2020.04.15.
4月4日付けのワシントン・ポスト（WP）及び4月11日付けのニューヨーク・タイムズ（NYT）は、新コロナ・ウィルスのアメリカにおける蔓延がトランプ大統領の失政によるものであることを明らかにする、詳しい調査報道を行いました。私は、毎朝チェックしている中国のニュースの中でこの二つの記事の存在を知りました。ネットで両記事の原文が載っていることを見つけた次第です。
私は、日本における新コロナ・ウィルスの蔓延も安倍政権の失政によるものだと確信しています。安倍政権が早くから早期発見、早期隔離、早期治療に乗り出していたならば、中国及び韓国とともに、蔓延封じ込み成功国となっていたことでしょう。それよりも本質的に重要なことは、多くの人命の犠牲を防ぐことができたはずであるということです。
トランプはすでに、自らの失政によって2万人以上の犠牲者を出してしまいました。安倍政権の場合は、検査基準の厳格な適用という、信じられない｢手段｣によって、犠牲者の数を低く押さえ込んでいますが、いまの"緊急事態宣言"によって最悪の事態を回避できるとは思えません。この無為無策、後手、後手の対応が今後どれだけの犠牲者をさらに生み出すのかと考えるだけでも慄然とします。
私は、日本のマス・メディアが安倍政権発の情報を垂れ流すだけに終始していることにも憤りを隠せません。もうすでに遅すぎるのですが、せめてWP及びNYT並みの安倍政権失政の真実を克明に明らかにする調査記事を公表するのは、私たち国民に対する彼らの義務だと思います。
そういう意味を込めて、両記事原文を載せます。
＜ワシントン・ポスト＞
Investigations
The U.S. was beset by denial and dysfunction as the coronavirus raged From the Oval Office to the CDC, political and institutional failures cascaded through the system and opportunities to mitigate the pandemic were lost.
By Yasmeen Abutaleb, Josh Dawsey, Ellen Nakashima and Greg Miller
April 4, 2020
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.
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 measures 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.
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.
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 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 a trans-Atlantic call from an anxious 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."
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 6.
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.
FDA leaders were split on whether it would be bad optics for Hahn to be personally calling companies he regulated. When FDA officials consulted leaders at HHS, they understood it as a direction to stand down.
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 the 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, as 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 on 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."
Julie Tate and Shane Harris contributed to this report.
＜ニューヨーク・タイムズ＞
He Could Have Seen What Was Coming: Behind Trump's Failure on the Virus
An examination reveals the president was warned about the potential for a pandemic but that internal divisions, lack of planning and his faith in his own instincts led to a halting response.
By Eric Lipton, David E. Sanger, Maggie Haberman, Michael D. Shear, Mark Mazzetti and Julian E. Barnes
Published April 11, 2020Updated April 14, 2020, 12:02 p.m. ET NYT
WASHINGTON — "Any way you cut it, this is going to be bad," a senior medical adviser at the Department of Veterans Affairs, Dr. Carter Mecher, wrote on the night of Jan. 28, in an email to a group of public health experts scattered around the government and universities. "The projected size of the outbreak already seems hard to believe."
A week after the first coronavirus case had been identified in the United States, and six long weeks before President Trump finally took aggressive action to confront the danger the nation was facing — a pandemic that is now forecast to take tens of thousands of American lives — Dr. Mecher was urging the upper ranks of the nation's public health bureaucracy to wake up and prepare for the possibility of far more drastic action.
"You guys made fun of me screaming to close the schools," he wrote to the group, which called itself "Red Dawn," an inside joke based on the 1984 movie about a band of Americans trying to save the country after a foreign invasion. "Now I'm screaming, close the colleges and universities." His was hardly a lone voice. Throughout January, as Mr. Trump repeatedly played down the seriousness of the virus and focused on other issues, an array of figures inside his government — from top White House advisers to experts deep in the cabinet departments and intelligence agencies — identified the threat, sounded alarms and made clear the need for aggressive action.
The president, though, was slow to absorb the scale of the risk and to act accordingly, focusing instead on controlling the message, protecting gains in the economy and batting away warnings from senior officials. It was a problem, he said, that had come out of nowhere and could not have been foreseen.
Even after Mr. Trump took his first concrete action at the end of January — limiting travel from China — public health often had to compete with economic and political considerations in internal debates, slowing the path toward belated decisions to seek more money from Congress, obtain necessary supplies, address shortfalls in testing and ultimately move to keep much of the nation at home.
Unfolding as it did in the wake of his impeachment by the House and in the midst of his Senate trial, Mr. Trump's response was colored by his suspicion of and disdain for what he viewed as the "Deep State" — the very people in his government whose expertise and long experience might have guided him more quickly toward steps that would slow the virus, and likely save lives.
Decision-making was also complicated by a long-running dispute inside the administration over how to deal with China. The virus at first took a back seat to a desire not to upset Beijing during trade talks, but later the impulse to score points against Beijing left the world's two leading powers further divided as they confronted one of the first truly global threats of the 21st century.
The shortcomings of Mr. Trump's performance have played out with remarkable transparency as part of his daily effort to dominate television screens and the national conversation.
But dozens of interviews with current and former officials and a review of emails and other records revealed many previously unreported details and a fuller picture of the roots and extent of his halting response as the deadly virus spread:
• The National Security Council office responsible for tracking pandemics received intelligence reports in early January predicting the spread of the virus to the United States, and within weeks was raising options like keeping Americans home from work and shutting down cities the size of Chicago. Mr. Trump would avoid such steps until March.
• Despite Mr. Trump's denial weeks later, he was told at the time about a Jan. 29 memo produced by his trade adviser, Peter Navarro, laying out in striking detail the potential risks of a coronavirus pandemic: as many as half a million deaths and trillions of dollars in economic losses.
• The health and human services secretary, Alex M. Azar II, directly warned Mr. Trump of the possibility of a pandemic during a call on Jan. 30, the second warning he delivered to the president about the virus in two weeks. The president, who was on Air Force One while traveling for appearances in the Midwest, responded that Mr. Azar was being alarmist.
• Mr. Azar publicly announced in February that the government was establishing a "surveillance" system in five American cities to measure the spread of the virus and enable experts to project the next hot spots. It was delayed for weeks. The slow start of that plan, on top of the well-documented failures to develop the nation's testing capacity, left administration officials with almost no insight into how rapidly the virus was spreading. "We were flying the plane with no instruments," one official said.
• By the third week in February, the administration's top public health experts concluded they should recommend to Mr. Trump a new approach that would include warning the American people of the risks and urging steps like social distancing and staying home from work. But the White House focused instead on messaging and crucial additional weeks went by before their views were reluctantly accepted by the president — time when the virus spread largely unimpeded.
When Mr. Trump finally agreed in mid-March to recommend social distancing across the country, effectively bringing much of the economy to a halt, he seemed shellshocked and deflated to some of his closest associates. One described him as "subdued" and "baffled" by how the crisis had played out. An economy that he had wagered his re-election on was suddenly in shambles.
He only regained his swagger, the associate said, from conducting his daily White House briefings, at which he often seeks to rewrite the history of the past several months. He declared at one point that he "felt it was a pandemic long before it was called a pandemic," and insisted at another that he had to be a "cheerleader for the country," as if that explained why he failed to prepare the public for what was coming.
Mr. Trump's allies and some administration officials say the criticism has been unfair. The Chinese government misled other governments, they say. And they insist that the president was either not getting proper information, or the people around him weren't conveying the urgency of the threat. In some cases, they argue, the specific officials he was hearing from had been discredited in his eyes, but once the right information got to him through other channels, he made the right calls.
"While the media and Democrats refused to seriously acknowledge this virus in January and February, President Trump took bold action to protect Americans and unleash the full power of the federal government to curb the spread of the virus, expand testing capacities and expedite vaccine development even when we had no true idea the level of transmission or asymptomatic spread," said Judd Deere, a White House spokesman.
There were key turning points along the way, opportunities for Mr. Trump to get ahead of the virus rather than just chase it. There were internal debates that presented him with stark choices, and moments when he could have chosen to ask deeper questions and learn more. How he handled them may shape his re-election campaign. They will certainly shape his legacy.
The Containment Illusion
By the last week of February, it was clear to the administration's public health team that schools and businesses in hot spots would have to close. But in the turbulence of the Trump White House, it took three more weeks to persuade the president that failure to act quickly to control the spread of the virus would have dire consequences.
When Dr. Robert Kadlec, the top disaster response official at the Health and Human Services Department, convened the White House coronavirus task force on Feb. 21, his agenda was urgent. There were deep cracks in the administration's strategy for keeping the virus out of the United States. They were going to have to lock down the country to prevent it from spreading. The question was: When?
There had already been an alarming spike in new cases around the world and the virus was spreading across the Middle East. It was becoming apparent that the administration had botched the rollout of testing to track the virus at home, and a smaller-scale surveillance program intended to piggyback on a federal flu tracking system had also been stillborn.
In Washington, the president was not worried, predicting that by April, "when it gets a little warmer, it miraculously goes away." His White House had yet to ask Congress for additional funding to prepare for the potential cost of wide-scale infection across the country, and health care providers were growing increasingly nervous about the availability of masks, ventilators and other equipment.
What Mr. Trump decided to do next could dramatically shape the course of the pandemic — and how many people would get sick and die.
With that in mind, the task force had gathered for a tabletop exercise — a real-time version of a full-scale war gaming of a flu pandemic the administration had run the previous year. That earlier exercise, also conducted by Mr. Kadlec and called "Crimson Contagion," predicted 110 million infections, 7.7 million hospitalizations and 586,000 deaths following a hypothetical outbreak that started in China.
Facing the likelihood of a real pandemic, the group needed to decide when to abandon "containment" — the effort to keep the virus outside the U.S. and to isolate anyone who gets infected — and embrace "mitigation" to thwart the spread of the virus inside the country until a vaccine becomes available.
Among the questions on the agenda, which was reviewed by The New York Times, was when the department's secretary, Mr. Azar, should recommend that Mr. Trump take textbook mitigation measures "such as school dismissals and cancellations of mass gatherings," which had been identified as the next appropriate step in a Bush-era pandemic plan.
The exercise was sobering. The group — including Dr. Anthony S. Fauci of the National Institutes of Health; Dr. Robert R. Redfield of the Centers for Disease Control and Prevention, and Mr. Azar, who at that stage was leading the White House Task Force — concluded they would soon need to move toward aggressive social distancing, even at the risk of severe disruption to the nation's economy and the daily lives of millions of Americans.
If Dr. Kadlec had any doubts, they were erased two days later, when he stumbled upon an email from a researcher at the Georgia Institute of Technology, who was among the group of academics, government physicians and infectious diseases doctors who had spent weeks tracking the outbreak in the Red Dawn email chain.
A 20-year-old Chinese woman had infected five relatives with the virus even though she never displayed any symptoms herself. The implication was grave — apparently healthy people could be unknowingly spreading the virus — and supported the need to move quickly to mitigation.
"Is this true?!" Dr. Kadlec wrote back to the researcher. "If so we have a huge whole on our screening and quarantine effort," including a typo where he meant hole. Her response was blunt: "People are carrying the virus everywhere."
The following day, Dr. Kadlec and the others decided to present Mr. Trump with a plan titled "Four Steps to Mitigation," telling the president that they needed to begin preparing Americans for a step rarely taken in United States history.
But over the next several days, a presidential blowup and internal turf fights would sidetrack such a move. The focus would shift to messaging and confident predictions of success rather than publicly calling for a shift to mitigation.
These final days of February, perhaps more than any other moment during his tenure in the White House, illustrated Mr. Trump's inability or unwillingness to absorb warnings coming at him. He instead reverted to his traditional political playbook in the midst of a public health calamity, squandering vital time as the coronavirus spread silently across the country.
Dr. Kadlec's group wanted to meet with the president right away, but Mr. Trump was on a trip to India, so they agreed to make the case to him in person as soon as he returned two days later. If they could convince him of the need to shift strategy, they could immediately begin a national education campaign aimed at preparing the public for the new reality.
A memo dated Feb. 14, prepared in coordination with the National Security Council and titled "U.S. Government Response to the 2019 Novel Coronavirus," documented what more drastic measures would look like, including: "significantly limiting public gatherings and cancellation of almost all sporting events, performances, and public and private meetings that cannot be convened by phone. Consider school closures.
Widespread 'stay at home' directives from public and private organizations with nearly 100% telework for some."
The memo did not advocate an immediate national shutdown, but said the targeted use of "quarantine and isolation measures" could be used to slow the spread in places where "sustained human-to-human transmission" is evident.
Within 24 hours, before they got a chance to make their presentation to the president, the plan went awry.
Mr. Trump was walking up the steps of Air Force One to head home from India on Feb. 25 when Dr. Nancy Messonnier, the director of the National Center for Immunization and Respiratory Diseases, publicly issued the blunt warning they had all agreed was necessary. But Dr. Messonnier had jumped the gun. They had not told the president yet, much less gotten his consent.
On the 18-hour plane ride home, Mr. Trump fumed as he watched the stock market crash after Dr. Messonnier's comments. Furious, he called Mr. Azar when he landed at around 6 a.m. on Feb. 26, raging that Dr. Messonnier had scared people unnecessarily. Already on thin ice with the president over a variety of issues and having overseen the failure to quickly produce an effective and widely available test, Mr. Azar would soon find his authority reduced.
The meeting that evening with Mr. Trump to advocate social distancing was canceled, replaced by a news conference in which the president announced that the White House response would be put under the command of Vice President Mike Pence.
The push to convince Mr. Trump of the need for more assertive action stalled. With Mr. Pence and his staff in charge, the focus was clear: no more alarmist messages. Statements and media appearances by health officials like Dr. Fauci and Dr. Redfield would be coordinated through Mr. Pence's office. It would be more than three weeks before Mr. Trump would announce serious social distancing efforts, a lost period during which the spread of the virus accelerated rapidly.
Over nearly three weeks from Feb. 26 to March 16, the number of confirmed coronavirus cases in the United States grew from 15 to 4,226.
Since then, nearly half a million Americans have tested positive for the virus and authorities say hundreds of thousands more are likely infected.
The China Factor
The earliest warnings about coronavirus got caught in the crosscurrents of the administration's internal disputes over China. It was the China hawks who pushed earliest for a travel ban. But their animosity toward China also undercut hopes for a more cooperative approach by the world's two leading powers to a global crisis.
It was early January, and the call with a Hong Kong epidemiologist left Matthew Pottinger rattled.
Mr. Pottinger, the deputy national security adviser and a hawk on China, took a blunt warning away from the call with the doctor, a longtime friend: A ferocious, new outbreak that on the surface appeared similar to the SARS epidemic of 2003 had emerged in China. It had spread far more quickly than the government was admitting to, and it wouldn't be long before it reached other parts of the world.
Mr. Pottinger had worked as a Wall Street Journal correspondent in Hong Kong during the SARS epidemic, and was still scarred by his experience documenting the death spread by that highly contagious virus.
Now, seventeen years later, his friend had a blunt message: You need to be ready. The virus, he warned, which originated in the city of Wuhan, was being transmitted by people who were showing no symptoms — an insight that American health officials had not yet accepted. Mr. Pottinger declined through a spokesman to comment.
It was one of the earliest warnings to the White House, and it echoed the intelligence reports making their way to the National Security Council. While most of the early assessments from the C.I.A. had little more information than was available publicly, some of the more specialized corners of the intelligence world were producing sophisticated and chilling warnings.
In a report to the director of national intelligence, the State Department's epidemiologist wrote in early January that the virus was likely to spread across the globe, and warned that the coronavirus could develop into a pandemic. Working independently, a small outpost of the Defense Intelligence Agency, the National Center for Medical Intelligence, came to the same conclusion. Within weeks after getting initial information about the virus early in the year, biodefense experts inside the National Security Council, looking at what was happening in Wuhan, started urging officials to think about what would be needed to quarantine a city the size of Chicago.
By mid-January there was growing evidence of the virus spreading outside China. Mr. Pottinger began convening daily meetings about the coronavirus. He alerted his boss, Robert C. O'Brien, the national security adviser.
The early alarms sounded by Mr. Pottinger and other China hawks were freighted with ideology — including a push to publicly blame China that critics in the administration say was a distraction as the coronavirus spread to Western Europe and eventually the United States.
And they ran into opposition from Mr. Trump's economic advisers, who worried a tough approach toward China could scuttle a trade deal that was a pillar of Mr. Trump's re-election campaign.
With his skeptical — some might even say conspiratorial — view of China's ruling Communist Party, Mr. Pottinger initially suspected that President Xi Jinping's government was keeping a dark secret: that the virus may have originated in one of the laboratories in Wuhan studying deadly pathogens. In his view, it might have even been a deadly accident unleashed on an unsuspecting Chinese population.
During meetings and telephone calls, Mr. Pottinger asked intelligence agencies — including officers at the C.I.A. working on Asia and on weapons of mass destruction — to search for evidence that might bolster his theory.
They didn't have any evidence. Intelligence agencies did not detect any alarm inside the Chinese government that analysts presumed would accompany the accidental leak of a deadly virus from a government laboratory. But Mr. Pottinger continued to believe the coronavirus problem was far worse than the Chinese were acknowledging. Inside the West Wing, the director of the Domestic Policy Council, Joe Grogan, also tried to sound alarms that the threat from China was growing.
Mr. Pottinger, backed by Mr. O'Brien, became one of the driving forces of a campaign in the final weeks of January to convince Mr. Trump to impose limits on travel from China — the first substantive step taken to impede the spread of the virus and one that the president has repeatedly cited as evidence that he was on top of the problem.
In addition to the opposition from the economic team, Mr. Pottinger and his allies among the China hawks had to overcome initial skepticism from the administration's public health experts.
Travel restrictions were usually counterproductive to managing biological outbreaks because they prevented doctors and other much-needed medical help from easily getting to the affected areas, the health officials said. And such bans often cause infected people to flee, spreading the disease further.
But on the morning of Jan. 30, Mr. Azar got a call from Dr. Fauci, Dr. Redfield and others saying they had changed their minds. The World Health Organization had declared a global public health emergency and American officials had discovered the first confirmed case of person-to-person transmission inside the United States.
The economic team, led by Treasury Secretary Steven Mnuchin, continued to argue that there were big risks in taking a provocative step toward China and moving to curb global travel. After a debate, Mr. Trump came down on the side of the hawks and the public health team. The limits on travel from China were publicly announced on Jan. 31.
Still, Mr. Trump and other senior officials were wary of further upsetting Beijing. Besides the concerns about the impact on the trade deal, they knew that an escalating confrontation was risky because the United States relies heavily on China for pharmaceuticals and the kinds of protective equipment most needed to combat the coronavirus.
But the hawks kept pushing in February to take a critical stance toward China amid the growing crisis. Mr. Pottinger and others — including aides to Secretary of State Mike Pompeo — pressed for government statements to use the term "Wuhan Virus."
Mr. Pompeo tried to hammer the anti-China message at every turn, eventually even urging leaders of the Group of 7 industrialized countries to use "Wuhan virus" in a joint statement.
Others, including aides to Mr. Pence, resisted taking a hard public line, believing that angering Beijing might lead the Chinese government to withhold medical supplies, pharmaceuticals and any scientific research that might ultimately lead to a vaccine.
Mr. Trump took a conciliatory approach through the middle of March, praising the job Mr. Xi was doing.
That changed abruptly, when aides informed Mr. Trump that a Chinese Foreign Ministry spokesman had publicly spun a new conspiracy about the origins of Covid-19: that it was brought to China by U.S. Army personnel who visited the country last October.
Mr. Trump was furious, and he took to his favorite platform to broadcast a new message. On March 16, he wrote on Twitter that "the United States will be powerfully supporting those industries, like Airlines and others, that are particularly affected by the Chinese Virus."
Mr. Trump's decision to escalate the war of words undercut any remaining possibility of broad cooperation between the governments to address a global threat. It remains to be seen whether that mutual suspicion will spill over into efforts to develop treatments or vaccines, both areas where the two nations are now competing.
One immediate result was a free-for-all across the United States, with state and local governments and hospitals bidding on the open market for scarce but essential Chinese-made products. When the state of Massachusetts managed to procure 1.2 million masks, it fell to the owner of the New England Patriots, Robert K. Kraft, a Trump ally, to cut through extensive red tape on both sides of the Pacific to send his own plane to pick them up.
The Consequences of Chaos
The chaotic culture of the Trump White House contributed to the crisis.
A lack of planning and a failure to execute, combined with the president's focus on the news cycle and his preference for following his gut rather than the data cost time, and perhaps lives.
Inside the West Wing, Mr. Navarro, Mr. Trump's trade adviser, was widely seen as quick-tempered, self-important and prone to butting in. He is among the most outspoken of China hawks and in late January was clashing with the administration's health experts over limiting travel from China.
So it elicited eye rolls when, after initially being prevented from joining the coronavirus task force, he circulated a memo on Jan. 29 urging Mr. Trump to impose the travel limits, arguing that failing to confront the outbreak aggressively could be catastrophic, leading to hundreds of thousands of deaths and trillions of dollars in economic losses.
The uninvited message could not have conflicted more with the president's approach at the time of playing down the severity of the threat. And when aides raised it with Mr. Trump, he responded that he was unhappy that Mr. Navarro had put his warning in writing.
From the time the virus was first identified as a concern, the administration's response was plagued by the rivalries and factionalism that routinely swirl around Mr. Trump and, along with the president's impulsiveness, undercut decision making and policy development.
Faced with the relentless march of a deadly pathogen, the disagreements and a lack of long-term planning had significant consequences. They slowed the president's response and resulted in problems with execution and planning, including delays in seeking money from Capitol Hill and a failure to begin broad surveillance testing.
The efforts to shape Mr. Trump's view of the virus began early in January, when his focus was elsewhere: the fallout from his decision to kill Maj. Gen. Qassim Suleimani, Iran's security mastermind; his push for an initial trade deal with China; and his Senate impeachment trial, which was about to begin.
Even after Mr. Azar first briefed him about the potential seriousness of the virus during a phone call on Jan. 18 while the president was at his Mar-a-Lago resort in Florida, Mr. Trump projected confidence that it would be a passing problem.
"We have it totally under control," he told an interviewer a few days later while attending the World Economic Forum in Switzerland. "It's going to be just fine."
Back in Washington, voices outside of the White House peppered Mr. Trump with competing assessments about what he should do and how quickly he should act.
The efforts to sort out policy behind closed doors were contentious and sometimes only loosely organized.
That was the case when the National Security Council convened a meeting on short notice on the afternoon of Jan. 27. The Situation Room was standing room only, packed with top White House advisers, low-level staffers, Mr. Trump's social media guru, and several cabinet secretaries. There was no checklist about the preparations for a possible pandemic, which would require intensive testing, rapid acquisition of protective gear, and perhaps serious limitations on Americans' movements.
Instead, after a 20-minute description by Mr. Azar of his department's capabilities, the meeting was jolted when Stephen E. Biegun, the newly installed deputy secretary of state, announced plans to issue a "level four" travel warning, strongly discouraging Americans from traveling to China. The room erupted into bickering.
A few days later, on the evening of Jan. 30, Mick Mulvaney, the acting White House chief of staff at the time, and Mr. Azar called Air Force One as the president was making the final decision to go ahead with the restrictions on China travel. Mr. Azar was blunt, warning that the virus could develop into a pandemic and arguing that China should be criticized for failing to be transparent.
Mr. Trump rejected the idea of criticizing China, saying the country had enough to deal with. And if the president's decision on the travel restrictions suggested that he fully grasped the seriousness of the situation, his response to Mr. Azar indicated otherwise.
Stop panicking, Mr. Trump told him.
That sentiment was present throughout February, as the president's top aides reached for a consistent message but took few concrete steps to prepare for the possibility of a major public health crisis.
During a briefing on Capitol Hill on Feb. 5, senators urged administration officials to take the threat more seriously. Several asked if the administration needed additional money to help local and state health departments prepare.
Derek Kan, a senior official from the Office of Management and Budget, replied that the administration had all the money it needed, at least at that point, to stop the virus, two senators who attended the briefing said.
"Just left the Administration briefing on Coronavirus," Senator Christopher S. Murphy, Democrat of Connecticut, wrote in a tweet shortly after. "Bottom line: they aren't taking this seriously enough." The administration also struggled to carry out plans it did agree on.
In mid-February, with the effort to roll out widespread testing stalled, Mr. Azar announced a plan to repurpose a flu-surveillance system in five major cities to help track the virus among the general population. The effort all but collapsed even before it got started as Mr. Azar struggled to win approval for $100 million in funding and the C.D.C. failed to make reliable tests available.
The number of infections in the United States started to surge through February and early March, but the Trump administration did not move to place large-scale orders for masks and other protective equipment, or critical hospital equipment, such as ventilators. The Pentagon sat on standby, awaiting any orders to help provide temporary hospitals or other assistance.
As February gave way to March, the president continued to be surrounded by divided factions even as it became clearer that avoiding more aggressive steps was not tenable.
Mr. Trump had agreed to give an Oval Office address on the evening of March 11 announcing restrictions on travel from Europe, where the virus was ravaging Italy. But responding to the views of his business friends and others, he continued to resist calls for social distancing, school closures and other steps that would imperil the economy.
But the virus was already multiplying across the country — and hospitals were at risk of buckling under the looming wave of severely ill people, lacking masks and other protective equipment, ventilators and sufficient intensive care beds. The question loomed over the president and his aides after weeks of stalling and inaction: What were they going to do?
The approach that Mr. Azar and others had planned to bring to him weeks earlier moved to the top of the agenda. Even then, and even by Trump White House standards, the debate over whether to shut down much of the country to slow the spread was especially fierce.
Always attuned to anything that could trigger a stock market decline or an economic slowdown that could hamper his re-election effort, Mr. Trump also reached out to prominent investors like Stephen A. Schwarzman, the chief executive of Blackstone Group, a private equity firm.
"Everybody questioned it for a while, not everybody, but a good portion questioned it," Mr. Trump said earlier this month. "They said, let's keep it open. Let's ride it."
In a tense Oval Office meeting, when Mr. Mnuchin again stressed that the economy would be ravaged, Mr. O'Brien, the national security adviser, who had been worried about the virus for weeks, sounded exasperated as he told Mr. Mnuchin that the economy would be destroyed regardless if officials did nothing.
Soon after the Oval Office address, Dr. Scott Gottlieb, the former commissioner of the Food and Drug Administration and a trusted sounding board inside the White House, visited Mr. Trump, partly at the urging of Jared Kushner, the president's son-in-law. Dr. Gottlieb's role was to impress upon the president how serious the crisis could become. Mr. Pence, by then in charge of the task force, also played a key role at that point in getting through to the president about the seriousness of the moment in a way that Mr. Azar had not.
But in the end, aides said, it was Dr. Deborah L. Birx, the veteran AIDS researcher who had joined the task force, who helped to persuade Mr. Trump. Soft-spoken and fond of the kind of charts and graphs Mr. Trump prefers, Dr. Birx did not have the rough edges that could irritate the president. He often told people he thought she was elegant.
On Monday, March 16, Mr. Trump announced new social distancing guidelines, saying they would be in place for two weeks. The subsequent economic disruptions were so severe that the president repeatedly suggested that he wanted to lift even those temporary restrictions. He frequently asked aides why his administration was still being blamed in news coverage for the widespread failures involving testing, insisting the responsibility had shifted to the states.
During the last week in March, Kellyanne Conway, a senior White House adviser involved in task force meetings, gave voice to concerns other aides had. She warned Mr. Trump that his wished-for date of Easter to reopen the country likely couldn't be accomplished. Among other things, she told him, he would end up being blamed by critics for every subsequent death caused by the virus.
Within days, he watched images on television of a calamitous situation at Elmhurst Hospital Center, miles from his childhood home in Queens, N.Y., where 13 people had died from the coronavirus in 24 hours.
Eric Lipton is a Washington-based investigative reporter. A three-time winner of the Pulitzer Prize, he previously worked at The Washington Post and The Hartford Courant. @EricLiptonNYT
David E. Sanger is a national security correspondent. In a 36-year reporting career for The Times, he has been on three teams that have won Pulitzer Prizes, most recently in 2017 for international reporting. His newest book is "The Perfect Weapon: War, Sabotage and Fear in the Cyber Age." @SangerNYT • Facebook
Maggie Haberman is a White House correspondent. She joined The Times in 2015 as a campaign correspondent and was part of a team that won a Pulitzer Prize in 2018 for reporting on President Trump's advisers and their connections to Russia. @maggieNYT
Michael D. Shear is a White House correspondent. He previously worked at The Washington Post and was a member of their Pulitzer Prize-winning team that covered the Virginia Tech shootings in 2007. @shearm
Mark Mazzetti is a Washington investigative correspondent, a job he assumed after covering national security from the Washington bureau for 10 years. He was part of a team that won a Pulitzer Prize in 2018 for reporting on Donald Trump's advisers and their connections to Russia. @MarkMazzettiNYT
Julian E. Barnes is a national security reporter based in Washington, covering the intelligence agencies. Before joining The Times in 2018, he wrote about security matters for The Wall Street Journal. @julianbarnes • Facebook