The roots of the nation's current inability to control the pandemic can be traced to mid-April, when the White House embraced overly rosy projections to proclaim victory and move on.
Each morning at 8 as the coronavirus crisis was raging in April, Mark Meadows, the White House chief of staff, convened a small group of aides to steer the administration through what had become a public health, economic and political disaster.
Seated around Meadows' conference table and on a couch in his office down the hall from the Oval Office, they saw their immediate role as practical problem-solvers. Produce more ventilators. Find more personal protective equipment. Provide more testing.
But their ultimate goal was to shift responsibility for leading the fight against the pandemic from the White House to the states. They referred to this as "state authority handoff," and it was at the heart of what would become at once a catastrophic policy blunder and an attempt to escape blame for a crisis that had engulfed the country — perhaps one of the greatest failures of presidential leadership in generations.
Over a critical period beginning in mid-April, President Donald Trump and his team convinced themselves that the outbreak was fading, that they had given state governments all the resources they needed to contain its remaining "embers" and that it was time to ease up on the lockdown.
In doing so, Trump was ignoring warnings that the numbers would continue to drop only if social distancing was kept in place, rushing instead to restart the economy and tend to his battered reelection hopes.
Casting the decision in ideological terms, Meadows would tell people, "Only in Washington, DC, do they think that they have the answer for all of America."
For scientific affirmation, they turned to Dr. Deborah L. Birx, the sole public health professional in the Meadows group. A highly regarded infectious diseases expert, she was a constant source of upbeat news for the president and his aides, walking the halls with charts emphasising that outbreaks were gradually easing. The country, she insisted, was likely to resemble Italy, where virus cases declined steadily from frightening heights.
On April 11, she told the coronavirus task force in the Situation Room that the nation was in good shape. Boston and Chicago are two weeks away from the peak, she cautioned, but the numbers in Detroit and other hard-hit cities are heading down.
A sharp pivot soon followed, with consequences that continue to plague the country today as the virus surges anew.
Even as a chorus of state officials and health experts warned that the pandemic was far from under control, Trump went, in a matter of days, from proclaiming that he alone had the authority to decide when the economy would reopen to pushing that responsibility onto the states. The government issued detailed reopening guidelines, but almost immediately, Trump began criticising Democratic governors who did not "liberate" their states.
Trump's bet that the crisis would fade away proved wrong. But an examination of the shift in April and its aftermath shows that the approach he embraced was not just a misjudgment. Instead, it was a deliberate strategy that he would stick doggedly to as evidence mounted that, in the absence of strong leadership from the White House, the virus would continue to infect and kill large numbers of Americans.
He and his top aides would openly disdain the scientific research into the disease and the advice of experts on how to contain it, seek to muzzle more authoritative voices like Dr. Anthony S. Fauci and continue to distort reality even as it became clear that Trump's hopes for a rapid rebound in the economy and his electoral prospects were not materialising.
Trump had missed or dismissed mounting signals of the impending crisis in the early months of the year. Now interviews with more than two dozen officials inside the administration and in the states, and a review of emails and documents, reveal previously unreported details about how the White House put the nation on its current course during a fateful period this spring.
• Key elements of the administration's strategy were formulated out of sight in Meadows' daily meetings by aides who for the most part had no experience with public health emergencies and were taking their cues from the president. Officials in the West Wing saw the better-known White House coronavirus task force as dysfunctional, came to view Fauci as a purveyor of dire warnings but no solutions and blamed officials from the Centers for Disease Control and Prevention for mishandling the early stages of the virus.
• Birx was more central than publicly known to the judgment inside the West Wing that the virus was on a downward path. Colleagues described her as dedicated to public health and working herself to exhaustion to get the data right, but her model-based assessment nonetheless failed to account for a vital variable: how Trump's rush to urge a return to normal would help undercut the social distancing and other measures that were holding down the numbers.
• The president quickly came to feel trapped by his own reopening guidelines. States needed declining cases to reopen, or at least a declining rate of positive tests. But more testing meant overall cases were destined to go up, undercutting the president's push to crank up the economy. The result was to intensify Trump's remarkable public campaign against testing, a vivid example of how he often waged war with science and his own administration's experts and stated policies.
• Trump's bizarre public statements, his refusal to wear a mask and his pressure on states to get their economies going again left governors and other state officials scrambling to deal with a leadership vacuum. At one stage, Governor Gavin Newsom of California was told that if he wanted the federal government to help obtain the swabs needed to test for the virus, he would have to ask Trump himself — and thank him.
• Not until early June did White House officials even begin to recognize that their assumptions about the course of the pandemic had proved wrong. Even now there are internal divisions over how far to go in having officials publicly acknowledge the reality of the situation.
Judd Deere, a White House spokesman, said the president had imposed travel restrictions on China early in the pandemic, signed economic relief measures that have provided Americans with critical assistance and dealt with other issues, including supplies of personal protective equipment, testing capacity and vaccine development.
"President Trump and his bold actions from the very beginning of this pandemic stand in stark contrast to the do-nothing Democrats and radical left who just complain, criticise and condemn anything this president does to preserve this nation," he said.
At a briefing on April 10, Trump predicted that the number of deaths in the United States from the pandemic would be "substantially" fewer than 100,000. As of Saturday, the death toll stood at 139,186; the pace of new deaths was rising again; and the country, logging a 7-day average of 65,790 new cases a day, had more confirmed cases per capita than any other major industrial nation.
Trump's choice
The president had a decision to make.
It was the end of March, and his initial, 15-day effort to slow the spread of the virus by essentially shutting down the country was expiring in days. Sitting in front of the Resolute Desk in the Oval Office were Fauci and Birx, along with other top officials. Days earlier, Trump had said he envisioned the country being "opened up and raring to go" by Easter, but now he was on the verge of announcing that he would keep the country shut down for another 30 days.
"Do you really think we need to do this?" the president asked Fauci.
"Yeah, we really do need to do it," Fauci replied, explaining again the federal government's role in making sure the virus did not explode across the country.
Trump's willingness to go along — driven in part by grim television images of bodies piling up at Elmhurst Hospital Center in New York City — was a concession that federal responsibility was crucial to defeating a virus that did not respect state boundaries. In a later Rose Garden appearance, he appeared resigned to continuing the battle.
"Nothing would be worse than declaring victory before the victory is won," Trump said.
But even as the president was acknowledging the need for tough decisions, he and his aides would soon be looking to do the opposite: build a public case that the federal government had completed its job and unshackle the president from ownership of the response.
The hub of the activity was the working group assembled by Meadows, who had just taken over as chief of staff.
Joe Grogan, the domestic policy adviser, had come around to Trump's view that the reaction to the virus was overblown, a position shared at that point by Marc Short, Vice President Mike Pence's chief of staff and a frequent participant in the meetings. Russell T. Vought, the president's acting budget director, was there to address the pandemic's mounting costs.
Chris Liddell, a deputy chief of staff, and Jared Kushner, the president's senior adviser and son-in-law, acted as the group's procurement and supply chain experts.
Hope Hicks, the protector of Trump's brand, was a regular participant. Kevin A. Hassett, a top economic adviser, came at times to help assess the numbers and also participated in a 9am meeting three times a week with Meadows and Treasury Secretary Steven Mnuchin on the economic aspects of the pandemic.
Then there was Birx, the response coordinator of the coronavirus task force. Unlike Fauci, who only stopped by the White House to attend meetings, she was given an office near the Situation Room and freely roamed the West Wing, fully embracing her role as a member of the president's team.
By mid-April, Trump had grown publicly impatient with the stay-at-home recommendations he had reluctantly endorsed. Weekly unemployment claims made clear the economy was cratering, and polling was showing his campaign bleeding support. Republican governors were agitating to lift the lockdown, and the conservative political machinery was mobilising to oppose what it saw as constraints on individual freedom.
At the meetings in Meadows' office, the issue was clear: How much longer do we keep this up?
To answer that, they focused on two more questions: Had the virus peaked? And had the government given the states the tools they needed to manage the remaining problems?
On the first question, Birx and Hassett were optimistic: mitigation was working, they insisted, even as many outside experts were warning that the nation would remain at great risk if it let up on social distancing and moved prematurely to reopen.
Meadows thought of himself as a data-driven decision-maker, and in addition to models and infection numbers from the states and the CDC, they looked at traffic on the New Jersey Turnpike (the volume of cars coming in and out of New York City was down by 95.2 per cent); payroll and credit card data; and the number of people who were reporting to have self-quarantined.
If the point was to sustain a monthlong lockdown, the numbers told them, the administration succeeded. If it was to squelch the virus to containable levels, later events would show the officials were oblivious to how widely it was already spreading.
The members of his group believed they had succeeded on the second question, too, although shortages of protective gear continued in some places (and would flare again months later).
A one-time anticipated shortage of more than 100,000 ventilators had been overcome; now there was enough of a surplus that the United States could lend them to other countries. A ban on elective surgeries meant there was plenty of bed space — and no more need for the Navy's hospital ships.
The group thought governors should no longer have trouble getting what they needed for hospitals, doctors and first responders. And they grew increasingly frustrated by what they saw as politically motivated complaining about a lack of federal help and the inability of some states to make effective use of the supplies they were receiving.
Enraged by criticism from New York's Democratic politicians about not being able to find a shipment of ventilators from the federal government, Grogan, the domestic policy chief, angrily told Kushner that they should put more ventilators on 18-wheelers, drive them into New York City and invite news helicopters to record it all — just to embarrass Governor Andrew Cuomo and Mayor Bill de Blasio.
On April 14, the country passed what the group saw as a milestone, administering its 3 millionth test. Inside the West Wing, Kushner was insistent on that point: Given their assumption that infections would not surge again until the fall, there was enough testing capability out there.
Those outside experts who disagreed were largely brushed off. In mid-April, Dr. Ashish K. Jha, director of the Harvard Global Health Institute, urged a top administration official to embrace his call for conducting 500,000 coronavirus tests a day — far more than was happening at the time.
The official, Adm. Brett P. Giroir, the administration's testing czar, who had been delivering upbeat descriptions of the nation's growing testing capacity, eventually conceded to Jha that his plan seemed to be needed. But he made clear the federal government was not prepared to get there quickly.
"At some point down the road," is what Jha said Giroir told him.
"My take is that Jared Kushner believes that this is not something that the White House should get too involved in," Jha recalled. "And then the president believes that it is better left up to the states."
Their critics notwithstanding, White House officials came to feel that they had in fact accomplished their job: giving governors the tools they needed to deal with remaining outbreaks as infections ebbed.
The wind down of the federal government's response would play out over the next several weeks. The daily briefings with Trump ended April 24. The Meadows team started barring Fauci from making most television appearances, lest he go off message and suggest continued high risk from the virus.
By the beginning of May, word leaked that the daily meetings of the task force itself would be ended, though Trump, who had not been told, backpedaled after the coverage caused an uproar.
On testing, Trump shifted from stressing that the nation was already doing more than any other country to deriding its importance. By June the president was regularly making nonsensical statements like, "If we stop testing right now, we'd have very few cases, if any."
But during the middle weeks of April, the president's decision to largely walk away from an active leadership role — and give many states permission to believe the worst of the crisis was behind them — came abruptly into public view.
On April 10, Trump declared that, in his role as something akin to a "wartime president," it would be his decision about whether to reopen the country. "That's my metrics," he told reporters, pointing to his own head. "I would say without question it's the biggest decision I've ever had to make."
Three days later, he reiterated his responsibility. "When somebody is the president of the United States, the authority is total, and that's the way it's got to be," he said.
The next day, Birx and Fauci presented Trump with a plan for issuing guidelines to start reopening the country at the end of the month. Developed largely by Birx and held closely by her until being presented to the president — most task force members did not see them beforehand — the guidelines laid out broad, voluntary standards for states considering how fast to come out of the lockdown.
In political terms, the document's message was that responsibility for dealing with the pandemic was shifting from Trump to the states.
On April 16, when Trump publicly announced the guidelines, he made the message to the governors explicit.
"You're going to call your own shots," he said.
Birx's influence
Inside the White House, Birx was the chief evangelist for the idea that the threat from the virus was fading.
Unlike Fauci, Birx is a strong believer in models that forecast the course of an outbreak. Fauci has cautioned that "models are only models" and that real-world outcomes depend on how people respond to calls for changes in behavior — to stay home, for example, or wear masks in public — sacrifices that required a sense of shared national responsibility.
In his decades of responding to outbreaks, Fauci, a voracious reader of political histories, learned to rely on reports from the ground. Late at night in his home office this spring, Fauci, who declined to comment for this article, dialled health officials in New Orleans, New York and Chicago, where he heard desperation unrecognisable in the more sanguine White House meetings.
Fauci had his own critics, who said he relied on anecdotes and experience rather than data and who felt he was not sufficiently attuned to the devastating economic and social consequences of a national lockdown.
As the pandemic worsened, Fauci's darker view of the circumstances was countered by the reassurances ostensibly offered by Birx's data.
A renowned Aids researcher who holds the title of "ambassador" as the State Department's special representative for global health diplomacy, she had assembled a team of analysts who worked late nights in the White House complex, feeding her a constant stream of updated data, packaged in PowerPoint slides emailed to senior officials each day.
There were warnings that the models she studied might not be accurate, especially in predicting the course of the virus against a backdrop of evolving political, economic and social factors. Among the models Birx relied on most was one produced by researchers at the University of Washington. But when Hassett reviewed its performance by looking back on its predictions from three weeks earlier, it turned out to be hit-or-miss.
The authors of the University of Washington model spoke to Birx or members of her team almost daily, they said, and often cautioned that their work was only supposed to offer a snapshot based on key assumptions, like people continuing to abide by social distancing until June 1.
"We made clear that to get the epidemic under control and bring it down to effectively zero transmission required the social distancing mandates to be in place," said Christopher J. L. Murray, director of the modelling program. "April 22 — somewhere around that period — that's when the tone shifted. They started to ask questions about, what will be the trajectory and where with the lifting of mandates?"
Some state officials were also alarmed by the administration's use of the University of Washington model.
Colorado health officials wrote to the administration on April 10, pleading that the White House not use the model to allocate supplies to the state, saying its predictions were rosier than the grim reality they were encountering. (When those concerns were relayed to her, Birx replied that decisions on allocating equipment were based on factors beyond the one model.)
Birx declined to be interviewed. A task force official said she had only used the University of Washington model in a limited way and that the White House used "real data, not modelled data, to understand the pandemic in the United States."
The official said the White House "immediately reacted to the early signs of community spread" by working with governors in the affected states.
But despite the outside warnings and evidence by early May that new infections, while down, remained higher than anticipated, the White House never fundamentally re examined the course it had set in mid-April.
Fauci, a friend of Birx's for 30 years, would describe her as more political than him, a "different species." More pessimistic by nature, Fauci privately warned that the virus was going to be difficult to control, often commenting that he was the "skunk at the garden party."
By contrast, Birx regularly delivered what the new team was hoping for.
"All metros are stabilising," she would tell them, describing the virus as having hit its "peak" around mid-April. The New York area accounted for half the total cases in the country, she said. The slope was heading in the right direction. "We're behind the worst of it." She endorsed the idea that the death counts and hospitalisation numbers could be inflated.
For Birx, Italy's experience was a particularly telling — and positive — comparison. She routinely told colleagues that the United States was on the same trajectory as Italy, which had huge spikes before infections and deaths flattened to close to zero.
"She said we were basically going to track Italy," one senior adviser later recalled.
Birx would roam the halls of the White House, talking to Kushner, Hicks and others, sometimes passing out diagrams to bolster her case. "We've hit our peak," she would say, and that message would find its way back to Trump.
Birx began using versions of the phrase "putting out the embers," wording that was later picked up by the press secretary, Kayleigh McEnany, and by Trump himself.
By the middle of May, the task force believed that another resurgence was not likely until the fall, senior administration officials said.
The New York region appeared well on its way to driving new infections down to levels it could handle; it was the one area of the country that did resemble the Italian model. But the models and analysis embraced by the West Wing failed to account for the weakening adherence to the lockdowns across the country that began even before Trump started urging governors to "liberate" their residents from the methodical guidelines his own government had established.
Later, it was clear that states that rushed to reopen before meeting the criteria in the guidelines — like Arizona, Texas and Alabama — would have among the worst surges in new cases.
Birx's belief that the United States would mirror Italy turned out to be disastrously wrong. The Italians had been almost entirely compliant with stay-at-home orders and social distancing, squelching new infections to negligible levels before the country slowly reopened. Americans, by contrast, began backing away by late April from what social distancing efforts they had been making, egged on by Trump.
The difference was critical. As communities across the United States raced to reopen, the daily number of daily cases barely dropped below 20,000 in early May. The virus was still circulating across the country.
Italy's recovery curve, it turned out, looked nothing like the American one.
The consequences
The real-world consequences of Trump's abdication of responsibility rippled across the country.
During a briefing April 20, Trump mocked Gov. Larry Hogan of Maryland, a fellow Republican, for the state's inability to find enough testing. Birx displayed maps with dozens of dots indicating labs that could help.
"He really didn't know about the federal laboratories," Trump told reporters with mock astonishment. "He didn't know about it."
But when Frances B. Phillips, the state's deputy health secretary, reached out to one of those dots — a National Institutes of Health facility in Maryland — she was told that they were suffering from the same shortages as state labs and were not in a position to help.
"It was clear that we were on our own and we need to develop our own strategy, which is very unlike the kind of federal response in the past public health emergencies," Phillips recalled.
In California, Newsom had already experienced firsthand the complexities of getting help from Washington.
After offering to help acquire 350,000 testing swabs during an early-morning conversation with one of Newsom's advisers, Kushner made it clear that the federal help would hinge on the governor doing him a favor.
"The governor of California, Gavin Newsom, had to call Donald Trump and ask him for the swabs," recalled the adviser, Bob Kocher, a Barack Obama-era White House health care official.
Newsom made the call as requested and then praised Trump that same day during a news conference where he announced the commitment, giving Trump credit for the "substantial increase in supply" headed to California.
Mayor Francis X. Suarez of Miami, a Republican, said that the White House approach had only one focus: reopening businesses, instead of anticipating how cities and states should respond if cases surged again.
"It was all predicated on reduction, open, reduction, open more, reduction, open," he said. "There was never, what happens if there is an increase after you reopen?"
Other nations had moved aggressively to employ an array of techniques that Trump never mobilised on a federal level, including national testing strategies and contact tracing to track down and isolate people who had interacted with newly diagnosed patients.
"These things were done in Germany, in Italy, in Greece, Vietnam, in Singapore, in New Zealand and in China," said Andy Slavitt, a former federal health care official who had been advising the White House.
"They were not secret," he said. "Not mysterious. And these were not all wealthy countries. They just took accountability for getting it done. But we did not do that here. There was zero chance here that we would ever have been in a situation where we would be dealing with 'embers.'"
A New surge
By early June, it was clear that the White House had gotten it wrong.
In task force meetings, officials discussed a spike in cases across the South and whether any bumps in caseloads were caused by crowded protests over the killing of George Floyd. They briefly considered if it was a fleeting side effect of Memorial Day gatherings.
They soon realized there was more at play.
Digging into new data from Birx, they concluded the virus was in fact spreading with invisible ferocity during the weeks in May when states were opening up with Trump's encouragement and many were all but declaring victory.
With the benefit of hindsight, the head of the Centers for Disease Control and Prevention, Dr. Robert R. Redfield, acknowledged this week in a conversation with the Journal of the American Medical Association that administration officials — himself included — severely underestimated infections in April and May. He estimated they were missing as many as 10 cases each day for every one they were confirming.
The number of new cases has now surged far higher than the previous peak of more than 36,000 a day in mid-April. On Thursday, there were more than 75,000 confirmed new cases, a record.
Trump's disdain for testing continues to affect the country. By the middle of June, lines stretched for blocks in Phoenix and in Austin, Texas. And getting results could take a week to 10 days, officials in Texas said — effectively inviting the virus to spread uncontrollably.
Dr. Mandy K. Cohen, the top health official in North Carolina, contacted the Trump administration after a surge in June, asking the government to quickly open 100 new testing sites in her state, in addition to the 13 it was then operating.
"'We will keep those 13 open for another month; you are welcome,'" Cohen said, mocking the response she received.
It was a devastating situation, said Mayor Steve Adler of Austin, who watched as the Covid-19 cases at intensive care units at area hospitals jumped from 3 in mid-May to 185 by early July. Adler had a simple plea for the White House.
"When we were trying to get people to wear masks, they would point to the president and say, 'Well, not something that we need to do,'" he said.
Suarez expressed similar frustrations with Trump's dismissive approach to mask wearing. "People follow leaders," he said, before rephrasing his remarks. "People follow the people who are supposed to be leaders."
Written by: Michael D. Shear, Noah Weiland, Eric Lipton, Maggie Haberman and David E. Sanger
Photographs by: Doug Mills, Eve Edelheit, Erin Schaff, Anna Moneymaker and Jenna Schoenefeld
© 2020 THE NEW YORK TIMES
