Monday, April 13, 2020
RSN: FOCUS: The President and the Plague
13 April 20
Goodell writes: "While Americans died of the modern plague, President Trump sang happy birthday to a fading Fox News personality."
How Donald Trump failed at the single most important task of the Oval Office: keeping the American people safe from harm
On March 7th, a who’s who of the Republican establishment gathered at Mar-a-Lago, Trump’s lavish retreat in Florida, for the 51st-birthday party of Kimberly Guilfoyle, one of the former co-hosts of The Five, and now the girlfriend of Donald J. Trump Jr. All the usual suspects were there, including Trump’s lawyer Rudy Giuliani and Sen. Lindsey Graham; Tiffany Trump; Ivanka and her husband, Jared Kushner; and Trump’s younger son Eric and his wife, Lara. They sang happy birthday to Guilfoyle and lit a big sparkler. At the end, she pumped her fist and shouted “Four more years!” This is what passes for a cozy family celebration in Trumpland. But out in the real world, darkness was falling fast.
There were already 100,000 confirmed cases of COVID-19, the disease caused by the coronavirus, around the world, and 3,600 people had died. In the U.S., more than 100 new cases had been reported that day, a rate that was doubling every three days. Other nations knew how serious this was: By that time, China had shut down major cities, all but quarantining 760 million people. Singapore and Hong Kong and South Korea had put in aggressive travel restrictions and testing procedures. In the U.S., fear was rising. South By Southwest, the giant music/tech conference in Austin had just been canceled. Grocery stores were stripped in panic buying. On Wall Street, stocks were in free fall.
Trump knew all this. In fact, he knew a lot more. He had been getting daily intelligence reports for two months, warning him about the risk of a pandemic. It’s impossible to believe he had not been told that COVID-19 was at least 10 times more deadly than the flu, or that it was passed human to human with a just touch or a cough. A top White House adviser had already warned that a full-blown pandemic could imperil the lives of millions of Americans. Virtually every public-health expert in the world was speaking out, warning politicians and community leaders what was about to hit us.
Nevertheless, since the moment the outbreak was first publicized in January, Trump had been doing nothing but downplaying it. To him, the pandemic was merely another plot to sabotage him. “They’re trying to scare everybody . . . cancel the meetings, close the schools — you know, destroy the country,” he told his guests that weekend. “And that’s OK, as long as we can win the election.”
Before the party, Trump played a round of golf. Then he had dinner at Mar-a-Lago with populist, right-wing Brazilian president Jair Bolsonaro, one of the few people in the world who can challenge Trump as the king of coronavirus denial. (Bolsonaro dismissed the illness as “a little flu.”) In what you might call God’s cruel little joke, three of Bolsonaro’s aides who attended the dinner would later test positive for the coronavirus. At least one other person who was at Mar-a-Lago also tested positive, as did Miami Mayor Francis Suarez, who met with Bolsonaro at a different event in Miami.
It was a Trump-branded petri dish that night. Guests danced in a “Trump Train” conga line to Gloria Estefan’s “Rhythm Is Gonna Get You.” They mingled and shook hands and hugged. There was no social distancing — according to one guest, there was not even any hand sanitizer around. So the coronavirus was there all night too, lingering on doorknobs, glasses, silverware, and seeking a meaty new host to infect with every hug and handshake. Epidemiologists may never know how many people got sick as a result of spending those few hours at Mar-a-Lago, or how many of them took the virus home to their friends and families, or passed it on to strangers they bumped into at airports.
What’s stunning about this is not the degree to which Trump — a self-confessed germophobe who often douses himself with hand sanitizer after a handshake — put himself at risk. By hosting this party, he also put his friends and his family at risk. It’s a chilling glimpse into the psyche of the president of the United States, a man who has demonstrated, over and over, that he thinks science is a church for losers and that there isn’t any predicament he can’t bully or con his way out of. When the full story of this pandemic is written, it will be clear that Trump not only failed in protecting 329 million Americans from a deadly virus but that he even failed to protect his own sons and daughters.
As I write this, the coronavirus is raging around the planet. Globally, the number of people infected with it has risen to more than 1.8 million, with 110,000 deaths. We are riding the terrible curve of exponential growth — in New York right now, which is a hot spot for the spread of the virus, the number of cases is doubling every three days. As of April 9th, nearly 800 people in the city were dying each day. A report by top disease-modeling experts in London suggested that left unchecked, 7 billion people on the planet would be infected with the virus, leading to as many as 40 million deaths.
The pandemic has already fundamentally changed virtually everything about modern life. The streets are eerily empty, we keep our distance from strangers, we worry that every cough is a harbinger of disease.
How bad this will get, and how we will weather the dark days ahead, is impossible to say. But we are deep enough into this pandemic now to see a few things clearly. The first is that President Trump has profoundly failed in his primary role: to keep America safe. The pandemic is not his creation, but as president of the United States, it was his job to make sure that we were prepared to deal with this before it happened, and then to react quickly when it did happen. After all, getting hit with a bad pandemic is not exactly a black-swan event. Virtually every public-health official in the world was openly warning of an outbreak for more than a decade. In 2005, President George W. Bush cautioned, “If we wait for a pandemic to appear, it will be too late to prepare.” During the presidential transition in early 2017, Obama’s national security team spent a full day with the Trump team, briefing them on the most pressing national security issues — including the threat of a pandemic. They even left the Trump team a 69-page book detailing what they had learned in viral outbreaks. In January 2019, the director of U.S. National Intelligence warned that the United States was vulnerable to the next flu pandemic and that it “could lead to massive rates of death” and “severely affect the world economy.”
“This is the worst pandemic of our lifetimes, and everyone saw it coming,” says renowned epidemiologist Larry Brilliant, one of the key figures in eradicating smallpox in the 1970s and senior technical adviser on the movie Contagion. “And I mean everybody in this field saw it coming.”
Trump ignored it all. After he took office, he gutted the National Security Council of anyone with expertise in pandemics. Public-health budgets were slashed. International groups focused on disease and medicine, such as the World Health Organization, were shunned. “This is a global pandemic, and it requires a commitment to global cooperation and science,” says Rajiv Shah, the president of the Rockefeller Foundation, who was a central figure in stopping the Ebola outbreak in Africa in 2014. “And it requires the president of the United States to lead.”
After the virus emerged from China, Trump spent nearly three months denying the threat it posed, playing it down, ignoring it, clearly worried that if he acknowledged it, it might tank Wall Street, which he believed was key to his re-election efforts. In January, he said, “We have it totally under control.” In February, he falsely declared that “we are very close to a vaccine,” and that “within a couple of days [the number of cases] is going to be down to close to zero.” In early March, he said, “It will go away. Just stay calm.” (Trump reportedly believed a widely circulated but scientifically unproven view that the virus would disappear as soon the weather warmed up.) He hyped the effectiveness of unproven drugs and all but promised to roll back social-distancing guidelines and have “the country opened up and just raring to go by Easter.” “No president has accomplished more in his first term than Donald J. Trump,” a senior administration official emailed me when asked for a comment on this article. “His unprecedented actions to protect the health and safety of the American people will ensure we emerge from this pandemic stronger and with a prosperous, growing economy.”
In fact, Trump mishandled virtually everything. As I write this, the United States has the highest caseload in the world, with many urban hospitals overrun, more than 16 million people out of work, and fights breaking out between Trump and governors such as New York’s Andrew Cuomo and Michigan’s Gretchen Whitmer over scarce equipment, including ventilators and medical masks.
“Trump’s pre-existing flaws as a leader have all come home to roost,” says Ben Rhodes, a speechwriter and deputy national security adviser to President Obama. “His disdain for expertise led him to disregard the many public-health experts he had in his own government. His disdain for international cooperation has led to a failure to work with other countries. His adversarial posture toward China made it harder to get cooperation out of the gate. Obviously his very tortured relationship with the truth has led him to repeatedly provide misinformation about what we’re facing. President Trump’s response [to the virus] encapsulates his own unfitness to handle the responsibilities of the office.”
A recent story in Foreign Policy — hardly a haven for partisan Democrats — called Trump’s response “the worst intelligence failure in U.S. history.” But Jeremi Suri, a presidential historian at the University of Texas, Austin, disagrees: “An intelligence failure is when you have the pieces but you haven’t put the pieces together,” Suri explains. “9/11 was a classic intelligence failure. We had all these signals, all these pieces of the story, but no one really put it together to think that they were actually going to be getting on planes and doing the things they did on planes.”
To Suri, Trump’s response to the pandemic is analogous to Joseph Stalin’s response in June 1941, when all his generals were telling him that Germany was about to attack the Soviet Union. “Every public-health expert in public as well as in private for the last five years has been predicting a pandemic exactly like this,” Suri says. “It is like Stalin being told by his generals, ‘Look, the Nazis are mobilizing. Look what Hitler’s saying. He’s going to attack.’ And Stalin saying, ‘No, it’s all phony. I don’t believe it.’ Well, you know what happened. Hitler invaded, as everyone predicted, killing more than 20 million of Stalin’s people.”
Former Secretary of State John Kerry tells me he considers Trump’s handling of the pandemic “a colossal failure. The entire national security process has broken down under Trump.” Suri goes further: “This is the greatest leadership failure in recent American history.”
The first warning came in the third week of December 2019, when Ai Fen, the director of the emergency room at Central Hospital in Wuhan, China, found an unusual chest infection — “multiple patchy blurry shadows scattered in lungs” — of a delivery person of the Huanan Seafood Wholesale Market. Wuhan is a city of 11 million people in central China, a concrete megacity with the Huanan market at its epicenter. The market is a dense stew of humans and animals. In dark corners, you can often find live wolf pups, golden cicadas, scorpions, bamboo rats, squirrels, foxes, civets, turtles, and crocodile tails and intestines. Such markets are known as “wet markets” because of all the water and blood and guts that splash around in a way that is guaranteed to cause trouble. As Christian Walzer, executive health director of the Wildlife Conservation Society, put it, “Each animal is a package of pathogens.”
Viruses are a peculiar kind of pathogen — not quite alive, not quite dead. One Nobel Prize-winning scientist called them “bad news wrapped up in a protein.” They are so small they are impossible to see with a conventional microscope (if one were the size of a tennis ball, a human would stand 500 miles tall). There are many billions of them loose in the world, most of which we haven’t identified. For humans, much of the risk comes from viruses that have jumped from animals to humans (a.k.a. zoonotic viruses), often through contact with feces or blood. Ebola likely originated in bats, jumped to gorillas and chimpanzees, then was passed on to poor African villagers who came in contact with infected meat. But in China, the taste for wild-animal meat is often about status. Several years ago, when I visited a market on the outskirts of Beijing that was crowded with caged snakes and pangolins and many other creatures I couldn’t recognize, I was surprised by the number of middle-class people in the market. “For some people,” a Chinese colleague explained, “eating exotic wildlife is a culinary adventure. The French eat snails. You eat buffalo. To us, it’s not so different.”
Epidemiologists have long warned that as more and more people live on the planet, in closer proximity to animals and wildlife, the more risk there is of viruses making the jump to humans. “We invade tropical forests and other wild landscapes, which harbor so many species of animals and plants — and within those creatures, so many unknown viruses,” David Quammen, author of Spillover: Animal Infections and the Next Human Pandemic, wrote. “We cut the trees; we kill the animals or cage them and send them to markets. We disrupt ecosystems, and we shake viruses loose from their natural hosts. When that happens, they need a new host. Often, we are it.”
On December 27th, a second person turned up at the Wuhan hospital with an unusual lung infection. Three days later, Ai noticed the phrase “SARS coronavirus” on the test sheet. For a doctor with Ai’s experience, the presence of a coronavirus in the patient’s blood was alarming. Millions of coronaviruses (so named because they have a halo of protein around them that looks like a crown) exist in nature. Only six infect human beings. Four are not much trouble. But two are dangerous — one, which was identified in 2003, caused Severe Acute Respiratory Syndrome (SARS). The SARS virus was highly contagious. It spread to 37 countries, infected 8,000 people, and caused 774 deaths. Another coronavirus, which caused a disease known as Middle East Respiratory Syndrome (MERS), was identified in 2012. MERS was not highly contagious (it spread from camels to humans). But it was deadly, killing about 35 percent of the 2,000 people who suffered from the disease.
On December 30th, Ai reported the virus to the hospital’s public-health department. She also circled the word “SARS” in the lab report, then took a picture of it and emailed it to other doctors. When Li Wenliang, a 33-year-old ophthalmologist, heard about the virus, he posted in a WeChat group that a coronavirus had been discovered in Wuhan. Within hours, the news had spread widely among doctors and public-health officials in the city.
President Trump and China bashers in Congress would later argue that the pandemic is the fault of the Chinese, that had they acted with more transparency during the early days of the outbreak, the trajectory of the pandemic might have been very different. Just to underscore that point, Trump started calling the SARS-CoV-2 virus “the Chinese virus.” In fact, Trumpland conspiracists, such as Rush Limbaugh and Sen. Tom Cotton, even suggested that the virus could have been an engineered bioweapon that escaped from a research lab in Wuhan.
The origins of the virus are still not clear. But Kristian Andersen, director of infectious disease genomics at Scripps Research Translational Institute in California, says it likely came from a bat (96 percent of the virus’s genome is identical to one found in horseshoe bats), then made the jump, perhaps through another animal, to humans. “The chances that a lab engineered this virus are essentially zero,” Andersen tells me.
However the plague was unleashed, it is certainly true that for the next few weeks, local Chinese officials tried to suppress or deny news of the discovery of the coronavirus. Li was summoned by police and censured for “making false comments on the internet.” After going back to work, Li became infected with the virus and died on February 7th, sparking widespread outrage in China over the government’s attempts to squelch whistleblowers. Other news sources alerting citizens of Wuhan to the virus were censored or shut down. Moreover, Bloomberg recently reported that U.S. intelligence officials suspected that China downplayed the scale and deadliness of the disease to the international community.
Still, in other important ways, the Chinese moved quickly. On December 31st — the day after Ai reported the virus to the Wuhan hospital’s public-health department — Chinese authorities alerted the local offices of the World Health Organization about a possible viral outbreak. On January 1st, they closed down the Huanan seafood market. Six days later, they identified the pathogen as a novel coronavirus (“novel” meaning new, which is always alarming because it means no one has immunity to it). Finally, on January 10th, Chinese authorities reported the genetic sequence of the virus, which the World Health Organization named SARS-CoV-2, to scientists around the world. Less than a week later, a German lab announced it had used the genetic data to create the first test for the virus, which was quickly adapted by WHO and made available to anyone who wanted it.
“In scientific terms, this is lightning speed,” says Andersen. “This is difficult stuff. We have to remember that all of this happened during flu season, so a lot of people would have had symptoms that looked like COVID-19. But because of flu, discovering a novel coronavirus this fast against that backdrop is simply unprecedented.” Andersen points out that Zika circulated in Brazil for a year and a half before anyone realized they had an epidemic. Ebola took three months to diagnose. Importantly, these are known pathogens and not a novel pathogen like SARS-CoV-2.
In the coming months, Trump would try to blame the WHO for failing to alert other nations early enough to the outbreak. But that’s just scapegoating. To anyone schooled in the science of pandemics, when the Chinese disclosed that they had identified a novel coronavirus on January 7th, it was cause for alarm. And certainly, by then, it was no secret to the Trump administration. Alex Azar, secretary of Health and Human Services, said that his agency learned of the coronavirus on January 3rd, based on Centers for Disease Control and Prevention director Robert Redfield’s conversations with Chinese colleagues. Azar told CNN that he and Redfield officially offered to send a CDC team into China on January 6th but did not receive permission for them to enter the country.
If the Trump administration had a better working relationship with the Chinese, that might not have been a problem. But the administration had slashed U.S. public-health staff working inside China from 47 people in 2017 to 14 people by 2019. In July 2019, the administration even defunded the position of an epidemiologist who had been embedded inside China’s own disease-control agency.
Still, according to former government officials, U.S. intelligence agencies would have been alerted in real time about the outbreak in China. “The U.S. intelligence community would have been well positioned to not only detect the emergence of a novel virus like this,” says Ben Rhodes, “but also to understand the extent to which the Chinese might have been suppressing some information about it in those early days.” John Kerry agrees: “I’m told [intelligence] had all this in late December, early January.”
Whatever Trump officials knew, they took no significant action in the early days of the outbreak. On January 6th, the CDC issued a level-one travel alert to Wuhan, advising travelers to avoid sick people and animal markets. On January 17th, the CDC and Department of Homeland Security announced that travelers from Wuhan to the U.S. would undergo entry screening for symptoms associated with COVID-19 at San Francisco, New York, and Los Angeles airports. According to The Washington Post, Azar had his first discussion about the virus with President Trump on January 18th, a full week after the Chinese had disclosed the genetic structure of the virus. According to the Post, “the president interjected to ask about vaping and when flavored vaping products would be back on the market.”
Susan Rice, Obama’s National Security director, says the lack of urgency in the Trump administration was extraordinary. “If we had been in office when this hit and we were informed at the White House that a dangerous, unfamiliar virus had broken out in China, we would have been all over that from Day One,” Rice told me. “We would have been figuring out how to ramp up testing quickly. We would have figured out how to prepare our health-system infrastructure in the states where we know they don’t have the equipment that is necessary to deal with a wide-scale health emergency or pandemic.”
After that, the speed of the virus increased exponentially. On January 20th, the coronavirus was found to have infected a man in Snohomish County, Washington, who had returned from China five days earlier. The next day, WHO put out its first situation report about the outbreak, which said there were 278 cases of COVID-19 in China, with 51 people severely ill, and six deaths. More ominously, it had spread to Thailand, Japan, and Korea.
Trump, of course, shrugged it off. “We have it totally under control,” he said at the World Economic Forum in Davos, Switzerland, referring to the case in Washington state. “It’s one person coming in from China. It’s going to be just fine.”
In China, authorities had exactly the opposite reaction. Two days later, on January 23rd, they locked down the entire city of Wuhan — overnight, 11 million people couldn’t leave their homes. Travel across China nearly stopped. “The number of deaths is rising quickly,” Chinese researchers wrote in a report about the disease published in The Lancet, a respected British medical journal, on January 24th. They urged careful surveillance of this new virus in view of its “pandemic potential.”
“China definitely botched and suppressed and covered up some of the early information on this,” says Jeremy Konyndyk, a senior policy fellow at the Center for Global Development, where he focuses on global-outbreak preparedness. “But by mid-January, certainly by the time they started locking down Wuhan, it was clear that this virus was human-to-human transmissible, that it was very aggressively contagious, that it could spread from human to human very easily, and that it had at least a concerning fatality rate. It was clear that it was highly dangerous, and that it had the potential to really overwhelm our modern health system. By late January, everyone in the pandemic research community around the world was in red-flag mode.”
By that time, other nations had swung into action to prepare for what was to come. South Korea, in particular, went into high gear. Within days of the country’s first case and upon seeing the same exact set of facts that U.S. authorities were seeing, officials brought together private-sector labs from around their country and began ramping up high-volume testing with great urgency.
Inside the Trump administration, some people were finally getting the message. “Any way you cut it, this is going to be bad,” a senior medical adviser at the Department of Veterans Affairs, Dr. Carter Mecher, wrote on January 28th, in an email to a group of public health experts which called itself Red Dawn, based on the 1984 movie starring Patrick Swayze about a band of American high school students fighting to save the country after a foreign invasion. “You guys made fun of me screaming to close the schools,” Mecher wrote in the email published by The New York Times. “Now I’m screaming, close the colleges and universities.”
On January 29th, Peter Navarro, Trump’s trade adviser, circulated a bluntly worded memo in the West Wing. “The lack of immune protection or an existing cure or vaccine would leave Americans defenseless in the case of a full-blown coronavirus outbreak on U.S. soil,” Navarro’s memo said. He warned that an outbreak could evolve “into a full-blown pandemic, imperiling the lives of millions of Americans.” But Trump continued to dismiss the risks. “We think we have it very well under control,” he said during a speech in Michigan on January 30th. “We have very little problem in this country at this moment — five — and those people are all recuperating successfully. But we’re working very closely with China and other countries, and we think it’s going to have a very good ending for us.”
Instead of pushing for testing or to prepare hospitals for what was to come, Trump’s only move was to ban Chinese foreign nationals from entering the U.S. In the coming weeks, as the pandemic spun out of control and the death toll mounted, he would tout the travel ban as a brave, bold move that saved thousands of lives. As he told Sean Hannity on Fox News: “We pretty much shut [the coronavirus] down coming in from China.”
In fact, the travel ban was a failure before it began. “You can’t hermetically seal the United States off from the rest of the world,” Rice says. For one thing, the ban only applied to Chinese citizens, not to Americans coming home from China or other international travelers, or to cargo that was coming into the U.S. from China. (Rice calls it “a Swiss-cheese travel ban.”)
But more important, by the time the ban went into effect on February 2nd, COVID-19 outbreaks were already growing in more than 30 cities in 26 countries — including the U.S. And that is just the place where the outbreaks were known to be — it was likely the virus was already spreading in many more places, silently moving from person to person with each touch, each handshake, grabbing doorknobs and glasses, in line in airports. Epidemiologists call this kind of transmission “community spread.”
“Once community spread is underway, then introductions through travel are not the main threat,” says Konyndyk. “The volume of cases that will emerge locally is always dramatically higher than the volume that will arrive from overseas. Putting up a travel ban is like locking the door after the robber is already inside.”
Regardless, any opportunities for early action gained by the travel ban were botched. “If the travel ban did anything, it potentially bought us a few weeks to get ahead of the curve,” Rice argues. “We did not use those weeks to any good effect. And for Trump to say how brilliant that was is belied by the obvious reality that we are now the world’s hot spot. So it’s a load of bullshit. Trump’s lies are killing us.”
In September 2015, I traveled to Alaska with President Obama, where we spent a day together talking about the science and politics of climate change. As we walked along the waterfront in Kotzebue, a city 30 miles north of the Arctic Circle, I asked him if reports about the catastrophic future impacts of climate change ever scared him. He replied, “Part of my job is to read stuff that terrifies me all the time.”
“I’ve got a chronic concern about pandemics, for example. And the odds are that sometime in our lifetime there’s going to be something like the Spanish flu that wipes out a lot of people . . . if we’re not taking care.”
It was not a surprise to me that Obama had pandemics on his mind. The year before, he had put a lot of muscle, as well as political capital, into fighting an Ebola virus outbreak in West Africa. The Ebola outbreak showed how powerful a role America could play in a pandemic if it chose to, as well as shaping the views of a generation of epidemiologists and virus hunters.
Ebola virus is far more deadly than SARS or COVID-19. It kills about half the people who are infected. “The virus makes people fatally leaky,” science writer Carl Zimmer explained. “They release huge quantities of diarrhea, vomit, and sometimes blood.” Unlike the coronavirus, which transmits easily from human to human, Ebola is only transmitted through bodily fluid — blood, vomit, semen, saliva, sweat. In a hospital setting or when burying a body, it’s highly transmissible.
The outbreak began in March 2014 and escalated quickly. People were dying horrible deaths in the streets of Monrovia. “We sat in the situation room in September,” John Kerry recalls. “We were told, ‘Look, a million people are going to die between now and Christmas if something isn’t done to prevent the spread here.’ ”
Obama acted decisively. He arranged an emergency meeting at the United Nations. Among other things, he sent 3,000 U.S. troops to West Africa to help build hospitals. “In order to recruit health care workers to go serve there, we wanted to make sure that they knew that they would be treated if they got infected,” says Ariana Berengaut, who worked in Africa with USAID. “So we built a special hospital for international and local health care workers, which was a way of saying, ‘We have your backs.’ Which is an important message that President Trump should be sending to first responders and health care workers.”
Obama also allowed a handful of medical evacuees to be brought into the country for treatment, which was hugely controversial, given the risks of importing a deadly virus into the U.S. Trump, whose hatred of Obama was never a secret, played a major role in hyping the possibility of a mass Ebola outbreak in the U.S. “I am starting to think that there is something seriously wrong with President Obama’s mental health,” Trump tweeted. “Why won’t he stop the flights. Psycho!” And then again later: “Ebola patient will be brought to the U.S. in a few days — now I know for sure that our leaders are incompetent. Keep them out of here!”
Two of those patients who were brought to the U.S. died; nine were saved. Globally, the outbreak killed 11,300, mostly in Africa. But it was widely viewed as a public-health triumph. “America has been the nation that offers the world this type of leadership, especially when that urgency is necessary,” says Rajiv Shah. “We are the trusted leader at bringing people together to solve big global challenges.”
In the aftermath, Rice organized the Global Health Security Agenda, which was an attempt to build cooperation and share knowledge about pandemics between nations. Its role was explicit: “to prevent, detect, and respond to infectious disease threats.” They also set up the National Security Council Directorate for Global Health Security and Biodefense, which was essentially a new department within the NSC, headed by Beth Cameron, an administrator with decades of experience with pandemics.
After the 2016 election, the outgoing Obama cabinet members and staff and incoming Trump cabinet members and staff gathered for three hours in the Eisenhower Executive Office Building next to the White House. The meeting was held to satisfy a 2015 law that required the outgoing administration to “prepare and host interagency emergency preparedness and response exercises.” All of Obama’s top advisers, including Susan Rice and Lisa Monaco, Obama’s Homeland Security adviser, were there. Trump’s National Security Adviser Michael Flynn (who later pleaded guilty to lying to the FBI and is now awaiting sentencing) was also present, as was Commerce Secretary Wilbur Ross and Homeland Security Adviser Tom Bossert. The purpose of the exercise, according to documents for the meeting published by Politico, was to “familiarize” the incoming team with “domestic incident management policy and practices and continuity of government programs” in case it faced a major crisis. They spent several hours discussing the risks of a pandemic. “Although the exercise was required, the specific scenarios we chose were not,” Monaco later wrote. “We included a pandemic scenario because I believed then, and I have warned since, that emerging infectious disease was likely to pose one of the gravest risks for the new administration.” The Trump folks just sat there, according to sources present, eyes glazed. Rice says she talked with Flynn about pandemics during 12 hours of briefings. Did she get any feedback from him? “I’m not going to say there was no feedback,” says Rice. “But there were very few issues beside China that he got energized about. China and Turkey.”
And if the briefing wasn’t enough, there was also a book. In the aftermath of the Ebola epidemic, the National Security Council staff assembled a 69-page playbook about how to respond to a pandemic, even down to key issues like what the political response might be to military involvement. The playbook is remarkably thorough, advising officials to question the numbers on viral spread, ensure appropriate diagnostic capacity, and check on the Strategic National Stockpile, which is a collection of equipment and medicine designed for use in a national emergency. Beth Cameron calls the book “a decision-making rubric for biological threats.” At times it reads like Pandemic Response for Dummies: “Is there sufficient personal protective equipment for health care workers who are providing medical care?” the playbook asks. “If yes: What are the triggers to signal exhaustion of supplies? Are additional supplies available? If no: Should the Strategic National Stockpile release PPE to states?”
NSC officials compiled the guide — officially called the Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents, but known to everyone as “the pandemic playbook” — in late 2016. The Trump administration was briefed on the playbook in 2017, and according to Cameron, it was widely distributed among departments and agencies, via email and in bound copies.
But there’s no evidence it was ever read. And within a little more than a year, all the pandemic expertise was gone. Trump pushed out Homeland Security Adviser Bossert, whose portfolio included global pandemics and who was widely respected for his understanding of the risks they pose. The pandemic office on the National Security Council was gone, terminated by then-National Security Adviser John Bolton as part of a broader reorganization and cost-cutting measures. (“Claims that streamlining NSC structures impaired our nation’s bio defense are false,” Bolton tweeted in March, after the pandemic was raging.) Rear Adm. Timothy Ziemer, an infectious-disease expert who had taken Beth Cameron’s job as the head of the pandemic office, was also pushed out. “Rather than heed the warnings, embrace the planning, and preserve the structures and budgets that had been bequeathed to him, the president ignored the risk of a pandemic,” Rice wrote in an editorial.
Still, outside warnings continued. In 2018, Bill Gates met with Trump, urging him to invest in new technology to help deal with a pandemic. In 2019, the Office of the Director of National Intelligence ranked a major disease outbreak among the top global threats to watch, warning: “We assess that the United States and the world will remain vulnerable to the next flu pandemic or large-scale outbreak of a contagious disease that could lead to massive rates of death and disability, severely affect the world economy, strain international resources, and increase calls on the United States for support.”
And if all that wasn’t enough, there were high-profile simulations — a.k.a. “germ games” — designed to highlight the risks of pandemics. In August 2019, the Crimson Contagion simulation included participation from more than 100 federal, state, and local leaders, as well as from private-sector partners and members of the White House National Security Council. The scenario was based on a novel influenza virus that originates in China and spreads around the world. It forecast 110 million illnesses, 7.7 million hospitalizations, and 586,000 deaths in the U.S. alone. The exercise also foresaw many weaknesses in U.S. capability, making the point that the “current medical-supply chain and production capacity cannot meet the demands imposed by nations during a global influenza pandemic.”
Luciana Borio, who worked in the pandemic office at the NSC before it was cut in 2018, spoke at a symposium at Emory University to mark the 100th anniversary of the 1918 influenza pandemic. “The threat of pandemic flu is the number-one health security concern,” she told the audience. “Are we ready to respond? I fear the answer is no.”
In the early days of the outbreak, public-health officials and others were focused on the blood-red numbers on display at the Johns Hopkins Coronavirus Resource Center website, which chronicled the rise of infections around the world in real time, giving anyone who cared to look a spooky sense of the global spread of the virus. But Trump was always focused — to the extent that he was focused on anything at all — on an entirely different set of numbers: the Dow Jones Industrial Average.
From the moment he took office, Trump saw the Dow as a barometer of his success and re-election chances. He was willing to do anything to keep the economy on a sugar high through November. Throughout the course of the pandemic, the economy seemed to be his primary concern. Not surging supplies of ventilators to hospitals and masks and gloves to front-line responders. Not listening to experts like Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases and a veteran of the war against diseases during the past four decades, who was surely telling him what was headed our way. Trump seemed to have viewed this pandemic not as a great humanitarian challenge, not as an opportunity to use his power to save the lives of Americans, but as an invisible germ that would infect his re-election and color him as a loser.
Thus, Trump spent the first month or so of the outbreak talking down the virus, tweeting about the impeachment “Witch Hunt!” and boasting of “record highs” of the stock market as vindication of his divine leadership skills. And that led to the single most calamitous, deadly, and unrecoverable screw-up in the entire narrative of the outbreak (so far): the failure to push the FDA and other federal agencies to get viral test kits distributed so that public-health officials could get “eyes” on the pandemic, as epidemiologists like to say. “The key to preventing or mitigating a pandemic,” Larry Brilliant tells me, “is early detection and response. It’s that simple.”
The experience of South Korea proves this. The coronavirus was detected there on the same day it was detected in the U.S. By February 16th, the CDC and state public-health labs had tested only about 800 people. That’s roughly 2.4 tests per million people in the U.S. In contrast, South Korea had tested about 8,000 people, or 154.7 tests per million. By March 17th, the U.S. still had performed about only 125 tests per million people; meanwhile, South Korea was testing more than 5,000 people per million.
Better testing is key because it allows public-health officials to understand how the virus is moving, how to restrict travel and implement quarantines, and where to surge medical supplies and equipment. And better testing is one big reason why, as of early April, South Korea’s per capita death rate was one-seventh that of the United States. Germany, which also implemented widespread testing early on, has a death rate that is even lower than South Korea’s.
Why couldn’t the U.S. manage to develop and distribute a test in the early days of the epidemic? It’s a complex story of bureaucratic infighting, incompetence, and technical snafus. It starts with Robert Redfield, the director of the CDC, the agency that was responsible for building the test kits, who was viewed as, as Brilliant puts it, “a political guy.” In the 1980s, Redfield worked on a vaccine for AIDS and was closely associated with W. Shepherd Smith Jr. and his Christian organization, Americans for a Sound AIDS/HIV Policy, or ASAP. Smith believed that AIDS was “God’s judgment” against homosexuals, spread in an America weakened by single-parent households and a loss of family values. Redfield also wrote the introduction to a 1990 book, Christians in the Age of AIDS, in which he denounced distribution of sterile needles to drug users and condoms to sexually active adults. “When you put a political guy in charge of the CDC, it demoralizes people in the agency,” Brilliant says. “It tells them their work isn’t important.”
The basic problem is that while other nations used a test kit that had been developed by the World Health Organization and encouraged private companies to quickly build and distribute the kits, the U.S., out of some mix of Trump-inspired nationalism and technological arrogance, insisted on building its own kit. But that kit was flawed, and it took precious weeks for the CDC to fix the problem. There were further delays by the FDA in lifting restrictions to allow private labs and companies to manufacture and distribute their own test kits. By that time, the virus had widely spread throughout the country. In the early days of the pandemic, even a few thousand test kits could have made a big difference in understanding and limiting the spread of the virus. But the logic of exponential growth is brutal: Every six days that U.S. public-health officials did not test, the number of infected Americans doubled. By March, the virus was everywhere, and millions of kits were needed to track its spread. “We just twiddled our thumbs as the coronavirus waltzed in,” William Hanage, a Harvard epidemiologist, wrote in The Washington Post.
“If we had been on top of this thing from early January, when we first got word of it,” Susan Rice says, “we would be living in a different world now.”
And it’s not just that Trump failed to push for aggressive testing. He actively tried to suppress the numbers, out of fear it would tank the market. In early March, when the Grand Princess cruise ship waited off the coast of San Francisco after 21 of its passengers and crew members contracted the coronavirus, Trump didn’t want to take the infected people off the ship because he was afraid it would look bad. “I like the numbers being where they are,” Trump said in a press briefing.
In late February, Nancy Messonnier, a respected senior CDC official, made the mistake of being honest with reporters, telling them that the coronavirus was likely to spread within communities in the United States and that disruptions to daily life could be “severe.” According to The New York Times, Trump heard Messonnier’s remarks as he was about to board Air Force One on a trip back from India. “On the 18-hour plane ride home, Trump fumed as he watched the stock market crash after Dr. Messonnier’s comments,” the Times reported. When he landed in the U.S., Trump called Azar at 6 a.m. and raged that Messonnier was scaring the stock markets.
At times, Trump’s obsession with the market was downright ghoulish. On March 13th, after the stock market spiked briefly after its weeks-long free fall, administration officials sent out a graph of the rising stock market average with Trump’s signature scrawled across it, as if he were single-handedly responsible for its rise. “The president would like to share the attached image with you, and passes along the following message: ‘From opening of press conference, biggest day in stock market history!’ ”
That same day, an NBC reporter asked him whether he took responsibility for the deadly testing delays. His reply was immediate: “No. I don’t take responsibility at all.”
Trump’s denial, and the delay in testing, meant the administration was blind to the virus as it was spreading. It let Trump, for a moment, get away with his fantasy that the virus was no big deal, that it was just the flu, that it would go away as soon as the weather warmed up. But Trump’s denial also meant that federal agencies did nothing to prepare, and when the surge of sick people began hitting the hospitals, they were not ready.
When Trump authorized the creation of a task force in late January, it was initially headed by Alex Azar, the head of Health and Human Services, the agency that broadly oversees hospitals and health care in America. But within weeks, Trump replaced him with Vice President Mike Pence, which is like giving the wheel of a ship over to an 11-year-old in the middle of a hurricane. If nothing else, it signaled that Trump valued political loyalty over scientific expertise. But Azar remained the key figure in the administration’s response to the pandemic. Azar is not an infectious disease expert. He is a lawyer and former pharmaceutical-industry executive better known for his partisan politics (after law school, he clerked for former conservative Supreme Court Judge Antonin Scalia, then worked with special prosecutor Ken Starr on the Clinton-Whitewater investigation) than for his health care expertise. Before the pandemic emerged, his main job was to figure out how to keep the cost of prescription drugs down. Once the pandemic hit, he failed to convince Trump of the seriousness of what was coming, failed to break a logjam between the CDC and the FDA over testing, and failed to figure out a system to equitably distribute personal protective equipment (PPE) like masks and gloves and other gear to health care workers overwhelmed with sick people.
In theory, the U.S. was not totally unprepared for a pandemic like this. In the 1990s, when President Bill Clinton became concerned about the risks of bioterrorism, he created the Strategic National Stockpile. The goal was to be prepared for chemical, biological, radiological, and nuclear threats. The reserve included everything from ventilators to nerve-agent antidotes, which were stored and maintained at 1,300 locations around the country.
The stockpile was never intended to supply enough equipment for a pandemic of this scale. But for Azar and others in the administration, a bigger problem was the fact that they were working for a man who viewed the doling out of ventilators and masks and gloves as an exercise in political power. Getting protective gear to the people who needed it most was not Trump’s primary concern. It was getting it to the people he needed for re-election.
So as states across the country pleaded for equipment from the national stockpile, Trump made sure his friends and wanna-be friends were taken care of first. Florida, a state that is vital to Trump’s 2020 hopes, submitted a request on March 11th for 430,000 surgical masks, 180,000 N95 respirators, 82,000 face shields, and 238,000 gloves, among other supplies — and received a shipment with everything three days later. And just in case it wasn’t clear how much Trump loved Floridians, the state received a second, identical shipment on March 23rd. Oklahoma, a fossil-fuel-friendly state that is home to a number of big Trump campaign donors, received 120,000 face shields despite requesting only 16,000. Meanwhile, in Obama’s home state of Illinois, officials were forced to do a $3.5 million deal in a McDonald’s parking lot to secure a supply of N95 masks.
In addition, Trump has gone out of his way to publicly attack governors of blue states who challenge him and all but refuses to work with them on pandemic supplies. For example, when Washington’s Gov. Jay Inslee tweeted that the administration’s effort to combat the coronavirus would be more successful “if the Trump administration stuck to the science and told the truth,” Trump responded by calling him “a snake” at a press briefing and all but refusing to work with him on relief supplies. When Gov. Whitmer, the Democratic governor of Michigan, pushed for more supplies from the stockpile, Trump immediately dismissed her. At a press briefing, he said that he had instructed Vice President Pence not to call the governors of blue states who question his efforts. “I say: ‘Mike, don’t call the governor of Washington. You’re wasting your time with him. Don’t call the woman in Michigan,’ ” he said, adding, “If they don’t treat you right, I don’t call.”
“All I want them to do — very simple — I want them to be appreciative,” Trump explained.
It’s hard to overstate how morally grotesque this is, but in Trumpland, it’s just how business is done. It comes down to this: Kiss the ring or the people of your state suffer. Death and disease are just leverage for Trump to hold onto power.
As the pandemic grew, Trump, under the guise of some half-baked understanding of federalism, did his best to push all responsibility for the response out to the states, which not only made a mockery of his self-image as a “wartime” president, but also undermined any effective response to slow the spread of the virus. Instead of allowing top scientists like Anthony Fauci develop a clear national response to the pandemic, he touted unproven treatments like the anti-malarial drug hydroxychloroquine. Instead of pushing for a nationwide shutdown, which public-health experts argued was the best way to stop the spread of the virus and save lives, Trump vacillated, giving cover to governors in states like Georgia and Florida to keep restaurants and beaches open. By doing so, Trump only ensured those states would become a breeding ground for new outbreaks. “Having states [do] different things will not work,” Bill Gates told CNN. “Cases will be exponentially growing anywhere you don’t have a serious shutdown.”
In March, as New York became overrun by the virus, Gov. Cuomo began holding daily press briefings that overshadowed Trump’s. Cuomo’s blunt, scientifically literate sessions just underscored Trump’s failings. Cuomo was particularly cutting when it came to Trump’s refusal to send enough ventilators to the state. “How can we be in a situation where you have New Yorkers possibly dying because they can’t get a ventilator, but a federal agency is saying ‘I’m going to leave the ventilators in the stockpile,’ ” Cuomo said. “I mean, have we really come to that point?”
Trump’s disregard for New York was evident everywhere, including the $150 billion “Coronavirus Relief Fund” that was part of the $2.2 trillion package that was passed by Congress in March. New York, which accounted for almost half of the nation’s diagnosed coronavirus cases at the time the bill passed — and more than one-third of its deaths — was due to receive just five percent of the money, or $7.5 billion (the state of Washington, governed by that “snake” Inslee, got a paltry two percent, or $2.9 billion).
When mask use spiked at New York hospitals, Trump speculated that masks may be “going out the back door,” suggesting they are being stolen.
Cuomo tried to take the high road. “Now is the time to gather supplies, do the preparations because it’s too late the day before,” Cuomo said, all but lecturing Trump. “Stop the politics. Listen to the scientists and plan because otherwise . . . people will die who don’t need to die. That’s the bottom line.”
Cuomo and other governors pushed Trump to use the Defense Production Act, which would allow him to compel manufacturers to produce ventilators, masks, and other protective gear. Trump dithered, preferring to rely on voluntary measures. Jared Kushner set up his own shadowy task force in the White House to try to sort things out, but of course that just added to the chaos. (“It’s supposed to be our stockpile,” Kushner said at a White House briefing, sounding like a five-year-old defending his toys. “It’s not supposed to be the states’ stockpiles that they then use.”) By early April, the national stockpile was depleted, and the U.S. was forced to fly in planeloads of supplies from (of all places) China. But instead of being distributed by the federal government, states had to bid for the equipment on the open market, often at exorbitant prices. And still, the shortage was acute. Doctors were creating makeshift ventilators out of garden hoses and lamp timers. Some front-line medical workers were forced to wear plastic garbage bags as protective gowns. And the pandemic was still growing. As Cuomo warned, “A tsunami is coming.”
For Trump, the tsunami hit on March 31st, when he stood in the White House briefing room and acknowledged that modeling suggested between 100,000 and 240,000 Americans could die in this pandemic. A week later, thanks to strict social distancing measures that were pushed by infectious disease experts, projections were lowered to 60,400 deaths by the end of August — which Trump tried to spin as some kind of victory. Even in a best-case scenario, he is likely to witness the deaths of as many Americans as the country endured in World War I and more than 10 times as many as have died in Iraq and Afghanistan combined. Does he look back with regret at his dishonesty and inaction? On the contrary, he’s now trying to recast himself as the hero of the pandemic.
“Any normal politician would be worried about saying anything wrong about a disease like this,” says Ben Rhodes. “Trump, because he has an incapacity to be shamed, clearly felt a certain freedom to just stand up there and lie or to tweet things that weren’t true, because he knew in his mind that, if this does get bad, I can just always rewrite the history of it.”
This story is far from over. This pandemic is not going to end in a week, or a month. It’s going to burn through Africa and Latin America and poor, vulnerable communities around the world. There will be economic chaos and lost loved ones. There is some hope that new antiviral drugs will help protect people from the virus, similar to the way Tamiflu treats flu symptoms and can stop some outbreaks. But the pandemic will not end until a vaccine is developed, which is, best-case scenario, at least a year away. Until then, the primary agenda of Trump and his allies in the Republican Party and Fox News will be to evade any responsibility for this catastrophe, just as they have evaded responsibility for everything from massive tax cuts for the rich to the climate crisis. Look for more China bashing, more conspiracy mongering, more Obama blaming, more trillion-dollar bailouts. And more under-the-radar regulatory moves, such as the EPA’s recent rollback of vehicle emissions standards, which will lead to more air pollution at the exact time when Americans are living through a pandemic that attacks their lungs.
But this crisis will be transformative in ways no one can see right now. In dark times like these, when the suffering is immense and grief is overwhelming, our better angels often emerge. By the time this is over, Americans may come to new conclusions about the importance of listening to scientists, about the dangers of going it alone in the world, and most of all, about the virtues of having a president who is capable of telling us the truth.
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