Denial, dysfunction torment U.S. government as coronavirus rages


By the time Donald Trump declared himself president of the war – and the coronavirus the enemy – the United States was already on the verge of seeing more of its inhabitants die than in the wars of Korea, Vietnam, Afghanistan and from Iraq together.

The country has adopted a range of wartime measures never used collectively in the history of the United States – banning incoming travelers from two continents, almost completely shutting down trade, committing industry to manufacturing emergency medical equipment and confining 230 million Americans to their homes in desperation to survive an attack from an invisible adversary.

Despite these and other extreme measures, the United States is likely to be the country that was supposed to be the best prepared to fight a pandemic, but which has been catastrophically outdone by the new coronavirus, making greater losses than anything. other country.

It didn’t have to happen that way. Although not fully prepared, the United States had more expertise, resources, plans and epidemiological experience than dozens of countries which, in the end, were far more successful in repelling the virus.

The failure echoes the lead-up to September 11: warnings were issued, including at the highest levels of government, but the president remained deaf until the enemy had already struck.

The Trump administration received its first official notification of the coronavirus epidemic in China on January 3. Within days, American spy agencies signaled the severity of the threat to Trump by including a warning about the coronavirus – the first of many – in the president’s daily brief.

And yet, it took 70 days from this initial notification for Trump to treat the coronavirus not as a distant threat or a well-controlled harmless flu strain, but as a lethal force that had spilled over into American defenses and was ready to kill tens of thousands of citizens. This period of more than two months now represents a critical moment that has been wasted.

Trump’s baseless claims in these weeks, including his claim that all of this would “miraculously” disappear, undoubtedly create significant public confusion and contradict urgent messages from public health experts.

“While the media prefer to speculate on scandalous allegations of palace intrigue, President Trump and this administration remain completely focused on the health and safety of the American people with 24-hour work to slow the spread of the virus, spread the testing and accelerating the vaccine development, “said Judd Deere, a spokesperson for the president. Thanks to the President’s leadership, we will emerge from this challenge in good health, stronger and with a prosperous and growing economy. ”

But the President’s behavior and combative statements were only a visible layer above deeper levels of dysfunction.

The most consecutive failure involved a disruption of efforts to develop a diagnostic test that could be mass produced and distributed across the United States, allowing agencies to map the early foci of the disease and impose measures quarantine to contain them. At one point, a Food and Drug Administration official tore up laboratory officials from the Centers for Disease Control and Prevention, telling them that their protocols were not being followed, including concerns that the laboratory was not meeting sterile condition criteria were so severe that the FDA would “shut you down” if the CDC was a commercial rather than a government entity.

Other failures cascaded through the system. The administration often appeared to be weeks behind in responding to the virus spread, closing doors that were already contaminated. Prolonged discussions between the White House and public health agencies over funding, combined with a meager existing stock of emergency supplies, left vast stretches of the country’s health system without protective equipment until the epidemic has become a pandemic. Bowls, turf wars and abrupt leadership changes have hampered the work of the coronavirus task force.

You may never know how many thousands of deaths or millions of infections could have been prevented with a more coherent, urgent and effective response. But even now, there are many indications that the administration’s handling of the crisis has had potentially devastating consequences.

National Guard Kevin Darrah, 25, wears his mask on April 1 at the Javits Center in Manhattan (Demetrius Freeman for the Washington Post)

Even the president’s base has started to face this reality. In mid-March, as Trump renamed himself war chairman and belatedly urged the public to help slow the spread of the virus, Republican leaders were looking at grim polling data that suggested Trump was lulling his supporters into a false feeling security in the face of a deadly threat. .

The poll found that far more Republicans than Democrats were influenced by Trump’s disdainful depictions of the virus and comparable contemptuous coverage on Fox News and other conservative networks. As a result, Republicans were distressingly numerous and refused to change their travel plans, follow “social distancing” directions, stock up on supplies, or take the threat of coronavirus seriously.

“Denial is unlikely to be a successful strategy for survival,” GOP pollster Neil Newhouse concluded in a document that was shared with GOP leaders at Capitol Hill and widely discussed in the White House. Trump’s staunchest supporters, he said, “were putting themselves and their loved ones in danger.”

Trump’s message changed as the report traveled through the top ranks of the GOP. In recent days, Trump has bristled with reminders that he once said that the workload would soon be “reduced to zero.”

To date, more than 7,000 people have died from coronavirus in the United States, with approximately 240,000 cases reported. But Trump has acknowledged that new models suggest the possible national death toll could be between 100,000 and 240,000.

Beyond the suffering that awaits thousands of victims and their families, the result has altered the international position of the United States, damaging and diminishing its reputation as a world leader in times of extraordinary adversity.

“It was a blow to the feeling that America was competent,” said Gregory F. Treverton, former president of the National Intelligence Council, the government’s largest provider of intelligence analysis services. He left NIC in January 2017 and now teaches at the University of Southern California. “It was part of our global role. Traditional friends and allies turned to us because they thought we might be called upon to work with them in a crisis. It was the opposite of that. ”

This article, which traces the failures of the first 70 days of the coronavirus crisis, is based on 47 interviews with administration officials, public health experts, intelligence officers and other actors involved in the fight against the pandemic. Many spoke on condition of anonymity to discuss sensitive information and decisions.

Vice President Pence Deborah Birx, White House Coronavirus Response Coordinator and CDC Director Robert Redfield arrive at McChord Field near Tacoma to meet with Washington Governor Jay Inslee on March 5. (David Ryder / Reuters)

Analyze the horizon

Public health officials are part of a special category of civil servants – along with counter-terrorism officials, military planners, aeronautical authorities and others – whose careers are spent in dealing with the worst-case scenarios.

The arsenal they exercise against viral invaders is powerful, capable of stifling a new pathogen while fighting for a remedy, but easily exceeded if it is not mobilized in time. As a result, officials from the Department of Health and Human Services, the CDC, and other agencies spend their days scanning the horizon for emerging dangers.

The CDC learned of a case group in China on December 31 and began reporting to the HHS on January 1. But the clearest warning that US officials have received about the coronavirus came on January 3, when Robert Redfield, director of the CDC, received a call from a Chinese counterpart. The official told Redfield that a mysterious respiratory illness was spreading in Wuhan, a congested commercial city of 11 million people inside the communist country.

Redfield quickly relayed the disturbing news to Alex Azar, the secretary of HHS, the agency that oversees the CDC and other public health entities. Azar, in turn, ensured that the White House was informed, by instructing his chief of staff to share the Chinese report with the National Security Council.

From that moment, the administration and the virus were locked in a race against time, a competition for the grip between the pathogen and the prevention which would dictate the scale of the epidemic when it reaches the coastlines and would determine how many would fall ill. or die.

The initial response was promising, but the authorities also immediately encountered obstacles.

On January 6, Redfield sent a letter to China’s offer to send help, including a team of scientists from the CDC. China has refused the offer for weeks, refusing assistance and depriving US officials of an early chance to get a sample of the virus, essential for developing diagnostic tests and any potential vaccines.

China has hindered the US response in other ways, including withholding specific information about the epidemic. Beijing has a long history of minimizing the diseases that have arisen within its borders, an impetus that US officials attribute to the desire of the country’s leaders to avoid embarrassment and responsibility with the 1.3 billion people from China and other countries who are on their way to the pathogen.

China has remained faithful to this costly scenario in the case of the coronavirus, reporting on January 14 that it had seen “no clear evidence of human-to-human transmission.” US officials treated the request with skepticism, which intensified when the first case surfaced outside of China with an infection reported in Thailand.

A traveler wearing a mask to protect himself from the coronavirus passes in front of the Beijing train station on January 17. (Mark Schiefelbein / AP)

A week earlier, senior HHS officials had started to assemble an intra-agency task force including Redfield, Azar and Anthony S. Fauci, director of the National Institute of Allergies and Infectious Diseases. The following week, dispersed meetings were also held in the White House with representatives from the National Security Council and the State Department, mainly about when and when to bring government officials back to China.

US authorities have started to take preliminary steps to counter a potential epidemic. In mid-January, Robert Kadlec, an Air Force officer and physician who acts as assistant secretary for HHS preparedness and response, instructed his subordinates to develop contingency plans for the application of the Defense Production Act, a measure that allows the government to compel companies to produce equipment or devices essential to the security of the country. Aid workers were bitterly divided on whether to implement the law, and nothing happened for several weeks.

On January 14, Kadlec scribbled a single word in a notebook he carried: “Coronavirus !!!”

Despite the wave of activity at lower levels of his administration, Trump was not substantially informed by health officials about the coronavirus until January 18, when, during his weekend in Mar-a-Lago, he got a call from Azar.

Before the health secretary could even speak about the virus, Trump interrupted him and began to criticize Azar for his handling of an abortion of the federal vaping ban, an issue that upset the president.

At the time, Trump was in the midst of a dismissal battle for his alleged attempt to coerce political favors from the head of Ukraine. Acquittal seemed certain by GOP-controlled Senate, but Trump was concerned about the trial, calling late-night lawmakers to complain and drawing up lists of perceived enemies he would seek to punish when the case against he would have ended.

In retrospect, officials said Azar could have been more energetic in urging Trump to focus at least part of his attention on a threat that would soon be an even more serious test for his presidency, a crisis that would cost American lives and consume the last year. of Trump’s first term.

But the secretary, who had a strained relationship with Trump and many other members of the administration, assured the president that officials were working and monitoring the issue. Azar told several associates that the president thought he was “alarmist,” and Azar struggled to draw Trump’s attention to the matter, even asking a confidant for advice.

Within days, there were new causes for the alarm.

Health and Social Services Secretary Alex Azar speaks at a White House briefing on coronavirus on January 31. (Jabin Botsford / The Washington Post)

On January 21, a Seattle man who had recently traveled to Wuhan tested positive for the coronavirus, becoming the first known infection on American soil. Then, two days later, the Chinese authorities took the radical step of closing Wuhan, transforming the bustling metropolis into a ghost town of empty highways and shuttered skyscrapers, with millions of people abandoned in their homes.

“It was like, whoa! “Said a senior US official involved in the White House meetings on the crisis. “That’s when the Richter scale reached 8.”

It was also when US officials began to face the failure of their own response efforts.

Azar, who had held positions of responsibility at HHS during crises, including the September 11 terrorist attacks and the 2005 bird flu epidemic, was intimately familiar with the crisis management manual.

He asked his subordinates to act quickly to establish a nationwide surveillance system to track the spread of the coronavirus – an enhanced version of what the CDC does each year to monitor new strains of the common flu.

But that would require assets that elude U.S. officials for months – a diagnostic test that could accurately identify those infected with the new virus and be produced on a large scale for rapid deployment across the United States, and from there. money to implement the system.

The Azar team also encountered another obstacle. The Chinese still refused to share the viral samples they had collected and used to develop their own tests. Frustrated, US officials searched for alternative routes.

A medical containment laboratory at the University of Texas at Galveston had a research partnership with the Wuhan Institute of Virology.

Kadlec, who knew the director of the Galveston laboratory, hoped that the scientists could arrange a transaction on their own without government interference. At first, the Wuhan laboratory agreed, but Beijing officials intervened on January 24 and blocked any transfer from laboratory to laboratory.

Assistant National Security Advisor Matthew Pottinger, left, and National Security Advisor Robert O’Brien listen during a briefing on the coronavirus at the White House on January 31. (Jabin Botsford / The Washington Post)

There is no evidence that officials sought to escalate the issue or to urge Trump to intervene. In fact, Trump has consistently praised Chinese President Xi Jinping despite warnings by US intelligence and health officials that Beijing is hiding the real extent of the epidemic and hampering cooperation on key fronts.

The CDC issued its first public alert on the coronavirus on January 8 and, on January 17, monitored major airports in Los Angeles, San Francisco and New York, where large numbers of passengers arrive daily from China.

But in other respects, the situation was already spinning out of control, with the multiplication of cases in Seattle, the intransigence of the Chinese, growing questions from the public and nothing in place to prevent infected travelers from arriving from abroad. .

Trump was out of the country for this critical period, taking part in the annual world economic forum in Davos, Switzerland. He was accompanied by a contingent of senior officials, including National Security Advisor Robert O’Brien, who took an anxious transatlantic call from Azar.

Azar told O’Brien that it was “chaos” in the White House, with HHS officials in a hurry to deliver nearly identical briefings to three audiences on the same day.

Azar urged O’Brien to have the NSC monitor a case that could have implications for air travel, immigration authorities, the State Department, and the Pentagon. O’Brien appeared to grasp the urgency and entrusted his deputy, Matthew Pottinger, who had worked in China as a reporter for the Wall Street Journal, with the responsibility of coordinating the still nascent American response.

But growing anxiety within the administration did not seem to register with the president. On January 22, Trump received his first question about the coronavirus in an interview on CNBC in Davos. When asked if he was worried about a possible pandemic, Trump replied, “No. Not at all. And we have it totally under control. He’s a person from China. . . . It will be very good. ”

Mick Mulvaney, then White House chief of staff, and national security adviser Robert O’Brien hold talks with President Trump aboard Marine One on his return from Davos, Switzerland, January 22. (Jabin Botsford / The Washington Post)

Uncontrollable broadcast

The decision by the NSC to take control of the response helped refocus the US strategy around containing the virus when possible and obtaining the resources that hospitals would need in any American epidemic, including equipment base such as protective masks and fans.

But instead of mobilizing for what was to come, US officials appeared to be more concerned with logistical issues, including how to evacuate the Americans from China.

In Washington, Mick Mulvaney and Pottinger, then serving chief of staff, began convening White House meetings with senior officials from the HHS, CDC, and the State Department.

The group, which included Azar, Pottinger and Fauci, as well as nine other members of the administration, formed the nucleus for what would become the administration’s coronavirus task force. But he has mainly focused on efforts to prevent infected people in China from traveling to the United States, while evacuating thousands of American citizens. The meetings did not seriously focus on testing or supplies, which have since become the administration’s most difficult problems.

The task force was officially announced on January 29.

“The origins of this group were around border control and repatriation,” said a senior official involved in the meetings. “It was not a whole, whole-of-government group to lead everything. “

The State Department’s agenda dominated these early discussions, participants said. Authorities have started planning charter planes to evacuate 6,000 stranded Americans in Wuhan. They also debated the wording of travel advisories that the state could issue to discourage other travel inside and outside of China.

On January 29, Mulvaney chaired a meeting in the White House Situation Room during which officials debated the decision to move the travel restrictions to “level 4”, which means a notice of “do not travel ”from the State Department. The next day, China made the draconian decision to lock down the entire province of Hubei, which includes Wuhan.

A hand sanitizer is available at each door of Terminal B at Oakland International Airport in California on March 4 to stop the spread of the coronavirus. (Melina Mara / The Washington Post)

The Beijing decision ultimately triggered proportionate action by the Trump administration. On January 31, Azar announced restrictions prohibiting any non-US citizen residing in China in the previous two weeks from entering the United States.

Trump has, with some justification, pointed to the China restriction as evidence that he reacted aggressively and early to the epidemic. It was one of the few options for intervention throughout the crisis that played on the instinct of the president, who often seems determined to erect borders and keep foreigners away from the country.

But by that time, 300,000 people had arrived in the United States from China in the previous month. As of the end of January, there were only 7,818 confirmed cases worldwide, according to figures released by the World Health Organization – but it is now clear that the virus is spreading uncontrollably.

Pottinger then lobbied for another travel ban, this time restricting the flow of travelers from Italy and other European Union countries that were quickly becoming major new nodes in the epidemic. Pottinger’s proposal was endorsed by senior health care officials, including Fauci, who argued that closing any path the virus could take in the country was essential.

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

Those who support the economy prevailed with the president. And it took more than a month before the administration issued a late and confusing ban on flights to the United States from Europe. Hundreds of thousands crossed the Atlantic during this interval.

A label for the N95 masks is visible March 13 under an empty shelf in the supply bunker at Dayton General Hospital in Washington State. (Nick Otto for the Washington Post)

Lewis Neace runs the emergency room at Dayton Hospital, Washington, which has an aging population. (Nick Otto for the Washington Post)

LEFT: A label for N95 masks is visible March 13 under an empty shelf in the supply bunker at Dayton General Hospital in Washington State. (Nick Otto for the Washington Post) RIGHT: Lewis Neace runs the emergency room at Dayton Hospital, Washington, which has an aging population. (Nick Otto for the Washington Post)

A wall of resistance

As the air travel fighting took place in the White House, public health officials began to panic over a surprising shortage of essential medical equipment, including protective masks for doctors and nurses, as well as a rapidly dwindling pool of money needed to pay for such things.

In early February, the administration quickly exhausted 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 a large part of the public. But for health officials responsible for storing supplies for the worst-case scenarios, the disaster seemed increasingly inevitable.

A national stock of N95 protective masks, gowns, gloves and other supplies was already woefully insufficient after years of underfunding. Prospects for the replenishment of this store were suddenly threatened by the ongoing crisis in China, which has disrupted offshore supply chains.

Much of the manufacturing of this equipment had long since migrated to China, where factories were now closed because workers had to stay at home. At the same time, China was buying masks and other equipment to prepare for its own coronavirus epidemic, driving up costs and hogging supplies.

In late January and early February, HHS leaders sent two letters to the White House Office of Budget and Management, asking to use its transfer authorization to transfer $ 136 million in departmental funds to pools that could be used to fight coronavirus. Azar and colleagues have also begun to speak of the need for a multi-billion dollar supplementary budget request to send to Congress.

Yet White House budget hawks have argued that taking too much money at a time when there were only a few cases in the United States would be considered alarmist.

Joe Grogan, head of the Domestic Policy Council, clashed with health officials over the preparation. He is wary of how the money will be spent and wonders how health officials have used previous readiness funds.

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

Azar did it the next day, writing an additional request for more than $ 4 billion, an amount that OMB officials and others in the White House hailed as a scandal. Azar arrived at the White House that day for a tense meeting in the situation room, which broke out in a blatant match, according to three people familiar with the incident.

A deputy from the budget office accused Azar of preemptively putting pressure on Congress for a gigantic sum that White House officials had no interest in granting. Azar bristled with criticism and argued for the need for an emergency infusion. But his position with White House officials, already fragile before the start of the coronavirus crisis, was further damaged.

White House officials gave up a degree a few weeks later, as the dreaded surge of coronavirus in the United States began to materialize. The OMB team has reduced Azar’s claims to $ 2.5 billion, money that would only be available for the current fiscal year. Le Congrès a ignoré ce chiffre, approuvant un projet de loi supplémentaire de 8 milliards de dollars que Trump a signé le 7 mars.

Mais encore une fois, les retards se sont révélés coûteux. Les différends ont signifié que les États-Unis ont raté une fenêtre étroite pour stocker des ventilateurs, des masques et d’autres équipements de protection avant que l’administration n’enchérisse contre de nombreux autres pays désespérés, et les responsables de l’État, fatigués des échecs fédéraux, ont commencé à chercher eux-mêmes des fournitures.

Fin mars, l’administration a commandé 10 000 ventilateurs – bien en deçà des besoins des responsables de la santé publique et des gouverneurs. Et beaucoup n’arriveront pas avant l’été ou l’automne, lorsque les modèles s’attendent à ce que la pandémie recule.

« C’est en fait une sorte de blague », a déclaré un responsable de l’administration impliqué dans les délibérations sur l’achat tardif.

Les cliniciens placent un écouvillon nasal dans un récipient après avoir testé un patient dans une station de test Covid-19 sur le campus français de Kaiser Permanente à San Francisco le 12 mars. (Michael Short pour The Washington Post)

Kit de test de laboratoire du CDC pour le nouveau coronavirus. (CDC / AP)

GAUCHE: Les cliniciens placent un écouvillon nasal dans un récipient après avoir testé un patient dans une station de test drive-through covid-19 sur le campus français de Kaiser Permanente à San Francisco le 12 mars. (Michael Short pour The Washington Post) DROITE: Le test de laboratoire du CDC kit pour le nouveau coronavirus. (CDC / AP)

Tests non concluants

Bien que les virus ne soient pas visibles, les responsables de la santé publique ont développé des moyens élaborés de cartographier et de suivre leurs mouvements. Endiguer une épidémie ou ralentir une pandémie à bien des égards se résume à la capacité de diviser rapidement la population en ceux qui sont infectés et ceux qui ne le sont pas.

Pour ce faire, cependant, il faut disposer d’un test précis pour diagnostiquer les patients et le déployer rapidement dans les laboratoires du pays. Le temps qu’il a fallu pour y parvenir aux États-Unis a peut-être été plus coûteux pour les efforts américains que tout autre échec.

« Si vous aviez le test, vous pourriez dire: » Oh mon dieu, il y a un virus en circulation à Seattle, sautons dessus. Il y a un virus en circulation à Chicago, sautons dessus », a déclaré un haut responsable de l’administration impliqué dans la lutte contre l’épidémie. « Nous n’avions pas cette visibilité. “

Le premier revers est survenu lorsque la Chine a refusé de partager des échantillons du virus, privant les chercheurs américains de fournitures à bombarder de médicaments et de thérapies dans la recherche de moyens de le vaincre. Mais même lorsque des échantillons avaient été achetés, l’effort des États-Unis était entravé par des problèmes systémiques et un orgueil institutionnel.

Parmi les erreurs les plus coûteuses figurait une évaluation déplacée des hauts responsables de la santé selon laquelle l’épidémie serait probablement de portée limitée aux États-Unis – comme cela avait été le cas pour toutes les autres infections depuis des décennies – et que le CDC pouvait se fier à lui-même pour se développer. un test de diagnostic de coronavirus.

Le CDC, lancé dans les années 40 pour contenir une épidémie de paludisme dans le sud des États-Unis, avait pris la tête du développement de tests de diagnostic dans les épidémies majeures, notamment Ebola, Zika et H1N1. Mais le CDC n’a pas été construit pour produire en masse des tests.

Le succès du CDC a favorisé une arrogance institutionnelle, un sentiment que même face à une crise potentielle, il n’était pas urgent d’impliquer des laboratoires privés, des établissements universitaires, des hôpitaux et des organisations de santé mondiales également capables de développer des tests.

Pourtant, certains craignaient que le test CDC ne soit pas suffisant. Stephen Hahn, le commissaire de la FDA, a demandé au début du mois de février l’autorisation d’appeler des sociétés privées de diagnostic et de produits pharmaceutiques pour obtenir leur aide.

Mais lorsque de hauts responsables de la FDA ont consulté les dirigeants du HHS, Hahn, qui dirigeait l’agence depuis environ deux mois, a été invité à se retirer. Il craignait qu’il ne contacte personnellement des sociétés réglementées par son agence.

À ce moment-là, Azar, le secrétaire du HHS, semblait engagé dans un plan qu’il poursuivait qui garderait son agence au centre de l’effort de réponse: obtenir un test du CDC puis construire un système national de surveillance des coronavirus en s’appuyant sur un système existant. réseau de laboratoires utilisé pour suivre la grippe ordinaire.

Lors des réunions du groupe de travail, Azar et Redfield ont fait pression pour 100 millions de dollars pour financer le plan, mais ont été abattus en raison du coût, selon un document décrivant la stratégie de test obtenue par le Washington Post.

S’appuyer autant sur le CDC aurait été problématique même s’il avait réussi à développer rapidement un test efficace qui pourrait être distribué à travers le pays. L’ampleur de l’épidémie et la nécessité de procéder à des tests de masse bien au-delà des capacités du réseau de la grippe auraient dépassé le plan d’Azar, qui n’envisageait pas d’engager des laboratoires commerciaux pendant six mois.

Les responsables se préparent pour une conférence de presse à Seattle le 29 février. Un homme de l’État de Washington dans la cinquantaine avec des problèmes de santé sous-jacents est devenu le premier décès de coronavirus sur le sol américain. (Elaine Thompson / AP)

Des fleurs artificielles sont vues attachées à des arbres avec des rubans le 13 mars à l’extérieur du Life Care Center, un établissement de soins de longue durée à Kirkland, Washington, qui était lié à plusieurs cas confirmés de coronavirus. (Lindsey Wasson / Reuters)

LEFT: Officials prepare for a news conference in Seattle on Feb. 29. A Washington state man in his 50s with underlying health conditions became the first coronavirus death on U.S. soil. (Elaine Thompson/AP) RIGHT: Artificial flowers are seen tied to trees with ribbons on March 13 outside Life Care Center, a long-term-care facility in Kirkland, Wash., that was linked to several confirmed coronavirus cases. (Lindsey Wasson/Reuters)

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 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 amongst 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.

President Trump, with HHS Secretary Alex Azar, left, and Steve Monroe of the CDC, holds a picture of the coronavirus during a tour of the CDC in Atlanta on March 6. (Jim Watson/AFP/Getty Images)

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.

Jackie Copeland wipes down her cart in an effort to protect against the coronavirus before shopping at a Walmart in Fairfield, Calif., on Feb. 29. (Nick Otto for the Washington Post)

People wear masks in Times Square in Manhattan on March 4 as the number of coronavirus cases started climbing. (Sharon Pulwer for The Washington Post)

LEFT: Jackie Copeland wipes down her cart in an effort to protect against the coronavirus before shopping at a Walmart in Fairfield, Calif., on Feb. 29. (Nick Otto for the Washington Post) RIGHT: People wear masks in Times Square in Manhattan on March 4 as the number of coronavirus cases started climbing. (Sharon Pulwer for The Washington Post)

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 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.

Anthony S. Fauci, left, director of the National Institute for Allergy and Infectious Diseases, attends a White House briefing with President Trump on April 1. He is one of the core members of the administration’s coronavirus task force. (Jabin Botsford/The Washington Post)

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.”

A medical professional works inside a refrigerated container truck functioning as a makeshift morgue at Brooklyn Hospital Center in New York on March 31. (John Minchillo/AP)

Julie Tate and Shane Harris contributed to this report.

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