Archives for category: Health

Chalkbeat reports that at least 40 NewYork City educators have died because of the coronavirus but the Department of Education refuses to release their names or to explain their reticence.

Christina Veiga writes:

Rosario Gonzalez, a 91-year-old paraprofessional who cared tenderly for children in an East Harlem special education program, rarely missed a day of work in more than three decades.

Claudia Shirley continued to teach in Bushwick even after retiring, and loved her job so much that she inspired her two daughters to become educators themselves.

Carol King-Grant, a special education teacher in the South Bronx, was known for her love of sudoku and beautiful singing voice.

All died in recent weeks from suspected cases of the coronavirus, according to the United Federation of Teachers. The union announced that, as of Friday, it knew of more than 40 of its members presumed to have been claimed by the pandemic, including both active educators and retirees.

The union is naming names, and releasing a tally of the lives lost at a time that the education department has refused to do so. The department’s silence has sparked an uproar among teachers, who feel the lack of recognition is a smack in the face, particularly as they continued to report for work even after the danger of COVID-19 was The education department has kept mum on the number of cases within its ranks even as other public agencies, including the police department and transportation authority, have released figures. However, the education department stopped confirming cases as community spread became rampant and the health department told New Yorkers to assume they have been exposed.

“We understand there is a lot of uncertainty across the City surrounding COVID-19,” education department spokesperson Miranda Barbot told Chalkbeat on April 2. “School employees are sometimes reporting information to their principals and superintendents, and we are determining how best to collect this information in one place.”

Teachers have demanded that the city publicly disclose deaths among their colleagues. In the absence of official information about the disease’s spread within school communities, teachers have taken it upon themselves to inform their co-workers of positive cases. They have blasted the city for keeping campuses open even as the number of sickened New Yorkers skyrocketed. well known.

Terri Michal is a member of the elected board of education in Birmingham, Alabama.

She writes:


I love public education employees. They are the most resourceful group of people you could ever meet. They have to be. These employees work in an atmosphere of politics and nepotism.

They suffer through Legislators and administrators that create policies for them even though many of these policy makers have never worked in a school a day in their lives. Because of this, school-based employees have had to learn to MacGyver their way through each and every day.

These employees do this because they know what’s at stake; The future of the 51 million students who attend our public schools as well as the future of our country that one day those students will run.

Recently being made aware of a new piece of federal legislation that could impact the lives of public education employees, I did a quick survey of all my friends that work in that sector. I found that a large portion of them are not aware of this new law.

You see, they are working hard trying to ensure that students are fed, that packets of school work are assembled, and that the digital divide, which this pandemic has now thrust into the spotlight, is addressed as best it can be.
They are busy trying to MacGyver their way through a pandemic that education policy does not address, yet they are still expected to somehow provide continuity in teaching and learning.

But at what cost? How much will our students actually benefit from these weeks of taped and spliced together hybrids of online and paper and pencil learning, and is that greater than the sacrifices our employees’ may ultimately make?

How much responsibility should school districts share in making sure the most vulnerable in our communities are fed? Under a pandemic and amidst shelter in place orders, at what point do schools step back and local governments and other agencies step up?

I think these are just a few of the questions that are being asked by those in position to educate public school employees about their rights under the new FFCRA, and they just don’t have the answers. So they are saying very little, fearful that what little societal infrastructure public education can provide during this pandemic will fall apart.

Lacking any universal definition of what public education is today and what its responsibilities truly are, public education employees are expected to be and do it all. With a smile on their faces. Because it’s “for the children”. The rest will be sorted out later.

Well, this pandemic has thrust this topic to the forefront. It’s time to sort it out. It’s time to recognize public school employees as employees, not martyrs or miracle workers, or folks with big hearts that are willing to sacrifice it all.

They are employees, and in the United States employees have rights.

In that vein, public education employees, you need to know what your rights are so that you can decide what is right for you and your families.

If you are being asked to work in a building and you feel that you cannot or should not be doing it, if you cannot work (telework included) due to childcare issues, if you or a family member are sick with COVID-19, or you take care of anyone that is in a high risk category, there are now some federal job protections for you.

The Families First Coronavirus Response Act (FFCRA) contains several provisions that will provide meaningful assistance to school district employees. It took effect April 2, 2020, and will end on December 31, 2020.
The FFCRA provides two types of leave for employees impacted by COVID-19: Emergency Paid Sick Leave and Emergency Family Medical Leave Act (FMLA) Leave.

First, let’s talk about the Emergency Paid Sick Leave.

It provides 10 days of paid sick leave to an employee who is unable to work or telework if:

1. The employee is subject to a federal, state or local quarantine or isolation order related to COVID -19;

2. The employee has been advised by a health care provider to self-quarantine due to concerns related to COVID-19;

3. The employee is experiencing symptoms and is seeking a medical diagnosis;

4. The employee is caring for someone described above;

5. The employee is caring for the employee’s child if the school or place of care for the child is closed, or if the childcare provider of the child is unavailable due to COVID-19 precautions.

6. The employee is experiencing any other substantially similar condition specified by the Secretary of Health and Human Services in consultation with the Secretary of the Treasury and the Secretary of Labor.

How much it pays:

If an employee is unable to work due to the conditions described in 1-3, the employee is entitled to their regular rate or the applicable minimum wage, whichever is higher, up to $511 per day over a 2-week period.

If an employee is unable to work due to the conditions described in 4 or 6, such as a lack of child care, the employee is entitled to pay at 2/3 their regular rate or 2/3 the applicable minimum wage, whichever is higher, up to $200 per day for 2 weeks.

If an employee is unable to work due to the conditions described in 5 the employee is entitled to pay at 2/3 their regular rate or 2/3 the applicable minimum wage, whichever is higher, up to $200 per day for 12 weeks.

If the employee is part-time, the employee is entitled to be paid for a number of hours equal to the number of hours that the employee works, on average, in a 2 week period.

All full-time and part-time school system employees are covered by the Emergency Paid Sick Leave and are eligible for the two weeks of emergency paid sick leave if they meet one of the six criteria listed above.

Now let’s discuss the Emergency FMLA Leave.

It allows an employee to take up to 12 weeks of leave if the employee is unable to work or telework due to a need for leave to take care of the employee’s child if the school or place of child care has been closed, or if the child care provider is unavailable due to a public health emergency.

How much it pays:

The first 10 days (2 weeks) of leave may be unpaid, except that an employee may choose to use the new emergency sick leave (as identified above) or any other accrued paid leave.

The remaining 10 weeks of FMLA leave provided by this law will be paid at 2/3rds of the employee’s regular rate, up to a maximum payment of $200 per day ($10,000 total).

Emergency FMLA applies to any full-time or part-time employee who have been on the payroll for 30 calendar days.

Another important fact for employees who lack childcare or are caring for an ill child:
Employees in those circumstances can combine both emergency leaves. Here how combining the two may work:

• Weeks 1-2 – Emergency Paid Sick Leave at 67% regular salary up to $200/day

• Weeks 3-12 – Emergency FMLA Leave at 67% regular salary up to $200/day

In the case of lack of childcare, an employee may choose to use accrued leave and emergency paid sick leave together in order to make 100% of his or her salary for that period of time up to two weeks.

Remember it is illegal for an employer to discharge, discipline, or otherwise discriminate against an employee taking leave.

If you feel you need to use one or both emergency leave options, please notify your organization for further guidance. If you are not a member of an organization contact your supervisor to obtain the proper paperwork.

I am not advocating for or against utilizing the FFCRA, but I will say this: IF these MacGyvered forms of distance learning do get shut down due to the fact that public school employees exercised their legal rights, parents don’t worry, we can make up any time in the classroom that may have been lost.

How?

The easiest and cheapest way to do this would be to end high stakes testing.

Think about it. Most school systems spend weeks after spring break doing test prep and high stakes testing. If schools are able to go back into session in August (which I PRAY is the case!) then they could use the first four weeks to make up what was lost and omit the high stakes testing at the end of the year. This is a slightly altered version of a suggestion made by Dr. Eric Mackey, Alabama’s State Superintendent.

Let’s not aid the destruction of public education by buying into the false narratives that these last few weeks of school are critical and must continue at all costs, that the sky is falling if we don’t get our children behind a digital device, and that our schools are solely responsible for the care and feeding of our students. Instead let’s recognize how out of focus our vision has become concerning our expectations of public education and public education employees, and let’s begin a discussion asking parents, communities, and community leaders what their responsibilities are when it comes to our children and youth.

Public Ed can come back from this better and stronger, but only if we take action to correct the inequities and misguided policies that this pandemic has thrust onto the National stage.

Finally, to our public school employees, please take this time to care for yourself and your families. We will need you more than ever once our school doors reopen.

Dana Milbank, opinion writer for the Washington Post, says that the a Republican right wing finally have the helpless federal government they have longed for, and people are dying because of the government’s incompetence. Is this a polite way of saying that the Tea Party libertarians have blood on their hands? Note: there are only two areas where these people are eager and willing to lavish public funds: the military and religious schools.

He writes:

I had been expecting this for 21 years.

“It’s not a matter of ‘if,’ but ‘when,’” the legendary epidemiologist D.A. Henderson told me in 1999 when we discussed the likelihood of a biological event causing mass destruction.

In 2001, I wrote about experts urging a “medical Manhattan Project” for new vaccines, antibiotics and antivirals…

I repeat these things not to pretend I was prescient but to show that the nation’s top scientists and public health experts were shouting these warnings from the rooftops — deafeningly, unanimously and consistently. In the years after the 2001 terrorist attacks, the Bush and Obama administrations seemed to be listening.

But then came the tea party, the anti-government conservatism that infected the Republican Party in 2010 and triumphed with President Trump’s election. Perhaps the best articulation of its ideology came from the anti-tax activist Grover Norquist, who once said: “I don’t want to abolish government. I simply want to reduce it to the size where I can drag it into the bathroom and drown it in the bathtub.”

They got their wish. What you see today is your government, drowning — a government that couldn’t produce a rudimentary test for coronavirus, that couldn’t contain the pandemic as other countries have done, that couldn’t produce enough ventilators for the sick or even enough face masks and gowns for health-care workers.

Now it is time to drown this disastrous philosophy in the bathtub — and with it the poisonous attitude that the government is a harmful “beast” that must be “starved.” It is not an exaggeration to say that this ideology caused the current debacle with a deliberate strategy to sabotage government.

Overall, entitlement programs continued to grow, and the Pentagon’s many friends protected its budget. And Trump has abandoned responsible budgeting. But in one area, the tea party types, with their sequesters, debt-limit standoffs and other austerity schemes, did all too well. Between 2011 and 2018, nondefense discretionary spending fell by 12 percent — and, with it, the government’s already iffy ability to prevent and ameliorate public health emergencies unraveled.

John Auerbach, president of Trust for America’s Health, described for me the fallout: Over a dozen years, the Public Health Emergency Preparedness grants to state and local public health departments were cut by a third and the Hospital Preparedness Program cut in half, 60,000 jobs were lost at state and local public health departments, and similarly severe cuts were made to laboratories. A $15 billion grant program under the 2010 Affordable Care Act, the Prevention and Public Health Fund, was plundered for other purposes.

Now Americans are paying for this with their lives — and their livelihoods.

If the United States had more public health capacity it “absolutely” would have been on par with Singapore, South Korea and Taiwan, which have far fewer cases, Auerbach said. South Korea has had four deaths per 1 million people, Singapore one death per million, and Taiwan 0.2 deaths per million. The United States: 39 per million — and rising fast.

To have mitigated the virus the way Singapore, South Korea and Taiwan did would have required spending about $4.5 billion a year on public health, Auerbach estimates. Instead we’re spending trillions to rescue the economy.
Democrats aren’t blameless in pandemic preparedness. And some Republicans tried to be responsible — but the starve-the-beast crowd wouldn’t hear of it.

After Sen. Arlen Specter (R-Pa.) voted for the 2009 stimulus bill because he secured $10 billion for the National Institutes of Health, he was essentially forced out of the GOP. Rising in the party were people such as Rep. Jim Jordan (Ohio), whose far-right Republican Study Committee in 2011 proposed a plan, applauded by GOP leadership, to cut NIH funding by 40 percent.

In 2014, NIH chief Francis Collins said there likely would have been a vaccine for the Ebola outbreak if not for a 10 percent cut in NIH funding between 2010 and 2014 that included halving Ebola vaccine research. Republicans jeered.

In 2016, when President Barack Obama requested $1.9 billion to fight the Zika virus, Republicans in Congress sat on the request for seven months and then cut it nearly in half.

Since then, Trump has proposed cuts to the NIH and the Centers for Disease Control and Prevention so severe even congressional Republicans rejected them. And last month they fed the “beast” a $2.2 trillion feast to fight the pandemic.

Now they know: When you drown the government in the bathtub, people die.

The New York Times published an insightful and informative analysis of the federal government’s failure to act, as the threat of the coronavirus became clear at the start of 2020. It’s an absorbing story of bureaucratic delays, missed signals, a lack of urgency, a failure of planning and communication, and a failure to mobilize the nation in time to save thousands of lives. It’s a long read but worth your time.

By Michael D. Shear, Abby Goodnough, Sheila Kaplan, Sheri Fink, Katie Thomas and Noah Weiland
March 28, 2020

WASHINGTON — Early on, the dozen federal officials charged with defending America against the coronavirus gathered day after day in the White House Situation Room, consumed by crises. They grappled with how to evacuate the United States consulate in Wuhan, China, ban Chinese travelers and extract Americans from the Diamond Princess and other cruise ships.

The members of the coronavirus task force typically devoted only five or 10 minutes, often at the end of contentious meetings, to talk about testing, several participants recalled. The Centers for Disease Control and Prevention, its leaders assured the others, had developed a diagnostic model that would be rolled out quickly as a first step.

But as the deadly virus spread from China with ferocity across the United States between late January and early March, large-scale testing of people who might have been infected did not happen — because of technical flaws, regulatory hurdles, business-as-usual bureaucracies and lack of leadership at multiple levels, according to interviews with more than 50 current and former public health officials, administration officials, senior scientists and company executives.

The result was a lost month, when the world’s richest country — armed with some of the most highly trained scientists and infectious disease specialists — squandered its best chance of containing the virus’s spread. Instead, Americans were left largely blind to the scale of a looming public health catastrophe.

The absence of robust screening until it was “far too late” revealed failures across the government, said Dr. Thomas Frieden, the former C.D.C. director. Jennifer Nuzzo, an epidemiologist at Johns Hopkins, said the Trump administration had “incredibly limited” views of the pathogen’s potential impact. Dr. Margaret Hamburg, the former commissioner of the Food and Drug Administration, said the lapse enabled “exponential growth of cases.”

And Dr. Anthony S. Fauci, a top government scientist involved in the fight against the virus, told members of Congress that the early inability to test was “a failing” of the administration’s response to a deadly, global pandemic. “Why,” he asked later in a magazine interview, “were we not able to mobilize on a broader scale?”

Across the government, they said, three agencies responsible for detecting and combating threats like the coronavirus failed to prepare quickly enough. Even as scientists looked at China and sounded alarms, none of the agencies’ directors conveyed the urgency required to spur a no-holds-barred defense.

Dr. Robert R. Redfield, 68, a former military doctor and prominent AIDS researcher who directs the C.D.C., trusted his veteran scientists to create the world’s most precise test for the coronavirus and share it with state laboratories. When flaws in the test became apparent in February, he promised a quick fix, though it took weeks to settle on a solution.

The C.D.C. also tightly restricted who could get tested and was slow to conduct “community-based surveillance,” a standard screening practice to detect the virus’s reach. Had the United States been able to track its earliest movements and identify hidden hot spots, local quarantines might have confined the disease.

Dr. Stephen Hahn, 60, the commissioner of the Food and Drug Administration, enforced regulations that paradoxically made it tougher for hospitals, private clinics and companies to deploy diagnostic tests in an emergency. Other countries that had mobilized businesses were performing tens of thousands of tests daily, compared with fewer than 100 on average in the United States, frustrating local health officials, lawmakers and desperate Americans.

Regulations at the F.D.A., led by Dr. Stephen Hahn, made it difficult for hospitals to test patients at the same rate as in other countries.

Alex M. Azar II, who led the Department of Health and Human Services, oversaw the two other agencies and coordinated the government’s public health response to the pandemic. While he grew frustrated as public criticism over the testing issues intensified, he was unable to push either agency to speed up or change course.
Mr. Azar, 52, who chaired the coronavirus task force until late February, when Vice President Mike Pence took charge, had been at odds for months with the White House over other issues. The task force’s chief liaison to the president was Mick Mulvaney, the acting White House chief of staff, who was being forced out by Mr. Trump. Without high-level interest — or demands for action — the testing issue festered.

Under Alex M. Azar II, the health secretary, the C.D.C. and F.D.A. failed to break out of their business-as-usual habits.

At the start of that crucial lost month, when his government could have rallied, the president was distracted by impeachment and dismissive of the threat to the public’s health or the nation’s economy. By the end of the month, Mr. Trump claimed the virus was about to dissipate in the United States, saying: “It’s going to disappear. One day — it’s like a miracle — it will disappear.”

By early March, after federal officials finally announced changes to expand testing, it was too late. With the early lapses, containment was no longer an option. The tool kit of epidemiology would shift — lockdowns, social disruption, intensive medical treatment — in hopes of mitigating the harm.

Now, the United States has more than 100,000 coronavirus cases, the most of any country in the world. Deaths are rising, cities are shuttered, the economy is sputtering and everyday life is upended. And still, many Americans sickened by the virus cannot get tested.

In a statement, Judd Deere, a White House spokesman, said that “any suggestion that President Trump did not take the threat of Covid-19 seriously or that the United States was not prepared is false.” He added that at Mr. Trump’s direction, the administration had “expanded testing capacities.”

Dr. Bruce Aylward, a senior adviser at the World Health Organization, led an expert team to China last month to research the mysterious new virus. Testing, he said, was “absolutely vital” for understanding how to defeat a disease — what distinguishes it from others, the spectrum of illness and, most important, its path through populations.

“You want to know whether or not you have it,” Dr. Aylward said. “You want to know whether the people around you have it. Because you know what? Then you could stop it.”

“You can’t stop it,” he warned, “if you can’t see it.”

A Startling Setback

The first time Dr. Robert Redfield heard about the severity of the virus from his Chinese counterparts was around New Year’s Day, when he was on vacation with his family. He spent so much time on the phone that they barely saw him. And what he heard rattled him; in one grim conversation about the virus days later, George F. Gao, the director of the Chinese Center for Disease Control and Prevention, burst into tears.

Dr. Redfield, a longtime AIDS researcher, had never run a government agency before his appointment to lead the C.D.C. in 2018. Until then, his biggest priorities had been fighting the opioid epidemic and the spread of H.I.V. Suddenly, a man who preferred treating patients in Haiti or Africa to being in the public glare was facing a new pandemic threat.

At first, Dr. Redfield’s agency moved quickly.

On Jan. 7, the C.D.C. created an “incident management system” for the coronavirus and advised travelers to Wuhan to take precautions. By Jan. 20, just two weeks after Chinese scientists shared the genetic sequence of the virus, the C.D.C. had developed its own test, as usual, and deployed it to detect the country’s first coronavirus case.

“That’s our prime mission,” Dr. Redfield said later in an interview, “to get eyes on this thing.”

Assessing the virus would prove challenging. It was so new that scientists had little information to work with. China provided limited data, and rebuffed an early attempt by Mr. Azar and Dr. Redfield to send C.D.C. experts there to learn more. That the virus could cause no symptoms and still spread — something not initially known — made it all the more difficult to understand.

To identify the virus, the C.D.C. test used three small genetic sequences to match up with portions of a virus’s genome extracted from a swab. A German-developed test that the W.H.O. was distributing to other countries used just two, potentially making it less precise.

But soon after the F.D.A. cleared the C.D.C. to share its test kits with state health department labs, some discovered a problem. The third sequence, or “probe,” gave inconclusive results. While the C.D.C. explored the cause — contamination or a design issue — it told those state labs to stop testing.

The startling setback stalled the C.D.C.’s efforts to track the virus when it mattered most. By mid-February, the nation was testing only about 100 samples per day, according to the C.D.C.’s website.

Dr. Redfield played down the problem in task force meetings and conversations with Mr. Azar, assuring him it would be fixed quickly, several administration officials said.

With capacity so limited, the C.D.C.’s criteria for who was tested remained extremely narrow for weeks to come: only people who had recently traveled to China or had been in contact with someone who had the virus.

The lack of tests in the states also meant local public health officials could not use another essential epidemiological tool: surveillance testing. To see where the virus might be hiding, nasal swab samples from people screened for the common flu would also be checked for the coronavirus.

The C.D.C. announced a plan on Feb. 14 to perform the screening in five high-risk cities: New York, Chicago, Los Angeles, San Francisco and Seattle. An agency official said it could provide “an early warning signal to trigger a change in our response strategy.” But most of the cities could not carry it out.

“Had we had done more testing from the very beginning and caught cases earlier,” said Dr. Nuzzo, of Johns Hopkins, “we would be in a far different place.”

The consequences became clear by the end of February. For the first time, someone with no known exposure to the virus or history of travel tested positive, in the Seattle area, where the U.S.’s first case had been detected more than a month earlier. The virus had probably been spreading there and elsewhere for weeks, researchers later concluded. Without a more complete picture of who had been infected, public health workers could not do “contact tracing” — finding all those with whom any contagious people had interacted and then quarantining them to stop further transmission.

The C.D.C. gave little thought to adopting the test being used by the W.H.O. The C.D.C.’s test was working in its own lab — still processing samples from states — which gave agency officials confidence. Dr. Anne Schuchat, the agency’s principal deputy director, would later say that the C.D.C. did not think “we needed somebody else’s test.”

And the German-designed W.H.O. test had not been through the American regulatory approval process, which would take time.

Throughout February, Dr. Redfield shuttled between Atlanta, where the C.D.C. is based, and Washington, holding multiple calls every day with Mr. Azar and participating in the coronavirus task force.

Mr. Azar’s take-charge style contrasted with the more deliberative manner of Dr. Redfield, who lacked the kind of commanding television presence that impressed Mr. Trump. He was “a consensus person,” as one colleague described him, who sought to avoid conflict. He relied heavily on some of the C.D.C.’s career scientists, like Dr. Schuchat and Dr. Nancy Messonnier, the director of the agency’s National Center for Immunization and Respiratory Diseases.

Under scrutiny from Congress, Dr. Redfield offered reassurances. Responding on Feb. 24 to a letter from 49 members of Congress about the need for testing in the states, he wrote, “CDC’s aggressive response enables us to identify potential cases early and make sure that they are properly handled.”

Days later, his agency provided a workaround, telling state and local health department labs that they could finally begin testing. Rather than awaiting replacements, they should use their C.D.C. test kits and leave out the problematic third probe.

Meanwhile, the agency’s epidemiologists were growing more concerned as the virus spread in South Korea and Italy. On Feb. 25, Dr. Messonnier gave a briefing with a much blunter warning than usual. “Disruption to everyday life might be severe,” she said.

Mr. Trump, returning from a trip to India, was furious, according to senior administration officials. Later that day, Mr. Azar seemed to be tamping down the level of concern. All Dr. Messonnier had meant, he said at a news conference, was that people should “start thinking about, in their own lives, what that might involve.”
“Might,” Mr. Azar repeated emphatically. “Might involve.”

Barriers to Testing

Dr. Stephen Hahn’s first day as F.D.A. commissioner came just six weeks before Mr. Azar declared a public health emergency on Jan. 31. A radiation oncologist and researcher who helped turn around MD Anderson in Houston, one of the nation’s leading cancer centers, Dr. Hahn had come to Washington to oversee a sprawling federal agency that regulates everything from lifesaving therapies to dog food.

But overnight, his mission — to manage 15,000 employees in a culture defined by precision and caution — was upended. A pathogen that Mr. Trump would later call the “invisible enemy” was hurtling toward the United States. It would fall to the newly arrived Dr. Hahn to help build a huge national capacity for testing by academic and private labs.

Instead, under his leadership, the F.D.A. became a significant roadblock, according to current and former officials as well as researchers and doctors at laboratories around the country.

Private-sector tests were supposed to be the next tier after the C.D.C. fulfilled its obligation to jump-start screening at public labs. In other countries hit hard by the coronavirus, governments acted quickly to speed tests to their populations. In South Korea, for example, regulators in early February summoned executives from 20 medical manufacturers, easing rules as they demanded tests.

But Dr. Hahn took a cautious approach. He was not proactive in reaching out to manufacturers, and instead deferred to his scientists, following the F.D.A.’s often cumbersome methods for approving medical screening.

Even the nation’s public health labs were looking for the F.D.A.’s help. “We are now many weeks into the response with still no diagnostic or surveillance test available outside of C.D.C. for the vast majority of our member laboratories,” Scott Becker, chief executive of the Association of Public Health Laboratories, wrote to Mr. Hahn in late February. “We believe a more expeditious route is needed at this time.”

Ironically, it was Mr. Azar’s emergency declaration that established the rules Dr. Hahn insisted on following. Designed to make it easier for drugmakers to pursue vaccines and other therapies during a crisis, such a declaration lets the F.D.A. speed approvals that could otherwise take a year or more.

But the emergency announcement created a new barrier for hospitals and laboratories that wanted to create their own tests to diagnose the coronavirus. Usually, they faced minimal federal regulation. But once Mr. Azar took action, they were subject to an F.D.A. process called an “emergency use authorization.”

Even though researchers around the country quickly began creating tests that could diagnose Covid-19, many said they were hindered by the F.D.A.’s approval process. The new tests sat unused at labs around the country.

Stanford was one of them. Researchers at the world-renowned university had a working test by February, based on protocols published by the W.H.O. The organization had already delivered more than 250,000 of the German-designed tests to 70 laboratories around the world, and doctors at the Stanford lab wanted to be prepared for a pandemic.

“Even if it didn’t come, it would be better to be ready than not to be ready,” said Dr. Benjamin Pinsky, the lab’s medical director.

But in the face of what he called “relatively tight” rules at the F.D.A., Dr. Pinsky and his colleagues decided against even trying to win permission. The Stanford clinical lab would not begin testing coronavirus samples until early March, when Dr. Hahn finally relaxed the rules.

Executives at bioMérieux, a French diagnostics company, had a similar experience. The company makes a countertop testing system, BioFire, that is routinely used to check for the flu and other respiratory illnesses in 1,700 hospitals around the country. It can provide results in about 45 minutes.

“A lot of us said, you know, your typical E.U.A. is just much too demanding,” said Dr. Mark Miller, the company’s chief medical officer, referring to the emergency approval. “It’s going to take much too much time. And can’t you do something to shorten that?”

Officials at the F.D.A. tried to be responsive, Dr. Miller said. But rather than throw out the rules, the agency only modified the regulatory requirements, still requiring weeks of discussions and negotiations.

After conversations with the F.D.A. in mid-February, the company received emergency approval for its BioFire test on March 24. (The company also began talking to the F.D.A. in January about another type of test, but decided not to pursue it in the United States for now.) Dr. Miller said that while he was ultimately satisfied with the F.D.A.’s actions, the overall response by the government was too slow, especially when it came to logistical questions like getting enough testing supplies to those who needed them.

“You’ve got other countries — and I’m sorry, unfortunately, the U.S. is one of those — where they’ve been slow, disorganized,” he said. “There are still not enough tests available there to test everybody who needs it.”

In an emailed statement, Dr. Hahn maintained that his agency had moved as quickly as it safely could to ensure that tests would be accurate. “Since the early days of this pandemic,” he said, “the F.D.A.’s doors have always been and still remain open to test developers.”

A Lack of Trust

Alex Azar had sounded confident at the end of January. At a news conference in the hulking H.H.S. headquarters in Washington, he said he had the government’s response to the new coronavirus under control, pointing out high-ranking jobs he had held in the department during the 2003 SARS outbreak and other infectious threats.

“I know this playbook well,” he told reporters.

A Yale-trained lawyer who once served as the top attorney at the health department, Mr. Azar had spent a decade as a top executive at Eli Lilly, one of the world’s largest drug companies. But he caught Mr. Trump’s attention in part because of other credentials: After law school, Mr. Azar was a clerk for some of the nation’s most conservative judges, including Justice Antonin Scalia of the Supreme Court. And for two years, he worked as Ken Starr’s deputy on the Clinton Whitewater investigation.

As Mr. Trump’s second health secretary, confirmed at the beginning of 2018, Mr. Azar has been quick to compliment the president and focus on the issues he cares about: lowering drug prices and fighting opioid addiction. On Feb. 6 — even as the W.H.O. announced that there were more than 28,000 coronavirus cases around the globe — Mr. Azar was in the second row in the White House’s East Room, demonstrating his loyalty to the president as Mr. Trump claimed vindication from his impeachment acquittal the day before and lashed out at “evil” lawmakers and the F.B.I.’s “top scum.”

As public attention on the virus threat intensified in January and February, Mr. Azar grew increasingly frustrated about the harsh spotlight on his department and the leaders of agencies who reported to him, according to people familiar with the response to the virus inside the agencies.

Described as a prickly boss by some administration officials, Mr. Azar has had a longstanding feud with Seema Verma, the Medicare and Medicaid chief, who recently became a regular presence at Mr. Trump’s televised briefings on the pandemic. Mr. Azar did not include Dr. Hahn on the virus task force he led, though some of the F.D.A. commissioner’s aides participated in H.H.S. meetings on the subject.

And tensions grew between the secretary and Dr. Redfield as the testing issue persisted. Mr. Azar and Dr. Redfield have been on the phone as often as a half-dozen times a day. But throughout February, as the C.D.C. test faltered, Mr. Azar became convinced that Dr. Redfield’s agency was providing him with inaccurate information about testing that the secretary repeated publicly, according to several administration officials.

In one instance, Mr. Azar appeared on Sunday morning news programs and said that more than 3,600 people had been tested for the virus. In fact, the real number was much smaller because many patients were tested multiple times, an error the C.D.C. had to correct in congressional testimony that week. One health department official said Mr. Azar was repeatedly assured that the C.D.C.’s test would be widely available within a week or 10 days, only to be given the same promise a week later.

Asked about criticism of his agency’s response to the pandemic, Dr. Redfield said: “I’m personally not focused on whether they’re pointing fingers here or there. We’re focused on doing all we can to get through this outbreak as quickly as possible and keep America safe.”

For all Mr. Azar’s complaints, however, he continued to defer to the scientists at the two agencies, according to several administration officials. Mr. Azar’s allies said he was told by Dr. Redfield and Dr. Fauci that the C.D.C. had the resources it needed, that there was no reason to believe the virus was spreading through the country from person to person and that it was important to test only people who met certain criteria.

But even in the face of a crescendo of complaints from doctors and health care researchers around the country, Mr. Azar failed to push those under him to do the one thing that could have helped: broader testing.

In a statement, Caitlin Oakley, Mr. Azar’s spokeswoman, said that the secretary had “empowered and followed the guidance of world-renowned U.S. scientists” on the testing issue. “Any insinuation that Secretary Azar did not respond with needed urgency to the response or testing efforts,” she said, “are just plain wrong and disproven by the facts.”

By Feb. 26, Dr. Fauci was concerned that the stalled testing had become an urgent issue that needed to be addressed. He called Brian Harrison, Mr. Azar’s chief of staff, and asked him to gather the group of officials overseeing screening efforts.

Around noon on Feb. 27, Dr. Hahn, Dr. Redfield and top aides from the F.D.A. and H.H.S. dialed in to a conference call. Mr. Harrison began with an ultimatum: No one leaves until we resolve the lag in testing. We don’t have answers and we need them, one senior administration official recalled him saying. Get it done.

By the end of the day, the group agreed that the F.D.A. should loosen regulations so that hospitals and independent labs could move forward quickly with their own tests.

But the evening before, Mr. Azar had been effectively removed as the leader of the task force when Mr. Trump abruptly put Mr. Pence in charge, a decision so last-minute that even the top health officials in the White House learned of it while watching the announcement.

Previous presidents have moved quickly to confront disease threats from inside the White House by installing a “czar” to manage the effort.

During an outbreak of the Ebola virus in 2014, President Barack Obama tapped Ron Klain, his vice president’s former chief of staff, to direct the response from the West Wing. Mr. Obama later created an office of global health security inside the National Security Council to coordinate future crises.

“If you look historically in the United States when it is challenged with something like this — whether it’s H.I.V. crises, whether it’s pandemic, whether it’s whatever — man, they pull out all the stops across the system and they make it work,” said Dr. Aylward, the W.H.O. epidemiologist.

But faced with the coronavirus, Mr. Trump chose not to have the White House lead the planning until nearly two months after it began. Mr. Obama’s global health office had been disbanded a year earlier. And until Mr. Pence took charge, the task force lacked a single White House official with the power to compel action.

Since then, testing has ramped up quickly, with nearly 100 labs at hospitals and elsewhere performing it. On Friday, the health care giant Abbott said it had received emergency approval for a portable test that could detect the virus in five minutes.

The president boasted on Tuesday that the United States had “created a new system that now we are doing unbelievably big numbers” of tests for the virus. The U.S., he said, had done more testing for the coronavirus in the last eight days than South Korea had done in eight weeks.

Yet hospitals and clinics across the country still must deny tests to those with milder symptoms, trying to save them for the most serious cases, and they often wait a week for results. In tacit acknowledgment of the shortage, Mr. Trump asked South Korea’s president on Monday to send as many test kits as possible from the 100,000 produced there daily, more than the country needs.

Public health experts reacted positively to the increased capacity. But having the ability to diagnose the disease three months after it was first disclosed by China does little to address why the United States was unable to do so sooner, when it might have helped reduce the toll of the pandemic.

“Testing is the crack that split apart the rest of the response, when it should have tied everything together,” said Dr. Nahid Bhadelia, ​the medical director of the Special Pathogens Unit at Boston University School of Medicine.

“It seeps into every other aspect of our response, touches all of us,” she said. “The delay of the testing has impacted the response across the board.”

The Washington Post published the following story on April 4. It is a story of an administration that ignored warnings and then misled the American people about the seriousness of the pandemic that was about to cause massive misery and loss of life to our nation. It was reported by Yasmeen Abutaleb, Josh Dawsey, Ellen Nakashima and Greg Miller. Journalism is often called “the first draft of history.” This story will be read by historians, along with the post that follows, as source material about the failure of the federal government to confront a grave danger to our nation with a unified and coherent and truthful response.

Trump continues to mislead the nation by refusing to take the coronavirus as deadly, as when he announced that the CDC wants everyone to wear a face-mask but that he himself will not wear one. Imagine a wartime president who said, “I want everyone to buy war bonds, but not me.” “I want everyone to go into a bomb shelter, but I won’t.”

By the time Donald Trump proclaimed himself a wartime president — and the coronavirus the enemy — the United States was already on course to see more of its people die than in the wars of Korea, Vietnam, Afghanistan and Iraq combined.

The country has adopted an array of wartime measures never employed collectively in U.S. history — banning incoming travelers from two continents, bringing commerce to a near-halt, enlisting industry to make emergency medical gear, and confining 230 million Americans to their homes in a desperate bid to survive an attack by an unseen adversary.

Despite these and other extreme steps, the United States will likely go down as the country that was supposedly best prepared to fight a pandemic but ended up catastrophically overmatched by the novel coronavirus, sustaining heavier casualties than any other nation.

It did not have to happen this way. Though not perfectly prepared, the United States had more expertise, resources, plans and epidemiological experience than dozens of countries that ultimately fared far better in fending off the virus.

The failure has echoes of the period leading up to 9/11: Warnings were sounded, including at the highest levels of government, but the president was deaf to them until the enemy had already struck.

The Trump administration received its first formal notification of the outbreak of the coronavirus in China on Jan. 3. Within days, U.S. spy agencies were signaling the seriousness 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 that initial notification for Trump to treat the coronavirus not as a distant threat or harmless flu strain well under control, but as a lethal force that had outflanked America’s defenses and was poised to kill tens of thousands of citizens. That more-than-two-month stretch now stands as critical time that was squandered.

33 times Trump downplayed the coronavirus

Trump’s baseless assertions in those weeks, including his claim that it would all just “miraculously” go away, sowed significant public confusion and contradicted the urgent messages of public health experts.

“While the media would rather speculate about outrageous claims of palace intrigue, President Trump and this Administration remain completely focused on the health and safety of the American people with around the clock work to slow the spread of the virus, expand testing, and expedite vaccine development,” said Judd Deere, a spokesman for the president. “Because of the President’s leadership we will emerge from this challenge healthy, stronger, and with a prosperous and growing economy.”

The president’s behavior and combative statements were merely a visible layer on top of deeper levels of dysfunction.

The most consequential failure involved a breakdown in efforts to develop a diagnostic test that could be mass produced and distributed across the United States, enabling agencies to map early outbreaks of the disease, and impose quarantine measure to contain them. At one point, a Food and Drug Administration official tore into lab officials at the Centers for Disease Control and Prevention, telling them their lapses in protocol, including concerns that the lab did not meet the criteria for sterile conditions, were so serious that the FDA would “shut you down” if the CDC were a commercial, rather than government, entity.

What went wrong with coronavirus testing in the U.S. | The Fact Checker

Other failures cascaded through the system. The administration often seemed weeks behind the curve in reacting to the viral spread, closing doors that were already contaminated. Protracted arguments between the White House and public health agencies over funding, combined with a meager existing stockpile of emergency supplies, left vast stretches of the country’s health-care system without protective gear until the outbreak had become a pandemic. Infighting, turf wars and abrupt leadership changes hobbled the work of the coronavirus task force.

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

National Guardsman Kevin Darrah, 25, has his mask fitted at the Javits Center in Manhattan on April 1. (Demetrius Freeman for The Washington Post)
Even the president’s base has begun to confront this reality. In mid-March, as Trump was rebranding himself a wartime president and belatedly urging the public to help slow the spread of the virus, Republican leaders were poring over grim polling data that suggested Trump was lulling his followers into a false sense of security in the face of a lethal threat.

The poll showed that far more Republicans than Democrats were being influenced by Trump’s dismissive depictions of the virus and the comparably scornful coverage on Fox News and other conservative networks. As a result, Republicans were in distressingly large numbers refusing to change travel plans, follow “social distancing” guidelines, stock up on supplies or otherwise take the coronavirus threat seriously.

“Denial is not likely to be a successful strategy for survival,” GOP pollster Neil Newhouse concluded in a document that was shared with GOP leaders on Capitol Hill and discussed widely at the White House. Trump’s most ardent supporters, it said, were “putting themselves and their loved ones in danger.”

Trump’s message was changing as the report swept through the GOP’s senior ranks. In recent days, Trump has bristled at reminders that he had once claimed the caseload would soon be “down to zero.”

More than 7,000 people have died of the coronavirus in the United States so far, with about 240,000 cases reported. But Trump has acknowledged that new models suggest that the eventual national death toll could be between 100,000 and 240,000.

Beyond the suffering in store for thousands of victims and their families, the outcome has altered the international standing of the United States, damaging and diminishing its reputation as a global leader in times of extraordinary adversity.

“This has been a real blow to the sense that America was competent,” said Gregory F. Treverton, a former chairman of the National Intelligence Council, the government’s senior-most provider of intelligence analysis. He stepped down from the NIC in January 2017 and now teaches at the University of Southern California. “That was part of our global role. Traditional friends and allies looked to us because they thought we could be competently called upon to work with them in a crisis. This has been the opposite of that.”

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

Scanning the horizon

Public health authorities are part of a special breed of public servant — along with counterterrorism officials, military planners, aviation authorities and others — whose careers are consumed with contemplating worst-case scenarios.

The arsenal they wield against viral invaders is powerful, capable of smothering a new pathogen while scrambling for a cure, but easily overwhelmed if not mobilized in time. As a result, officials at 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 cluster of cases in China on Dec. 31 and began developing reports for HHS on Jan. 1. But the most unambiguous warning that U.S. officials received about the coronavirus came Jan. 3, when Robert Redfield, the CDC director, received a call from a counterpart in China. The official told Redfield that a mysterious respiratory illness was spreading in Wuhan, a congested commercial city of 11 million people in the communist country’s interior.

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 notified, 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 a ticking clock, a competition for the upper hand between pathogen and prevention that would dictate the scale of the outbreak when it reached American shores, and determine how many would get sick or die.

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

On Jan. 6, Redfield sent a letter to the Chinese offering to send help, including a team of CDC scientists. China rebuffed the offer for weeks, turning away assistance and depriving U.S. authorities of an early chance to get a sample of the virus, critical for developing diagnostic tests and any potential vaccine.

China impeded the U.S. response in other ways, including by withholding accurate information about the outbreak. Beijing had a long track record of downplaying illnesses that emerged within its borders, an impulse that U.S. officials attribute to a desire by the country’s leaders to avoid embarrassment and accountability with China’s 1.3 billion people and other countries that find themselves in the pathogen’s path.

China stuck to this costly script in the case of the coronavirus, reporting Jan. 14 that it had seen “no clear evidence of human-to-human transmission.” U.S. officials treated the claim with skepticism that intensified when the first case surfaced outside China with a reported infection in Thailand.

A traveler wearing a mask to protect against the coronavirus walks past the Beijing railway station on Jan. 17. (Mark Schiefelbein/AP)
A week earlier, senior officials at HHS had begun convening an intra-agency task force including Redfield, Azar and Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. The following week, there were also scattered meetings at the White House with officials from the National Security Council and State Department, focused mainly on when and whether to bring back government employees in China.

U.S. officials began taking preliminary steps to counter a potential outbreak. By mid-January, Robert Kadlec, an Air Force officer and physician who serves as assistant secretary for preparedness and response at HHS, had instructed subordinates to draw up contingency plans for enforcing the Defense Production Act, a measure that enables the government to compel private companies to produce equipment or devices critical to the country’s security. Aides were bitterly divided over whether to implement the act, and nothing happened for many weeks.

On Jan. 14, Kadlec scribbled a single word in a notebook he carries: “Coronavirus!!!”

Despite the flurry of activity at lower levels of his administration, Trump was not substantially briefed by health officials about the coronavirus until Jan.18, when, while spending the weekend at Mar-a-Lago, he took a call from Azar.

Even before the heath secretary could get a word in about the virus, Trump cut him off and began criticizing Azar for his handling of an aborted federal ban on vaping products, a matter that vexed the president.

At the time, Trump was in the throes of an impeachment battle over his alleged attempt to coerce political favors from the leader of Ukraine. Acquittal seemed certain by the GOP-controlled Senate, but Trump was preoccupied with the trial, calling lawmakers late at night to rant, and making lists of perceived enemies he would seek to punish when the case against him concluded.

In hindsight, officials said, Azar could have been more forceful in urging Trump to turn at least some of his attention to a threat that would soon pose an even graver test to his presidency, a crisis that would cost American lives and consume the final year of Trump’s first term.

But the secretary, who had a strained relationship with Trump and many others in the administration, assured the president that those responsible were working on and monitoring the issue. Azar told several associates that the president believed he was “alarmist” and Azar struggled to get Trump’s attention to focus on the issue, even asking one confidant for advice.

Within days, there were new causes for alarm.

On Jan. 21, a Seattle man who had recently traveled to Wuhan tested positive for the coronavirus, becoming the first known infection on U.S. soil. Then, two days later, Chinese authorities took the drastic step of shutting down Wuhan, turning the teeming metropolis into a ghost city of empty highways and shuttered skyscrapers, with millions of people marooned in their homes.

“That was like, whoa,” said a senior U.S. official involved in White House meetings on the crisis. “That was when the Richter scale hit 8.”

It was also when U.S. officials began to confront the failings of their own efforts to respond.

Azar, who had served in senior positions at HHS through crises including the 9/11 terrorist attacks and the outbreak of bird flu in 2005, was intimately familiar with the playbook for crisis management.

He instructed subordinates to move rapidly to establish a nationwide surveillance system to track the spread of the coronavirus — a stepped-up version of what the CDC does every year to monitor new strains of the ordinary flu.

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

Azar’s team also hit another obstacle. The Chinese were still refusing to share the viral samples they had collected and were using to develop their own tests. In frustration, U.S. officials looked for other possible routes.

A biocontainment lab at the University of Texas medical branch in Galveston had a research partnership with the Wuhan Institute of Virology.

Kadlec, who knew the Galveston lab director, hoped scientists could arrange a transaction on their own without government interference. At first, the lab in Wuhan agreed, but officials in Beijing intervened Jan. 24 and blocked any lab-to-lab transfer.

There is no indication that officials sought to escalate the matter or enlist Trump to intervene. In fact, Trump has consistently praised Chinese President Xi Jinping despite warnings from U.S. intelligence and health officials that Beijing was concealing the true scale of the outbreak and impeding cooperation on key fronts.

The CDC had issued its first public alert about the coronavirus Jan. 8, and by the 17th was monitoring major airports in Los Angeles, San Francisco and New York, where large numbers of passengers arrived each day from China.

In other ways, though, the situation was already spinning out of control, with multiplying cases in Seattle, intransigence by the Chinese, mounting questions from the public, and nothing in place to stop infected travelers from arriving from abroad.

Trump was out of the country for this critical stretch, taking part in the annual global economic forum in Davos, Switzerland. He was accompanied by a contingent of top officials including national security adviser Robert O’Brien, who took an anxious trans-Atlantic call from Azar.

Azar told O’Brien that it was “mayhem” at the White House, with HHS officials being pressed to provide nearly identical briefings to three audiences on the same day.

Azar urged O’Brien to have the NSC assert control over a matter with potential implications for air travel, immigration authorities, the State Department and the Pentagon. O’Brien seemed to grasp the urgency, and put his deputy, Matthew Pottinger, who had worked in China as a journalist for the Wall Street Journal, in charge of coordinating the still-nascent U.S. response.

But the rising anxiety within the administration appeared not to register with the president. On Jan. 22, Trump received his first question about the coronavirus in an interview on CNBC while in Davos. Asked whether he was worried about a potential pandemic, Trump said, “No. Not at all. And we have it totally under control. It’s one person coming in from China. . . . It’s going to be just fine.”

Mick Mulvaney, then acting White House chief of staff, and national security adviser Robert O’Brien talk with Trump aboard Marine One on the president’s return from Davos, Switzerland, on Jan. 22. (Jabin Botsford/The Washington Post)
Spreading uncontrollably

The move by the NSC to seize control of the response marked an opportunity to reorient U.S. strategy around containing the virus where possible and procuring resources that hospitals would need in any U.S. outbreak, including such basic equipment as protective masks and ventilators.

But instead of mobilizing for what was coming, U.S. officials seemed more preoccupied with logistical problems, including how to evacuate Americans from China.

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

The group, which included Azar, Pottinger and Fauci, as well as nine others across the administration, formed the core of what would become the administration’s coronavirus task force. But it primarily focused on efforts to keep infected people in China from traveling to the United States even while evacuating thousands of U.S. citizens. The meetings did not seriously focus on testing or supplies, which have since become the administration’s most challenging problems.

The task force was formally announced on Jan. 29.

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

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

On Jan. 29, Mulvaney chaired a meeting in the White House Situation Room in which officials debated moving travel restrictions to “Level 4,” meaning a “do not travel” advisory from the State Department. Then, the next day, China took the draconian step of locking down the entire Hubei province, which encompasses Wuhan.

That move by Beijing finally prompted a commensurate action by the Trump administration. On Jan. 31, Azar announced restrictions barring any non-U.S. citizen who had been in China during the preceding two weeks from entering the United States.

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

But by that point, 300,000 people had come into the United States from China over the previous month. There were only 7,818 confirmed cases around the world at the end of January, according to figures released by the World Health Organization — but it is now clear that the virus was spreading uncontrollably.

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

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

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

A wall of resistance

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

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

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

Much of the manufacturing of such equipment had long since migrated to China, where factories were now shuttered because workers were on order to stay in their households. At the same time, China was buying up masks and other gear to gird for its own coronavirus outbreak, driving up costs and monopolizing supplies.

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

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

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

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

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

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

White House officials relented to a degree weeks later as the feared coronavirus surge in the United States began to materialize. The OMB team whittled Azar’s demands down to $2.5 billion, money that would be available only in the current fiscal year. Congress ignored that figure, approving an $8 billion supplemental bill that Trump signed into law March 7.

Trump on his ‘natural ability’ for medical science: ‘I really get it’

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

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

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

Inconclusive tests

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

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

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

The first setback came when China refused to share samples of the virus, depriving U.S. researchers of supplies to bombard with drugs and therapies in a search for ways to defeat it. But even when samples had been procured, the U.S. effort was hampered by systemic problems and institutional hubris.

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

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

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

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

But when senior FDA officials consulted leaders at HHS, Hahn, who had led the agency for about two months, was told to stand down. There were concerns about him personally contacting companies regulated by his agency.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Another four-week stretch had been squandered.

Life and death

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Paul Waldman, an opinion writer for the Washington Post, writes here that the coronavirus pandemic has made reform of healthcare an urgent matter.

Millions of people have been laid off, losing the health insurance provided by their employers. He predicts that access to health insurance will be a major issue in the November election because Trump’s war on Obamacare has stripped millions of their health insurance.

Many will be destroyed by the cost of their healthcare during this current crisis.

The pandemic will revive support for Medicare for All, and its fate will depend on the composition of Congress.

He writes:

Let’s begin by considering a few things the coronavirus crisis and the accompanying economic downturn have illustrated about our system.

Perhaps the most vivid is that untold numbers of people are going to get huge bills from being treated for covid-19. Insurance companies made a big deal about waiving cost-sharing for coronavirus tests, but if you get it and have to get treated, you could still face thousands of dollars in costs, especially if you have a high-deductible plan of the kind that has proliferated in recent years.

The number of people facing those costs will be enormous. As bad as the virus has gotten in some other countries, that’s one thing their citizens don’t have to worry about.

That’s not to mention the huge numbers of Americans who have no insurance at all — especially in Republican-run states that refused the Affordable Care Act’s expansion of Medicaid — and so either won’t seek care when they get sick or will have to have the state pick up their tab, further straining state budgets.

Not only that, because of this wave of patients needing expensive treatment, insurance premiums could rise by 40 percent next year. How many people are going to be saying that everyone loves their private insurance when that happens?

Then we get to the effects of the budding recession. As I’ve argued before, the fact that we force most people to get insurance through their employers not only has no rational basis (it’s an accident of history), but it also makes things incredibly complicated during an economic downturn.

Right now we’re scrambling to figure out what to do about the millions or perhaps tens of millions of people who are losing their jobs and so may lose health care. Should we subsidize them to keep their old coverage through COBRA? Increase ACA subsidies? Widen Medicaid? Some combination of those and more?
In any other system, we wouldn’t even have to ask those questions, because your coverage is not tied to your job. If you get laid off or quit or your company goes out of business, your coverage is unaffected. Wouldn’t that be easier and less stressful?

It was always a myth that if you like your employer-sponsored coverage, you can keep it — your boss can change it at any time and often does, even if you keep your job. But if some of the predictions going around are right and as many as a quarter to a third of Americans lose their jobs in this recession, the idea of keeping insurance tied to employment may seem even more absurd than it already was.

Advocates of Medicare-for-all will say these twin crises make the case for their preferred system stronger than ever. But even if we’re not ready to go that far, what we’re living through still reinforces every argument in favor of reform.

It will certainly make health care a more potent issue for Democrats in November, since the central pillar of President Trump’s health-care policy is to get the ACA declared unconstitutional, immediately tossing 20 million or so people off their coverage and taking away protections for those with preexisting conditions (such as, say, having had covid-19).

And if Joe Biden should become president, it will increase the pressure on him to forge ahead with the reform he advocated during the campaign, a surprisingly progressive plan centered on the creation of a public option that could quickly enroll millions of Americans in coverage that would be stable and secure even through another pandemic.

The New York Times reported that Trump again advocated for a treatment for COVID-19 and silenced his chief medical adviser, Dr.Anthony Fauci, who does not agree with him. Other physicians warn that the side effects of the drug recommended by Trump could be dangerous.

The Washington Post reported that Rudy Guiliani has advised Trump about the drug that he touts.

The Washington Post writes:

In one-on-one phone calls with Trump, Giuliani said, he has been touting the use of an anti-malarial drug combination that has shown some early promise in treating covid-19, the disease the novel coronavirus causes, but whose effectiveness has not yet been proved. He said he now spends his days on the phone with doctors, coronavirus patients and hospital executives promoting the treatment, which Trump has also publicly lauded.

The New York Times writes:

President Trump doubled down Sunday on his push for the use of an anti-malarial drug against the coronavirus, issuing medical advice that goes well beyond scant evidence of the drug’s effectiveness as well as the advice of doctors and public health experts.

Mr. Trump’s recommendation of hydroxychloroquine, for the second day in a row at a White House briefing, was a striking example of his brazen willingness to distort and outright defy expert opinion and scientific evidence when it does not suit his agenda.

Standing alongside two top public health officials who have declined to endorse his call for widely administering the drug, Mr. Trump suggested that he was speaking on gut instinct and acknowledged that he had no expertise on the subject.

Saying that the drug is “being tested now,” Mr. Trump said that “there are some very strong, powerful signs” of its potential, although health experts say that the data is extremely limited and that more study of the drug’s effectiveness against the coronavirus is needed.

“But what do I know? I’m not a doctor,” Mr. Trump added.

“If it does work, it would be a shame we did not do it early,” Mr. Trump said, noting again that the federal government had purchased and stockpiled 29 million pills of the drug. “We are sending them to various labs, our military, we’re sending them to the hospitals.”

Mr. Trump, who once predicted that the virus might “miraculously” disappear by April because of warm weather, and who has rejected scientific consensus on issues like climate change, was undaunted by skeptical questioning.

“What do you have to lose?” Mr. Trump asked, for the second day in a row, saying that terminally ill patients should be willing to try any treatment that has shown some promise.

When a reporter at Sunday’s briefing asked Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, to weigh in on the subject, Mr. Trump stopped him from answering. As the reporter noted that Dr. Fauci, who has been far more skeptical about the drug’s potential, was the president’s medical expert, Mr. Trump made it clear he did not want the doctor to answer.

“You know how many times he’s answered that question? Maybe 15 times,” the president said, stepping toward the lectern where Dr. Fauci was standing.

Even as Mr. Trump has promoted the drug, which is also often prescribed for patients with lupus, it has created rifts within his own coronavirus task force. And while many hospitals have chosen to use hydroxychloroquine in a desperate attempt to treat dying patients who have few other options, others have noted that it carries serious risks. In particular, the drug can cause a heart arrhythmia that can lead to cardiac arrest.

Dr. Megan L. Ranney, an emergency physician at Brown University in Rhode Island, said in an interview on Sunday night that she had never seen an elected official advertise a miracle cure the way Mr. Trump has.

“There are side effects to hydroxychloroquine,” Dr. Ranney said. “It causes psychiatric symptoms, cardiac problems and a host of other bad side effects.”

Dr. Ranney said that the drug could be effective for some patients, but that there was not nearly enough scientific evidence to support Mr. Trump’s claims.

“There may be a role for it for some people,” she said, “but to tell Americans ‘you don’t have anything to lose,’ that’s not true. People certainly have something to lose by taking it indiscriminately.”

Hydroxychloroquine has not been proved to work against Covid-19 in any significant clinical trials. A small trial by Chinese researchers made public last week found that it helped speed the recovery in moderately ill patients, but the study was not peer-reviewed and had significant limitations. Earlier reports from France and China have drawn criticism because they did not include control groups to compare treated patients with untreated ones, and researchers have called the reports anecdotal. Without controls, they said, it is impossible to determine whether the drugs worked.

But Mr. Trump on Sunday dismissed the notion that doctors should wait for further study.

“We don’t have time to go and say, ‘Gee, let’s take a couple of years and test it out,’ and let’s go out and test with the test tubes and the laboratories,” Mr. Trump said. “I’d love to do that, but we have people dying today.”

Mr. Trump is typically joined at his briefings by top medical advisers, including Dr. Fauci and Dr. Deborah L. Birx, his coronavirus coordinator. But the president does most of the talking, and has told several advisers that the briefings give him free airtime and good ratings.

A day earlier, Dr. Fauci had privately challenged rising optimism about the drug’s efficacy during a meeting of the coronavirus task force in the White House’s Situation Room, according to two people familiar with the events who spoke on the condition of anonymity to describe a conversation in a sensitive setting. The argument was first reported by the website Axios.

The meeting’s agenda included the question of how the administration would discuss chloroquines. Dr. Stephen Hahn, the Food and Drug Administration commissioner, gave an update on chloroquines, and what various tests and anecdotal evidence had shown. Peter Navarro, the president’s trade adviser who is overseeing supply chain issues related to the coronavirus, asked to join the meeting, said the people briefed on what took place.

Mr. Navarro, who has been pushing to secure chloroquines at the president’s request to provide to caregivers, walked in with a sheaf of folders he had placed on a chair next to him, plopped them on the table and said he had seen studies from various countries, as well as information culled from officials at the Centers for Disease Control and Prevention, showing the “clear” efficacy of the drug in treating the coronavirus. Mr. Navarro also argued that the medicine was being used by doctors and nurses on the front lines of the coronavirus fight.

Dr. Fauci pushed back, echoing remarks he has made in interviews in the past week that rigorous study is still necessary. Mr. Navarro, an economist by training, shot back that the information he had collected was “science,” according to the people familiar with the episode.

Vice President Mike Pence tried to tamp down the debate, and as emotions calmed, Mr. Trump’s son-in-law and senior adviser, Jared Kushner, advised Mr. Navarro to “take yes for an answer.” The president went to the briefing room lectern a short while later and glowed about chloroquine use, suggesting he might even take it himself despite not having symptoms or evidence of the virus.

Bill Gates went on Trevor Noah’s “The Faily Show” to announce that he would fund the building of several factories to produce vaccines for the coronavirus. He expects that only two will be successful, which means he will “waste” a few billion dollars. But since he is worth about $110 billion, this is no big loss.

This is great news, given the incompetence of the Trump administration, which expects every state to take care of its own problems.

At last, Gates is spending his billions for a worthy cause!

He should definitely concentrate his charity on global health.

Thanks, Bill!

Medical experts and even some Trump advisors are questioning the validity of the estimates of likely coronavirus deaths released by Trump.

The estimate of 100,000-240,000 was hurriedly selected, but there is little agreement about whether it is too low or too high.

Leading disease forecasters, whose research the White House used to conclude 100,000 to 240,000 people will die nationwide from the coronavirus, were mystified when they saw the administration’s projection this week.


The experts said they don’t challenge the numbers’ validity but that they don’t know how the White House arrived at them.


White House officials have refused to explain how they generated the figure — a death toll bigger than the United States suffered in the Vietnam War or the 9/11 terrorist attacks. They have not provided the underlying data so others can assess its reliability or provided long-term strategies to lower that death count.


Some of President Trump’s top advisers have expressed doubts about the estimate, according to three White House officials who spoke on the condition of anonymity because they were not authorized to speak publicly.

There have been fierce debates inside the White House about its accuracy.
At a task force meeting this week, according to two officials with direct knowledge of it, Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, told others there are too many variables at play in the pandemic to make the models reliable: “I’ve looked at all the models. I’ve spent a lot of time on the models. They don’t tell you anything. You can’t really rely upon models.”


Robert Redfield, director of the Centers for Disease Control and Prevention, and the vice president’s office have similarly voiced doubts about the projections’ accuracy, the three officials said.

Teresa Hanafin of the Boston Globe writes in her daily Fast Forward column that there are 12 states whose governors refuse to issue stay-home orders:


“I suppose we shouldn’t be surprised that it’s mostly governors who belong to the science-denying GOP who have been cavalierly ignoring the unanimous and increasingly frantic calls by the nation’s top epidemiologists and researchers for everybody to stay home to try to slow the spread of this deadly virus.

“The mayors of some cities in seven of those states have ignored their governors and implemented local stay-home orders: That has happened in a few cities and towns in Alabama, Missouri, Oklahoma, South Carolina, Texas, Utah, and Wyoming.

“But in Arkansas, Iowa, Nebraska, and both Dakotas, there are no such orders. Maybe they think they have magic borders.”