Deluge of warnings ignored

As the novel coronavirus outbreak has intensified over the past weeks, we continue to learn that the Trump administration ignored numerous warnings and curtailed significant preparation steps that would have helped respond to the pandemic more quickly and effectively.

Pandemic playbook

In 2016, the National Security Council (NSC) created a “pandemic playbook” based on lessons learned from the 2014-2015 Ebola outbreak, meant to instruct future administrations on the best strategies to respond to an outbreak. The contents have been revealed to be especially relevant to the coronavirus pandemic, addressing almost every problem the Trump administration has struggled with so far:

…the government should’ve begun a federal-wide effort to procure that personal protective equipment at least two months ago. “Is there sufficient personal protective equipment for healthcare workers who are providing medical care?” the playbook instructs its readers, as one early decision that officials should address when facing a potential pandemic. “If YES: What are the triggers to signal exhaustion of supplies? Are additional supplies available? If NO: Should the Strategic National Stockpile release PPE to states?”

Other recommendations include that the government move swiftly to fully detect potential outbreaks, secure supplemental funding and consider invoking the Defense Production Act — all steps in which the Trump administration lagged behind the timeline laid out in the playbook.

The Trump administration was told of the playbook in 2017 but according to a former U.S. official, “it just sat as a document that people worked on that was thrown onto a shelf.” One person was interested in the playbook – Tom Bossert, then-Homeland Security Adviser and chief of the department’s global health security unit. Though Bossert “expressed enthusiasm” about using the lessons to create an official strategy to fight pandemics, Trump fired Bossert and disbanded both the Homeland Security global health team and its counterpart in the NSC.

Summary: The Trump Administration failed to utilize a pandemic playbook that would have helped guide urgent decisions and coordinate the all-of-government approach that Trump has failed to master. If the playbook had been followed, the government would have begun responding to the outbreak in January.

Homeland Security pandemic models

Under the Trump administration, the Department of Homeland Security (DHS) stopped running models to simulate the effects of a pandemic on U.S. society and infrastructure. Since 2005, a team inside DHS worked with analysts and supercomputers to analyze the consequences of a pandemic and “guide policymakers toward areas that would demand their attention in the event of an outbreak.” However, in 2017 the program was brought to an end when Trump administration officials disputed the value of the work.

One 2015 DHS report, based partly on data produced by NISAC, warned that America’s public and private health systems might “experience significant shortages in vaccines, antivirals, pharmaceuticals needed to treat secondary infections and complications, personal protective equipment (PPE), and medical equipment, including ventilators.”

…Some of the predictions in the July 2015 DHS report were eerily prescient about the kinds of issues that the U.S. has faced in recent weeks because of the coronavirus; the report said that “a severe influenza pandemic could overwhelm the Healthcare and Public Health Sector in as little as 3-6 weeks” and warned that healthcare facilities in cities could be swamped.

A former DHS official criticized the agency for being “singularly focused on border enforcement” under Trump and neglecting to properly plan for other threats, like a pandemic: “We should not be surprised that a department that has for the last 3½ years viewed itself solely as a border enforcement agency seems ill-equipped to address a much greater threat to the homeland,” Juliette Kayyem said.

Following the government’s realization that the coronavirus outbreak poses a serious threat, some Trump officials have requested that DHS try to dig up these old modeling reports and analyses. “Nobody even knew where any of the documents were anymore,” one of the former officials said.

Summary: If the pandemic models had been maintained properly, the Trump administration would have had an earlier understanding of where shortages might occur, and acted accordingly to address them. Instead, “a lot of what we’re doing now is shooting in the dark,” according to a former DHS official.

Crimson Contagion

Three times over the past four years, the Department of Health and Human Services ran an exercise simulating a real-world influenza pandemic and testing agencies on their response. The first took place in 2016 under the Obama administration, using the lessons learned from the Ebola outbreak.

Then, during the transition to the Trump administration, outgoing Obama officials put incoming Trump officials through the exercise to prepare them for the possibility. Among the officials who took part – Rex Tillerson, John Kelly, Rick Perry, and Tom Bossert, all of whom became casualties of the administration’s high turnover. Lisa Monaco, Obama’s homeland security adviser, coordinated the exercise and said she was impressed with how seriously the now-former officials took the lessons.

“We modeled a new strain of flu in the exercise precisely because it’s so communicable,” Ms. Monaco said. “There is no vaccine, and you would get issues like nursing homes being particularly vulnerable, shortages of ventilators.”

The most recent pandemic exercise was run just last year and involved twelve states and over a dozen federal agencies, including DHS and NSC. The scenario was eerily similar to the one we’re living through now: a pandemic flu that originated in China and was exported via humans on airlines. The symptoms, also similar: fever, dry cough, low energy. It became immediately clear that federal and state officials did not know how to respond, confused about everything from shutting down non-essential businesses to how to orderly handle medical shortages.

Confusion emerged as state governments began to turn in large numbers to Washington for help to address shortages of antiviral medications, personal protective equipment and ventilators. Then states started to submit requests to different branches of the federal government, leading to bureaucratic chaos.

The United States, the organizers realized, did not have the means to quickly manufacture more essential medical equipment, supplies or medicines, including antiviral medications, needles, syringes, N95 respirators and ventilators, the agency concluded.

Summary: Many agencies and current officials were aware of the potential for a respiratory virus outbreak originating in China to spread quickly to the United States and overwhelm the nation. Yet, they were not prepared for the coronavirus and Trump continues to claim that “nobody ever thought of numbers like this.”

Complete disregard for intelligence

The Trump administration was warned about the specific threat posed by the coronavirus at the beginning of the year. Health and Human Services Secretary Alex Azar was officially alerted by the CDC on January 3. In the weeks that followed, U.S. intelligence agencies issued consistent warnings that the outbreak in China was more severe than the public realized. Yet publicly, Trump and Republican lawmakers minimized the threat and insisted that the outbreak was under control.

Despite these ominous warnings, “Trump’s advisers struggled to get him to take the virus seriously.” Azar tried to discuss the matter with Trump in early January, but could not get through to the president until Jan. 18. Finally, with Trump on the phone, Azar attempted to bring up the warnings but the president “interjected to ask about vaping and when flavored vaping products would be back on the market.”

In late January, aides convened regular meetings in an attempt to get Trump to understand the severity of the threat, but “Trump was dismissive because he did not believe that the virus had spread widely throughout the United States.” Some officials even foresaw the shortages of coronavirus test kits, calling for a more forceful response, but Trump again resisted.

According to The Washington Post, Trump dismissed his own intelligence officials and chose instead to believe China’s President Xi Jingping.

Some of Trump’s advisers told him that Beijing was not providing accurate numbers of people who were infected or who had died, according to administration officials. Rather than press China to be more forthcoming, Trump publicly praised its response.

Note: Last year, the Trump administration defunded a position inside the CDC’s China office that would have provided a headstart in responding to the coronavirus outbreak before it reached the U.S. Such a specialist on the ground “could have provided real-time information to U.S. and other officials around the world during the first weeks of the outbreak, when they said the Chinese government tamped down on the release of information and provided erroneous assessments.”

More recent warnings discounted

There were so many alarms set off in the past few months, it’s difficult to list them all. Here are some of the most prominent. Remember that Trump did not publicly acknowledge that the coronavirus was a threat until March 16.

Jan. 28: Former Food and Drug Administration Commissioner Scott Gottlieb and former NSC Director for Medical and Biodefense Preparedness Luciana Borio published an op-ed in the Wall Street Journal titled “Act Now to Prevent an American Epidemic.” The pair called for expanded testing and isolation, increased efforts to vaccinate for the regular flu to reduce the load on hospitals, a massive operation to provide hospitals with medical supplies like masks, and immediate prioritizing of vaccine development. Their recommendations were spot on – the U.S. is still unable to widely test for the virus and hospitals are having to rely on makeshift masks and gowns.

• Trump on Jan. 29: “The risk of infection for Americans remains low, and all agencies are working aggressively to monitor this continuously evolving situation and to keep the public informed.”

Jan. 30: Dr. James Hamblin published an analysis in the Atlantic titled “We Don’t Have Enough Masks,” warning that already at the end of January the supplies of protective equipment were running out. “This threat of shortages of basic medical tools extends well beyond masks. In a serious pandemic, the U.S. is not prepared to be isolated for long,” he wrote.

• Trump on Jan. 30: “We think we have it very well under control… We only have five people. Hopefully, everything’s going to be great.”

Feb. 4: Gottlieb and Borio published another piece in the Wall Street Journal, titled “Stop a U.S. Coronavirus Outbreak Before It Starts.” They warned that Trump’s Chinese travel ban was inadequate to prevent the spread of coronavirus in the U.S. and implored the CDC to change its testing guidelines to include all individuals, not just those who visited China recently.

• Trump on Feb. 10: “I think the virus is going to be — it’s going to be fine.”

Feb. 12: Gottlieb and Borio participated in a Senate Homeland Security Committee meeting to sound the alarm that the actual number of coronavirus cases is “much, much higher” than reported and “very concerning for a pandemic.” Gottlieb told senators that the U.S. desperately needed to expand testing and predicted: “We’re going to see those outbreaks start to emerge in the next two to four weeks.” Trump administration officials were asked to participate in the Senate hearing, but they refused.

• Trump on Feb. 24: “The Coronavirus is very much under control in the USA. … Stock Market starting to look very good to me!”

Feb. 25: The most significant warning from within the administration came from senior CDC official Nancy Messonnier, who alerted reporters that Americans should be prepared for “community spread” of the coronavirus within the U.S. “Disruption to everyday life might be severe,” Messonnier said. Rather than take heed of her warning, Trump called Azar and complained that Messonnier was scaring the stock markets.

• Trump on Feb. 27: “When you have 15 people, and the 15 within a couple of days is going to be down to close to zero, that’s a pretty good job we’ve done.”

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A quick end to a non-existent lockdown?

After suddenly changing his public messaging to support social distancing on March 16, Trump just as suddenly announced that he wanted to rollback national guidelines to mitigate the spread of COVID-19. Last Sunday, March 23, the president spent the day retweeting numerous random accounts expressing concern that social distancing measures would harm the economy. For instance, Trump retweeted @SexCounseling’s message stating “The fear of the virus cannot collapse our economy that President Trump has built up.”

Then at midnight in D.C., Trump sent the following tweet: “WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF. AT THE END OF THE 15 DAY PERIOD, WE WILL MAKE A DECISION AS TO WHICH WAY WE WANT TO GO!”

Aside from the unavoidable conclusion that random rightwing Twitter accounts are now creating U.S. public health policy, it is obvious that Trump is worried the mitigation measures will ruin his chances of re-election, which he has long based on the success of the economy. Let’s not forget, Trump resisted aggressive testing for the virus because he feared that public knowledge of a pandemic would undermine his campaign.

Last week, we learned of another factor in Trump’s abrupt push to “re-open” the country quickly: Just hours before announcing that he wanted to get people back to work by Easter, Trump hosted a private conference call Tuesday morning with billionaire CEO’s and hedge fund investors. The discussion “focused on how America’s top money managers are viewing markets and the U.S. economy,” with the general consensus being that the U.S. needs “a date-certain approach to getting back to business.” Hours later, Trump went on national TV and pushed for just that.

• One of the earliest proponents of this “economy first” approach was Goldman Sachs chairman Lloyd Blankfein. It would be hard to argue that the White House didn’t heed the capitalist’s call, as the words Blankfein used seem to be repeated by Trump almost verbatim: “…crushing the economy, jobs and morale is also a health issue-and beyond. Within a very few weeks let those with a lower risk to the disease return to work,” Blankfein tweeted.

Finally, why else might Trump be anxious to end mitigation measures? Six of his top seven biggest revenue-generating properties are now closed under state and/or county guidance: Doral, Turnberry, Mar-a-Lago, Las Vegas, Bedminster, and Doonbeg. Doral resort alone produces $75 million a year, more than Trump’s D.C., Chicago, Vancouver, Waikiki, Aberdeen, and Vegas hotels combined. As the Washington Post explains, Trump is losing about $478,000 a day from the closures.

Defense Production Act

Governors around the country are begging the Trump administration to use the Defence Production Act (DPA) to force corporations and businesses to manufacture desperately needed medical equipment, from ventilators to masks.

Washington Gov. Jay Inslee (D) clashed with President Trump during a conference call with governors on Thursday, pleading with him to take more dramatic action to secure medical supplies for his state as it suffers from the coronavirus pandemic… After Trump told governors that his administration was ready to be the “backup” for states in crisis, Inslee spoke up and said to the president, “We don’t need a backup. We need a Tom Brady.” …Inslee, they added, also alluded to the Defense Production Act and said Washington state needs businesses to be more than encouraged to produce items such as masks and ventilators — they need a federal mandate to force them to act. He said the Pentagon needed to make immediate moves to prod defense companies to provide materials.

• Note: Trump did not understand the Tom Brady reference. “Somebody in the fake news said that one of the governors said, ‘Oh, we need Tom Brady.’ He meant that in a positive way. He said ‘We need Tom Brady, and we’re gonna do great,’ and he took it very positively. They took it differently. They think Tom Brady should be leading the effort.

Why won’t Trump use widespread enforcement of the DPA? Because big business doesn’t want him to. The New York Times reports that “the U.S. Chamber of Commerce and the heads of major corporations have lobbied the administration against using the act.” Instead, corporations are selling vital medical gear to highest-bidding states, netting profits for themselves and middlemen in the process.

Prices change by the day, soaring for the items health-care providers need most. Surgical masks that once cost 3 to 5 cents now cost several dollars a piece, while coveted N95 masks that once cost less than a dollar are now sold for $7.50 or more.

States across the nation have experienced difficulties in obtaining medical supplies, often finding themselves outbid by the federal government itself.

Massachusetts Governor Charlie Baker told Trump during a video conference on Thursday that his state three times lost out to the federal government on purchases of critical supplies… “Prices are always a component of that also. And maybe that’s why you lost to the feds, OK, that’s probably why,” Trump said.

Beshear said Kentucky had a line on equipment when “FEMA came out and bought it all out from under us… It is a challenge that the federal government says, ‘States, you need to go and find your supply chain,’ and then the federal government ends up buying from that supply chain.”

Trump could solve this by using the power of the federal government to centralize the purchasing of equipment and streamline delivery to areas based on need rather than purchasing power. However, he has refused to do so, insisting that the governors can handle it on their own.

“Governors are supposed to be doing a lot of this work, and they are doing a lot of this work,” Trump said. “The Federal government is not supposed to be out there buying vast amounts of items and then shipping. You know, we’re not a shipping clerk.”

This quote from Cuomo encompasses what the majority of governors are experiencing:

Gov. Andrew Cuomo: “I’ll contract with a company for 1,000 masks. They’ll call back 20 minutes later and say the price just went up because they had a better offer. And I understand that: Other states who are desperate for these goods, literally, offer more money than we were paying. The states simply cannot manage it. I’m competing with California and Illinois and Florida. And that’s not the way it should be.”

Can we trust the federal government?

Under a normal administration, citizens could have confidence that the federal government would distribute aid equitably, But not under Trump, who has demanded that governors and officials praise him in order to get funding and supplies: During a Fox town hall on Tuesday, the president said governors “have to treat us well… they can’t say, ‘Oh, gee, we should get this, we should get that.’” He added, “it’s a two-way street, they have to treat us well.”

A senior White House official confirmed Trump’s statement, telling the Daily Beast: “If you’re good and respectful to [Trump], he will treat you the same—it’s that simple.”

Two of the states in the most need, New York and Washington state, have governors who publicly challenge the president – and their states seem to be suffering for it. For instance, Trump called Inslee “a snake” and instructed Vice President Pence “not to be complimentary” of him, even reportedly refusing to talk to him for weeks when Washington was the only state with confirmed coronavirus deaths. Recently, Trump admonished Cuomo to “keep politics out of” the coronavirus response, referring to criticism of the administration’s slow reaction to the outbreak.

”Everyone is negotiating the challenge of telling the federal government where they are falling behind versus making sure we meet the needs of our citizens by getting federal help, knowing that you risk it if you anger Trump,” said an aide to a Democratic governor involved in handling the coronavirus spread. “It’s a balance that all governors are dealing with right now. Well, not all governors. Democratic governors.”

Last night, on Hannity, Trump again implied that only those who are sufficiently grateful will receive future aid:

Trump: “Some these governors, they take, take, take and then they complain.” (clip) “People live Gov. Inslee, he should be doing more, he shouldn’t be relying on the federal government… he’s always complaining.” (clip)

About Michigan Gov. Gretchen Whitmer, who asked for a disaster declaration: “She is a new governor, and it’s not been pleasant…We don’t like to see the complaints.” Trump continued, suggesting he may not approve the state’s request: “Now, she wants a declaration of emergency, and, you know, we have to make a decision on that.”

Ventilator shortages

“You want a pat on the back for sending 400 ventilators?” Mr. Cuomo said. “What are we going to do with 400 ventilators when we need 30,000 ventilators? You’re missing the magnitude of the problem, and the problem is defined by the magnitude.”

The Trump administration is trying to catch up to the immediate need for tens of thousands of ventilators nationwide, but refusing to use the DPA and hoping for corporations to volunteer to contribute. Ford and GE are teaming up to manufacture ventilators…that will not begin to be available until June. The months-long delay in taking the coronavirus seriously may cost our nation thousands of lives as deathly-ill patients go without breathing assistance.

Amid growing pressure to provide ventilators, the president was prepared to announce a joint venture between General Motors and Ventec Life Systems for the production of 80,000 ventilators. However, we just learned that the federal government canceled the deal when FEMA revealed the $1 billion price tag. “Some government officials expressed concern about the possibility of ordering too many ventilators, leaving them with an expensive surplus,” the New York Times reported.

• It’s especially striking that the administration is delaying a life-saving deal over what amounts to just millions in potential savings from shopping around for a better price, particularly when the Senate just passed a stimulus bill that includes $500 billion in “relief” for large companies. The government is unwilling to pay 1/500th of that amount to save countless lives.

Further hampering the response, the effort to produce ventilators has been “confused and disorganized,” perhaps because it is being directed by Trump’s son-in-law Jared Kushner. You might remember, Kushner was originally in charge of ramping up the production of coronavirus test kits, and we all know how well that went: Even now, “a critical shortage of swabs and other testing components is, in many cases, making it impossible for labs across the country to expand their capacity.”

Just last night, appearing on Hannity’s show, President Trump cast doubt (clip) on Gov. Cuomo’s claim that New York needs 30,000-40,000 ventilators:

“I have a feeling that a lot of the numbers that are being said in some areas are just bigger than they’re going to be,” he said. “I don’t believe you need 40,000 or 30,000 ventilators. You go into major hospitals sometimes, and they’ll have two ventilators. And now all of a sudden they’re saying, ‘Can we order 30,000 ventilators?’”

“Look, it’s a bad situation,” he added. “We haven’t seen anything like it. But the end result is we have to get back to work and I think we can start by opening up certain parts of the country.”

The president compared purchasing a ventilator to purchasing a car, calling the machines “very expensive” and “very intricate.”

“And you know they’d say, like Gov. Cuomo and others, they’d say we want 30,000 of them. Thirty thousand?” Trump said. “Think of this, you know you go to hospitals that have one in a hospital and now all of a sudden everyone’s asking for these vast numbers.”