The outbreak of the respiratory virus began in China and
was quickly spread around the world by air travelers, who ran high
fevers. In the United States, it was first detected in Chicago, and 47
days later, the World Health Organization declared a pandemic. By then
it was too late: 110 million Americans were expected to become ill,
leading to 7.7 million hospitalized and 586,000 dead.That
scenario, code-named “Crimson Contagion” and imagining an influenza
pandemic, was simulated by the Trump administration’s Department of
Health and Human Services in a series of exercises that ran from last
January to August.
The simulation’s sobering results —
contained in a draft report dated October 2019
that has not previously been reported — drove home just how
underfunded, underprepared and uncoordinated the federal government
would be for a life-or-death battle with a virus for which no treatment
existed.
The draft report, marked “not to be disclosed,” laid out
in stark detail repeated cases of “confusion” in the exercise. Federal
agencies jockeyed over who was in charge. State officials and hospitals
struggled to figure out what kind of equipment was stockpiled or
available. Cities and states went their own ways on school closings.
Many
of the potentially deadly consequences of a failure to address the
shortcomings are now playing out in all-too-real fashion across the
country. And it was hardly the first warning for the nation’s leaders.
Three times over the past four years the U.S. government, across two
administrations, had grappled in depth with what a pandemic would look
like, identifying likely shortcomings and in some cases recommending
specific action.
In 2016, the Obama administration produced a
comprehensive report
on the lessons learned by the government from battling Ebola. In
January 2017, outgoing Obama administration officials ran an extensive
exercise on responding to a pandemic for incoming senior officials of
the Trump administration.
The full story of the Trump
administration’s response to the coronavirus is still playing out.
Government officials, health professionals, journalists and historians
will spend years looking back on the muddled messages and missed
opportunities of the past three months, as President Trump moved from
dismissing the coronavirus as a few cases that would soon be “under
control” to
his revisionist announcement on Monday that he had known all along that a pandemic was on the way.
What
the scenario makes clear, however, is that his own administration had
already modeled a similar pandemic and understood its potential
trajectory.
The
White House defended its record, saying it responded to the 2019
exercise with an executive order to improve the availability and quality
of flu vaccines, and that it moved early this year to
increase funding for the Department of Health and Human Services’ program that focuses on global pandemic threats.
“Any
suggestion that President Trump did not take the threat of COVID-19
seriously is false,” said Judd Deere, a White House spokesman.
But
officials have declined to say why the administration was so slow to
roll out broad testing or to move faster, as the simulations all
indicated it should, to urge social distancing and school closings.
Asked
at his news briefing on Thursday about the government’s preparedness,
Mr. Trump responded: “Nobody knew there would be a pandemic or epidemic
of this proportion. Nobody has ever seen anything like this before.”
The
work done over the past five years, however, demonstrates that the
government had considerable knowledge about the risks of a pandemic and
accurately predicted the very types of problems Mr. Trump is now
scrambling belatedly to address.
Crimson Contagion, the exercise
conducted last year in Washington and 12 states including New York and
Illinois, showed that federal agencies under Mr. Trump continued the
Obama-era effort to think ahead about a pandemic.
But the planning and thinking happened many
layers down in the bureaucracy. The knowledge and sense of urgency about
the peril appear never to have gotten sufficient attention at the
highest level of the executive branch or from Congress, leaving the
nation with funding shortfalls, equipment shortages and disorganization
within and among various branches and levels of government.
The
October 2019 report in particular documents that officials at the
Departments of Homeland Security and Health and Human Services, and even
at the White House’s National Security Council, were aware of the
potential for a respiratory virus outbreak originating in China to
spread quickly to the United States and overwhelm the nation.
“Nobody ever thought of numbers like this,’’ Mr. Trump said on Wednesday, at a news conference.
In fact, they had.
As
early as the George W. Bush administration, homeland security and
health officials focused on big gaps in the American response to a
biological attacks and the growing risk of pandemics. The first test
came in April 2009, just a few months after the start of President
Barack Obama’s first term. A 10-year-old California girl was diagnosed
with a contagious disease that would be called swine flu or H1N1, the
first flu pandemic in more than 40 years.
The
Centers for Disease Control and Prevention estimates
that ultimately there were about 60.8 million cases in the United
States, along with 274,304 hospitalizations and 12,469 deaths associated
with H1N1.
The virus
turned out to be less deadly than first expected.
But it was a warning shot that officials in the Obama administration
said they took seriously, kicking off a planning effort that escalated
in early 2014, with the outbreak of Ebola in West Africa and ensuing
fear that it could spread to the United States.
Ebola was less
contagious than the flu, but far more deadly. It killed 11,000 people in
Africa. But it could have been far worse. The United States sent nearly
3,000 troops to Africa to help keep the disease from spreading. While
the containment effort was considered a success, inside the White House,
officials sensed that the United States had gotten lucky — and that the
response had revealed gaps in preparedness.
Christopher
Kirchhoff, a national security aide who moved from the Pentagon to the
White House to deal with the Ebola crisis, was given the job of putting
together a “lessons learned” report, with input from across the
government.
The weaknesses Mr. Kirchhoff identified were early warning signals of what has unfolded in the past three months.
His report
concluded that the United States assumed more ability on the part of
the World Health Organization than the agency actually had.
The
United States had its own issues. There was no airplane in the U.S.
fleet capable of evacuating an American doctor who was infected while
treating patients in Liberia. The Pentagon was largely unprepared for
the intervention that Mr. Obama ordered.
While the United States
rapidly developed a way to screen air passengers coming into the country
— borrowing from intelligence tools developed after the Sept. 11, 2001,
attacks to track possible terrorists — Mr. Kirchhoff found deficiencies
in even measuring how fast the virus was spreading.
On
the plus side, the Obama White House had created an Ebola Task Force,
run by Ron Klain, Vice President Joseph R. Biden Jr.’s former chief of
staff, before a single case emerged in the United States. Congress
allocated $5.4 billion in emergency funding to pay for Ebola treatment
and prevention efforts in the United States and West Africa.
The
money helped fund a little-known agency inside the Department of Health
and Human Services in charge of preparing for future contagious disease
outbreaks, the same office that in 2019 ran the Crimson Contagion
exercise and other similar events in the years since.
After a man
named Thomas Duncan, a Liberian citizen, became the first person given a
diagnosis of Ebola on American territory in September 2014,
errors resulted in the infection of two nurses and fear of a wider spread in the United States. (
Mr. Duncan died, but the two nurses recovered.)
What
is striking in reading Mr. Kirchhoff’s account today, however, is how
few of the major faults he found in the American response resulted in
action — even though the report was filled with department-by-department
recommendations.
There were deficiencies “in personal protective
equipment use, disinfection” and “social services for those placed under
quarantine.”
There was confusion over travel restrictions, and
the need “for a smoother sliding scale of escalation of government
response, from local authorities acting on their own to local
authorities acting with some federal assistance” to the full activation
of the federal government.
The report concluded that “a minimum
planning benchmark might be an epidemic an order of magnitude or two
more difficult than that presented by the outbreak of Ebola in West
Africa, with much more significant domestic spread.”
But one big
change did come out of the study: The creation of a dedicated office at
the National Security Council to coordinate responses and raise the
alarm early.
“What
I learned most is that we had to stand up a global biosecurity and
health directorate, and get it enshrined for the next administration,”
said Lisa Monaco, Mr. Obama’s homeland security adviser.
After
Mr. Trump’s election, Ms. Monaco arranged an extensive exercise for
high-level incoming officials — including Rex W. Tillerson, the nominee
for secretary of state; John F. Kelly, designated to become homeland
security secretary; and Rick Perry, who would become energy secretary —
gaming out the response to a deadly flu outbreak.
She asked Tom Bossert, who was preparing to come in as Mr. Trump’s homeland security adviser, to run the event alongside her.
“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.”
Ms. Monaco was impressed by how seriously Mr.
Bossert, her successor, appeared to take the threat, as did many of the
30 or so Trump team members who participated in the exercise, details of
which were
reported by Politico.
But
by the time the current crisis hit, almost all of the leaders at the
table — Mr. Tillerson, Mr. Kelly and Mr. Perry among them — had been
fired or moved on.
In
2018, Mr. Trump’s national security adviser at the time, John R.
Bolton, ousted Mr. Bossert and eliminated the National Security Council
directorate, folding it into an office dedicated to weapons of mass
destruction in what Trump officials called a logical consolidation.
Asked about that shift on March 13, Mr. Trump told a reporter that it was “
a nasty question,”
before adding: “I don’t know anything about it.” Writing on Twitter the
next day, Mr. Bolton lashed out at critics who said the shift had
reflected disregard for pandemic threats.
“Claims that streamlining NSC structures impaired our nation’s bio defense are false,”
Mr. Bolton tweeted. “Global health remained a top NSC priority.”
In
a statement, the National Security Council said it “has directors and
staff whose full-time job it is to monitor, plan for, and respond to
pandemics, including an infectious disease epidemiologist and a
virologist.”
But in testimony to Congress last week, Dr. Anthony
S. Fauci, the director of the National Institute of Allergy and
Infectious Diseases, suggested that ending the stand-alone directorate
was ill-advised. “It would be nice if the office was still there,” he
said.
On Feb. 10,
nearly three weeks after
the first coronavirus case was diagnosed in the United States, Mr.
Trump submitted a 2021 budget proposal that called for a $693.3 million
reduction in funding for the C.D.C., or about 9 percent, although there
was a modest increase for the division that combats global pandemics.
The
Crimson Contagion planning exercise run last year by the Department of
Health and Human Services involved officials from 12 states and at least
a dozen federal agencies. They included the Pentagon, the Department of
Veterans Affairs and the National Security Council. Groups like the
American Red Cross and American Nurses Association were invited to join,
as were health insurance companies and major hospitals like the Mayo
Clinic.
The war game-like exercise was overseen by Robert P.
Kadlec, a former Air Force physician who has spent decades focused on
biodefense issues. After stints on the Bush administration’s Homeland
Security Council and the staff of the Senate Intelligence Committee, he
was appointed assistant secretary of Health and Human Services for
Preparedness and Response.
“He recognized early that we have a big
problem and we needed much bigger budgets to prepare,” said Richard
Danzig, the secretary of the Navy in the Clinton administration, who had
worked with Mr. Kadlec.
The exercise played out in four separate stages, starting in January 2019.
The
events were supposedly unspooling in real time — with the worst-case
scenario underway as of Aug. 13, 2019 — when, according to the script,
12,100 cases had already been reported in the United States, with the
largest number in Chicago, which had 1,400.
The fictional outbreak
involved a pandemic flu, which the Department of Health and Human
Services says was “very different than the novel coronavirus.” The
staged outbreak had started when a group of 35 tourists visiting China
were infected and then flew home to Australia, Kuwait, Malaysia,
Thailand, Britain and Spain, as well as to the United States, with some
developing respiratory symptoms and fevers en route.
A 52-year-old
man from Chicago, who was on the tour, had “low energy and a dry cough”
upon his return home. His 17-year-old son on that same day went out to a
large public event in Chicago, and the chain of illnesses in the United
States started.
Many of the moments during the tabletop exercise are now chillingly familiar.
In
the fictional pandemic, as the virus spread quickly across the United
States, the C.D.C. issued guidelines for social distancing, and many
employees were told to work from home.
But
federal and state officials struggled to identify which employees were
essential and what equipment was needed to effectively work from home.
There
also was confusion over how to handle school children. The C.D.C.
recommended that states delay school openings — the exercise took place
toward the end of the summer. But some school districts decided to go
ahead with the start of school while others followed the federal advice,
causing the
same types of confusion and discrepancies that have marked the response to the coronavirus.
The
exercise from last year then went on to predict how the situation on
the ground in the United States would worsen as the weeks passed.
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.
Friction also emerged between the
Federal
Emergency Management Agency, which is traditionally in charge of
disaster response, and the Department of Health and Human Services, another scenario playing out now.
But
the problems were larger than bureaucratic snags. 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.
Congress was
briefed in December
on some of these findings, including the inability to quickly replenish
certain medical supplies, given that much of the product comes from
overseas.
These
concerns turned more urgent at a hearing last Thursday on Capitol Hill,
as lawmakers peppered officials with the Department of Health and Human
Services with questions that sounded almost as if they had read the
script from the fictional exercise, reflecting the shortage of
respirators and protective gear.
Senator Mitt Romney, Republican
of Utah, said last week that he blamed Congress and prior
administrations for not increasing stockpiles of this type of equipment.
“That
is an area we ought to consider making an investment in,” he added,
making a point, apparently unknown to him, that the administration’s own
simulation had made clear five months earlier.
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