[ED NOTE: Some months ago, bewildered by the amount of oncoming data and information - and its misapplications - I started putting together a coronavirus database. That can be found here. Much of the information in this piece is taken from there.]
POSTMORTEM: Too Early?
Part II
by Domingo Soto
Isolation and Quarantine
Keeping the disease far from our shores, as Obama had done with the Ebola virus, was a botched attempt, again, partially the result of Chinese politics and of the WHO’s global considerations, but due mainly to the machinations and conflicts within the administration; actions, failures to timely act and missteps were fed by a presidential indolence that amounts to political negligence.
To be fair, the question initially was how to lock down a country as large as ours, not to mention, China. These were not relatively isolated African countries but two teeming nations with mobile and transient populations. Again, fiscal considerations came to dominate. The President, according to media reports, was resistant to reading reports, even the daily briefings on issues more obviously on the plate. A pandemic was even further removed. He refused to center on the gravity of the virus situation even after the early warning signals of mid January. That left no one with ultimate authority pushing the pandemic panic button or, even, manning the helm.
Given that, the NSC’s proposal of restricting flights from China, met resistance from other cabinet-level agencies who were concerned about the effect of a lock down on the stock market. China’s trade importance was certainly lost on no one, least of all the President. “Do you trust that we're going to know everything we need to know from China?”, he was asked. “I do. I do. I have a great relationship with President Xi. We just signed probably the biggest deal ever made. It certainly has the potential to be the biggest deal ever made.”
Again, some measure of blame must be ascribed to the WHO’s macropolitical views. By late January they were still advising against travel restrictions and maintaining that there was no person-to-person danger. The iceberg looming, the band played on. The debate over the scope of the lock-down raged much longer than necessary. The country was in no way, as Trump would tell his media chum Hannity, “shut down”.
The compromise had become medical screenings for only Wuhan travelers and then at just three international airports. This was expanded to twenty US airports by the end of January. Travel restrictions applied only to foreign nationals traveling to the United States after visiting the China, with specific exemptions for travelers coming from the Special Administrative Regions of Hong Kong and Macao. US citizens and permanent residents were also exempt from the restrictions, and incoming flights did not stop landing at US airports until several weeks later.
Even these halfway measures were met with criticisms from the political opposition. Nancy Pelosi and New York Mayor Bill de Blasio would see them as more of the President’s anti-immigrant inclinations; the pyromaniac has matches, they would warn. On March 11 Trump announced a Europe travel ban targeting “foreign nationals”. The following day, travel from countries in the European Union was prohibited. One week later, a temporary closure of the US-Canada border to non-essential traffic was announced.
Meanwhile in Wuhan, a city of 11 million was completely locked down by the first week of January. Starting within hours of the announcement, transport into and out of the city was closed, with no exceptions even for personal and medical emergencies.
Trump’s happy talk is by now well known. Some measure of empathy has to be given to the reality that these public servants, in dealing with a novel catastrophic monster were dancing on the two-edged sword of also maintaining public confidence in their efforts. HHS’ Azar would assure the public early on that the “potentially serious” coronavirus "was one for which we have a playbook.” Yet, this public face was belied by reports that his advisers, amongst them Azar, were having difficulties getting Trump to take the matter seriously.
Trump acknowledges receiving intelligence briefings on the coronavirus by late January but claims that the warnings were minimized. "On January 23, I was told that there could be a virus coming in, but it was of no real import. In other words, it wasn't, 'Oh, we've got to do something, we've got to do something.' It was a brief conversation...said it very matter-of-factly, and it was not a big deal." That it was of no concern is belied by the fact that at the State Department, our China diplomats and their families were being brought home on chartered planes.
That was recently belied by the assertions found in Rage, Bob Woodward’s latest book. As he reports it, On January 28, he received a briefing from National Security Adviser Robert O’Brien who told him that the virus would be “the biggest national security threat you face in your presidency. This is going to be the roughest thing you face.” Trump's head "popped up," Woodward writes. As late as May 3, Trump would repeat his assertion that intelligence officials did not raise the coronavirus with him until late January and that they did it in a casual manner.
Also in mid-January, media reports claim that “White House aides huddled with then-acting chief of staff Mick Mulvaney in his office, trying to get senior officials to pay more attention to the virus. Joe Grogan, the head of the White House Domestic Policy Council, argued that the administration needed to take the virus seriously or it could cost the president his reelection, and that dealing with the virus was likely to dominate life in the United States for many months.”
In a subsequent interview with Woodward, Trump acknowledges what must have been, at least by February 7, the realization of the magnitude of the problem. “This is deadly stuff....You just breathe the air and that’s how it’s passed,” Trump said in a Feb. 7 call. “And so that’s a very tricky one. That’s a very delicate one. It’s also more deadly than even your strenuous flus.” And, while it finally moved the President to take the action of shutting down international travel access, January and part of February slipped by without any meaningful treatment plan. Indeed, what did develop was a roll-your-own process that served only to undermine its efficacy.
A Treatment A-Team
By January’s end, the White House had formed the Coronavirus Response Task Force. To deal effectively with what was perceived to be an oncoming catastrophic scourge - especially if one expected compliance from a host body of an usually pampered citizenry - there would have to be a confidence in the course of action. To get there the universal guidepost would have to be: let the medical professionals handle the crisis and do nothing to get in the way.
There is no quarrel with the makeup of this team. The group, consisting of approximately 25 agency and administration bureaucrats, included some of the country’s most esteemed health professionals: HHS’ Azar; Anthony Fauci, the Director of the National Institute of Allergy and Infectious Diseases; AIDS expert Deborah Birx who would serve as the White House Coronavirus Response Coordinator; Jerome Adams, the country’s Surgeon General; Seema Verma, Administrator of the Centers for Medicare and Medicaid Services; Ben Carson, Secretary of HUD; Stephen Hahn, Commissioner of Food and Drugs; and Francis Collins, Director of the National Institutes of Health.
What had been just stress lines in the process started looking more like a fracture and it was immediately evident in the months that followed as a tango played out, the political machine bending the health professionals into near contortions to their lead.
Almost immediately the meddling started. Azar, who had declared a Public Health Emergency at the end of January and had, along with the task force been preparing for what he feared was a looming health crisis, had his role downsized. He was replaced by the Vice President, supposedly because the President and his advisers thought Azar too “alarmist”. Pence was not only a politician but had some troubling healthcare and religious baggage. It would be the first of many conflicts between the professionals and the politicians, tensions often played out in national press conferences.
Others thought it was the administration’s mind set that was fanciful. The President’s men declined an offer of early congressional funding assistance. The officials, including Azar, said they “didn’t need emergency funding, that they would be able to handle it within existing appropriations.” Senator Chris Murphy would tweet: “Just left the Administration briefing on Coronavirus. Bottom line: they aren't taking this seriously enough. Notably, no request for ANY emergency funding, which is a big mistake. Local health systems need supplies, training, screening staff etc. And they need it now.”
January closed with the country having now reported its first cases. We had a tenuous lock down travel plan and we had an able and prestigious team of medical professionals. But that was it. There was no real plan, just the administration intuitively caroming side to side along ad hoc courses of action that they often rescinded, retracted or contradicted. Other afflicted countries met the disease with aggressive and forceful courses of actions that included closures, quarantines, testing, and contract tracing. But here what we had for the better part of February - and by now we had our first fatalities - was a nightmare of dithering missteps. Trust and transparency were the crucial first victims and would infect every action along the way.
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