’t it be nice to do this with Oracle?’ ”

If the coronavirus has exposed the country’s misplaced confidence in its ability to handle a crisis, it also has cast harsh light on the limits of Trump’s approach to the presidency — his disdain for facts, science and experience.

He has survived other challenges to his presidency — including the Russia investigation and impeachment — by fiercely contesting the facts arrayed against him and trying to control the public’s understanding of events with streams of falsehoods.

The coronavirus may be the first crisis Trump has faced in office where the facts — the thousands of mounting deaths and infections — are so devastatingly evident that they defy these tactics.

After months of dismissing the severity of the coronavirus, resisting calls for austere measures to contain it, and recasting himself as a wartime president, Trump seemed finally to succumb to the coronavirus reality. In a meeting with a Republican ally in the Oval Office last month, the president said his campaign no longer mattered because his reelection would hinge on his coronavirus response.

“It’s absolutely critical for the American people to follow the guidelines for the next 30 days,” he said at his March 31 news conference. “It’s a matter of life and death.” 

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