The Four Men Responsible For America's COVID-19 Test Disaster

The Four Men Responsible For America's COVID-19 Test Disaster

(Published by Rolling Stone, June, 2020)

Dr. Robert Redfield, the director of the Centers for Disease Control, flanked Donald Trump at the podium in the White House briefing room. It was February 29th, the day of the first reported U.S. death from the coronavirus, and the president fielded an urgent question: “How should Americans prepare for this virus?” a reporter asked. “Should they go on with their daily lives? Change their routine? What should they do?”

In that moment, America was flying blind into a pandemic; the virus was on the loose, and nobody quite knew where. The lives of tens of thousands hinged on the advice about to be delivered by the president and his top public-health advisers. Trump began: “Well, I hope they don’t change their routine,” before he trailed off, and, quite uncharacteristically, called on an expert to finish the response. “Bob?” he said. “Do you want to answer that?”

A tall man, with a tan, freckled head, and a snow-white chinstrap beard, Redfield stepped to the podium. “The risk at this time is low,” Redfield told the country. “The American public needs to go on with their normal lives.”

Welcome to the Trumpocalypse

This reassurance came at precisely, and tragically, the wrong time. With a different answer, much of the human devastation that was about to unfold in the United States would have been avoidable. Academic research from Imperial College in London, modeling the U.S. response, estimates that up to 90 percent of COVID-19 deaths could have been prevented had the U.S. moved to shut down by March 2nd. Instead, administration leaders dragged their feet for another two weeks, as the virus continued a silent, exponential assault. By early May, more than 75,000 Americans were dead.

Even as he spoke, Redfield knew the country should be taking a different course. The Coronavirus Task Force had resolved to present the president with a plan for mitigation efforts, like school and business closures, on February 24th, but reportedly reversed course after Trump exploded about the economic fallout. Instead, the CDC director continued touting “aggressive containment” to Congress on February 27th. Experts tell Rolling Stone that ship had sailed when the virus made the leap from infected travelers into the general public. “If you’ve got a community spreading respiratory virus, it’s not going to be containable,” says Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security. “You have to shift to mitigation right away.”

Patty Murray is the ranking member of the Senate’s top health committee, and represents Washington state, the nation’s first coronavirus hot spot. She blames the administration for a delay that “overwhelmed the health care system and resulted in tens of thousands of deaths.” And she singles out Redfield, in particular, for “dereliction of duty.”

Despite months of alarms that the coronavirus was lurking at our doorstep, the Trump administration failed to mount an urgent response until the nation was engulfed and overwhelmed by the pandemic.

“We had ample notice to get our country ready,” says Ron Klain, who served as President Obama’s Ebola czar, and lists the rolling out of testing, securing protective equipment, and building up hospital capacity as necessary preventative steps. “We spent all of January and February doing none of those things, and as a result, when this disease really exploded  in March, we weren’t prepared.”

The government leaders who failed to safeguard the nation are CDC Director Redfield; FDA Commissioner Stephen Hahn; Health and Human Services Secretary Alex Azar; and of course, President Trump. Together, these men had the power to change the direction of this pandemic, to lessen its impact on the economy, and constrain the death toll from COVID-19. Each failed, in a series of errors and mismanagement that grew into a singular catastrophe — or as Jared Kushner described it on Fox & Friends, “a great success story.”

Defeating an invisible enemy like the coronavirus requires working diagnostics. But when the CDC’s original test kit failed, there was no Plan B. The nation’s private-sector biomedical establishment is world-class, but the administration kept these resources cordoned behind red tape as the CDC foundered. Precious weeks slipped by — amid infighting, ass covering, and wasted effort — and the virus slipped through the nation’s crippled surveillance apparatus, taking root in hot spots across the country, and in particular, New York City.

The mismanagement cost lives. With adequate testing from the beginning, says Dr. Howard Forman, a Yale professor of public-health policy, “we would have been able to stop the spread of this virus in its tracks the way that many other nations have.” Instead, says Sen. Murray, the administration’s response was “wait until it’s too late, and then try and contain one of the most aggressive viruses that we’ve ever seen.”

Blind to the virus’s penetration and unable to target mitigation where it was needed, the administration and state governors had to resort to the blunt instrument of shuttering the economy, says Dr. Ashish Jha, director of the Harvard Global Health Institute. And the lack of testing kept us in limbo. “Our economy is shut down because we still do not have adequate testing,” Jha says. “We have been woefully behind from the beginning of this pandemic.”

If the president’s deputies made trillion-dollar mistakes, accountability for the pandemic response lies with Trump, who waived off months of harrowing intelligence briefings, choosing to treat the coronavirus as a crisis in public relations, rather than a public-health emergency. Having staked his re-election on a strong economy, Trump downplayed the virus.

To the horror of public-health experts, America remains rudderless in the crisis. Obama’s CDC director, Tom Frieden, says “you can look back with 20/20 hindsight on lots of things.” But even months into the response — and despite Vice President Mike Pence nominally at the helm of the Coronavirus Task Force — Frieden says he can’t discern who is actually in charge of the federal response, “and that’s dangerous.”

The coronavirus would be a devilish test of any president’s leadership, but Trump has failed beyond measure. And the errors are metastasizing. “The failed coronavirus response is not a story of mistakes that were made and have now been fixed,” Klain says. “It’s the story of mistakes that continue to cost lives.”

THE ZEALOT

The front-line agency built to respond to a pandemic, the CDC, was placed in unreliable hands. Dr. Robert Redfield is a right-wing darling with a checkered scientific past. His 2018 nomination was a triumph for the Christian right, a coup in particular for evangelical activists Shepherd and Anita Smith, who have been instrumental in driving a global AIDS strategy centered on abstinence.

Redfield’s tight-knit relationship with the Smiths goes back at least three decades, beginning when Shepherd Smith recruited him to join the board of his religious nonprofit, Americans for a Sound AIDS/HIV Policy (ASAP). The Smiths made their views plain in the 1990 book Christians in the Age of AIDS, which argued HIV infection resulted from “people’s sinfulness,” and described AIDS as a consequence for those who “violate God’s laws.” Redfield, a devout Catholic who was then a prominent HIV researcher in the Army, wrote the introduction, calling for the rejection of “false prophets who preach the quick-fix strategies of condoms and free needles.”

Redfield was a rising star at the Walter Reed Army Institute of Research, whose name had been floated as a candidate for surgeon general. But the late 1980s were benighted times in the AIDS epidemic, and Redfield championed discriminatory policies that he defended as “good medicine” — including quarantining of HIV-positive soldiers in a segregated barracks. These soldiers were routinely given dishonorable discharges after superiors rooted out evidence of homosexuality, and left to suffer the course of their devastating disease without health insurance. “It was dark,” remembers Laurie Garrett, the Pulitzer Prize-winning author of The Coming Plague, who reported on Redfield’s actions. “It was the opposite of compassion.”

Redfield’s Army career derailed after he was accused of “sloppy or, possibly, deceptive” research for touting a trial HIV therapy that later proved useless. An investigation found no wrongdoing, but called out his “inappropriately close” relationship with Shepherd Smith, who also hyped the drug. Redfield insisted there was “no basis for any of the allegations,” but the scandal spurred his departure to a research lab at the University of Maryland.

Still, Redfield’s résumé — religious-right bona fides, a military background, and a knack for ingratiating himself with powerful people — primed his return to government. “Over the years, there have been several attempts to push him into powerful slots within Republican administrations,” says Garrett. “I don’t think most of his promoters have ever been particularly interested in the science.”

When his CDC appointment was announced in March 2018, Sen. Murray warned of Redfield’s “pattern of ethically and morally questionable behavior,” as well as his “lack of public-health expertise,” and urged Trump to “reconsider.” But the CDC post does not require Senate approval. Redfield sought to reassure CDC staff that his views had modernized, and that he now embraced condoms to slow HIV infection. He insisted at an all-hands meeting, “I’ve never been an abstinence-only person.” In point of fact, Redfield co-authored a 1987 textbook, AIDS & Young People, that preached abstinence until marriage, writing that “medicine and morality tell us the same thing.” It warned, in all caps, against the notion of safe sex: “IF YOU ENGAGE IN CLOSE SEXUAL CONDUCT, YOU ARE PLAYING RUSSIAN ROULETTE WITH YOUR LIFE.”

THE INSIDER

The CDC reports to the Department of Health and Human Services, led by Alex Azar, a former executive for the pharmaceutical giant Eli Lilly who gained infamy, in his five-year tenure, by doubling the price of insulin.

Azar is a creature of the GOP establishment: He cut his teeth as a Supreme Court clerk to Antonin Scalia, worked with Brett Kavanaugh on the Clinton-Whitewater investigation under special counsel Ken Starr, and served as a deputy HHS administrator in the George W. Bush era, before becoming Eli Lilly’s top lobbyist. Azar, 52, is the type of corporate leader Republicans have long touted as capable of driving efficiencies in the unwieldy federal bureaucracy. Senate Majority leader Mitch McConnell praised Azar’s nomination in 2017, insisting, “Alex brings a wealth of private-sector knowledge that will prepare him well for this crucial role.”

Azar sought to shrink the CDC, an agency that has been on the chopping block throughout the Trump administration. In HHS’s most recent budget proposal — unveiled this past February, 10 days after the World Health Organization declared a global emergency over the coronavirus — Azar sought an $85 million cut to the CDC’s Emerging and Zoonotic Infectious Diseases program and a $25 million cut to Public Health Preparedness and Response. Azar defended the budget at the time as making “difficult, prudent choices.”

The Trump administration had also hollowed out the CDC’s China presence, slashing staff from 47 to barely a dozen. These cuts were part of a broad-reaching drawdown of America’s disease preparedness, including Trump’s decision to disband the National Security Counsel’s pandemic-response team. In late 2018, Azar’s HHS rejected a proposal, solicited by the Obama administration, to buy a machine capable of churning out 1.5 million N95 respirators a day, for use in a pandemic.

Despite this austerity crusade, the CDC’s initial response to the outbreak was by the book. On January 3rd, Redfield spoke with Chinese colleagues about a mysterious viral outbreak causing a rash of pneumonia cases in Wuhan, and immediately informed Azar. On January 11th, the Chinese published the genetic sequence of the novel coronavirus, and the CDC began creating a diagnostic test.

The CDC wasn’t alone in this effort. Research labs across the country were racing to come up with their own assays. “Every molecular virologist I knew had a test before the CDC did,” says Dr. Donald Milton, who runs the Public Health Aerobiology, Virology, and Exhaled Biomarker Laboratory at the University of Maryland. By January 16th, a German company had produced a reliable diagnostic that WHO would adopt as its own. Five days later, the CDC announced it had a working test — which it used to diagnose the first known U.S. coronavirus patient, a Wuhan traveler near Seattle.

Rick Bright directed HHS’s Biomedical Advanced Research and Development Authority until his ouster in April. In a whistleblower complaint, he reveals he warned Azar on January 23rd that the virus could already be spreading in the U.S. but “we just don’t have the tests to know one way or the other.” Bright accuses HHS leadership of “a lax and dismissive attitude” toward the coronavirus, and singles out Azar for “downplaying this catastrophic threat.”

Hailing from the establishment wing of the GOP, Azar didn’t have much juice with Trump. He did not reach the president to discuss the outbreak until January 18th. Another 10 days would pass before the White House created a Coronavirus Task Force, with Azar at the helm. Two days later, Azar declared a public-health emergency.

This emergency declaration had the confounding effect of slowing the testing rollout. Normally, private and university labs can make their own diagnostic tests without approval by the Food and Drug Administration. But these labs become “paradoxically more regulated during an emergency,” says Adalja, the Johns Hopkins doctor. Azar had activated strict regulations that made the FDA the gatekeeper for coronavirus-test approval. But there was a big problem: The gate operator was new on the job, and painfully slow to pull the lever.

UNREADY AT THE FDA

Stephen Hahn had been on the job at the FDA for barely a month. A bald, 60-year-old of modest height, Hahn has an impeccable résumé — he served as chief medical executive at the University of Texas MD Anderson Cancer Center — but he had no experience running a government agency.

The need to engage the private sector for coronavirus testing was not only foreseeable, it was foreseen — by Trump’s first FDA commissioner, Scott Gottlieb. In a January 28th Wall Street Journal article, “Act Now to Prevent an American Epidemic,” Gottlieb warned that the “CDC will struggle to keep up with the volume of screening.” He said the government must begin “working with private industry to develop easy-to-use, rapid diagnostic tests.”

If Hahn read his predecessor’s call to action, he did not act on it. Hahn did not lack authority; the FDA has broad discretion to relax the rules that were locked into place with Azar’s declaration. But Azar had, unaccountably, not included Hahn on the Coronavirus Task Force. By default, private test developers were now required to obtain an “emergency-use authorization” from the FDA to deploy COVID-19 testing. “Companies couldn’t make their own lab-developed tests,” Adalja says, “so you had Quest and LabCorp and the big-university labs on the sidelines.”

FDA officials would not speak on the record, but in extended background interviews, they defended the FDA’s role in regulating lab tests as both righteous and desirable. They described an agency whose doors were always open to private companies that wanted to develop testing, and denied that Hahn’s inexperience hobbled the FDA’s response. Hahn did not agree to be interviewed, but said in a statement that the FDA was engaged “at the earliest stages of the coronavirus outbreak and at no point was FDA excluded. FDA and HHS have been hand in hand in our aggressive response.”

Yet the failure to activate the private sector was the key difference between the U.S. response to the coronavirus and that of South Korea, which first detected the virus in its country at the same time the U.S. did. “Instead of going through regulatory hijinks,” says Milton, the University of Maryland virologist, South Korea “turned their biomedical industry loose, and they started producing lots of tests right away.” With this massive rollout — including drive-through testing clinics for patients with mild symptoms — South Korea got in front of its outbreak. At the beginning of May, South Korea had recorded fewer than 11,000 cases and 250 COVID-19 deaths. The United States, Milton insists, missed the window to activate its biomedical might to achieve the same result. “We have that capability,” he says. “We could have done that.”

THE BLACK-SWAN EVENT

With the private sector offline, the stakes for the CDC test could not have been higher. The CDC had a peerless reputation. Despite its underfunding, it was considered a crown jewel of public-health agencies.

“Starting with the CDC test makes perfectly good sense,” says Kathleen Sebelius, who served as HHS secretary in the Obama administration. The CDC performed ably during the H1N1 outbreak on her watch. “Within two weeks of knowing what H1N1 looked like,” she recalls, “the CDC had millions of test kits to push out to the states and around the world.” There was little reason to think that the CDC could not perform the same in this crisis.

The CDC — itself subject to FDA regulation — obtained emergency approval of its own test on February 4th and began shipping out kits, manufactured in its own laboratories, to roughly 100 public-health labs across the country. The CDC test was complex, including two steps that tested for genetic markers of the novel coronavirus, and a third meant to rule out other known coronaviruses. But when state labs began testing, the unthinkable happened: The third prong failed, providing inconclusive results.

Scott Becker is the executive director of the Association of Public Health Laboratories, the umbrella group that represents these labs and helps them interface with the CDC. On the morning of February 8th, a Saturday, his cellphone began blowing up with messages from member labs. “I started to see this string of the problems, and I thought, ‘Oh, my God, this can’t be happening,’” Becker says. “To me, it was the same moment of ‘Where were you on 9/11?’ because of the enormity of what we knew was coming. If this test had a problem, we were weeks behind.” He was stung by the realization that “we were not going to be able to contain this.”

For the CDC, and the public labs that depend on its tests, this was a black-swan event on top of a global pandemic. An incredibly infectious respiratory virus was poised for a mass outbreak, and the surveillance system needed to contain it was broken. It was as if enemy ballistic missiles were incoming and NORAD had gone offline.

The crisis was acute: The U.S. had a single test for the coronavirus, and it could only be run at the CDC’s Atlanta headquarters, as well as a handful of state labs that had been able to make assay work. This bottleneck would require extreme rationing of tests, to patients who’d traveled to foreign hot spots and tested negative for other diseases. The criteria were so strict that the CDC allegedly refused a test to a nurse who fell ill after treating COVID patients.

There was another, well-functioning test on the global market, of course. At the same time the CDC was sending its flawed tests to U.S. labs, WHO was distributing 250,000 of its test kits to laboratories across the world. Sebelius, Obama’s HHS secretary, insists that Azar should have recognized the bottleneck at the CDC and bypassed the agency until it sorted out its failed test. “It’s a real problem that we didn’t immediately pivot to the WHO test, which we know was working very well,” Sebelius says. “We could have purchased a lot of those and pushed them out.” HHS, working with the FDA, should also have taken that moment to call in the private-sector cavalry. “We could have opened up the private-lab capacity,” she says. “And we didn’t do any of that.”

One might excuse Alex Azar for his failure to manage up. At the time the CDC tests began to fail, Trump was in the throes of denial, praising President Xi of China on Twitter — “He is strong, sharp and powerfully focused on leading the counterattack on the Coronavirus” — and predicting the disease “goes away in April with the heat.”

But Azar proved equally hapless at managing down. Instead of engineering a workaround to the unreliable CDC test, or leaning on his private-sector connections to jump-start commercial testing, Azar insisted that the original kit be fixed. He reportedly rejected use of the WHO test, out of concern that the test was unreliable. (CDC and HHS officials also underscored that the WHO test, itself, would have had to go through the sticky wicket of FDA regulation.)

The impulse at Redfield’s CDC was to slow down, Becker says, to guard against producing a second, flawed batch of test kits. Hahn’s FDA, meanwhile, was focused on its role as the CDC’s regulator, intent on rooting out the flaw in the original test it had approved. The agencies were soon enmeshed in a bureaucratic struggle so toxic that an FDA diagnostic expert sent in to troubleshoot was briefly locked out of CDC facilities. (HHS blames a scheduling conflict.)

In interviews with Rolling Stone, FDA officials accused the CDC of providing incomplete and misleading information, of downplaying the number of public labs that were unable to run the test, and of signaling to the FDA that the CDC would be able to fix the problem on its own. A CDC representative, in turn, claimed that the FDA slowed the CDC’s response by throwing up redundant regulatory hurdles. The FDA would ultimately conclude that the “CDC did not manufacture its test consistent with its own protocol” and that a “manufacturing issue” — believed to be contamination at the CDC’s lab — rather than a design defect, was responsible for the flawed results.

Sebelius says it is par for the course for bureaucracies to seize up in a crisis: “The default position is do nothing, to stand behind the regs, and say, ‘We can’t move.’ ” But she insists that the foot-dragging and finger-pointing had a solution: leadership at the parent agency, HHS, by Azar. “I can guarantee you that the secretary can get their attention,” she says.

Kerry Weems is a former career official at HHS, who served with Azar in leadership posts during the Bush administration — and helped draw up that White House pandemic playbook. He says HHS got stuck trying to undo the failure. “It’s a human thing,” he says. “When you start out on a path, you have a tendency to stick to it.” The playbook says the CDC produces the test and the FDA approves it. “That’s the gold standard. And we just got stuck with path dependence, and didn’t move beyond that.”

The crisis dragged on for weeks. Publicly, the CDC put on a brave face. “We’re fully stood up at CDC,” Dr. Nancy Messonnier, the director of the National Center of Immunization and Respiratory Diseases, said on February 21st. “There is no lag time for testing.” Messonnier continued to point to false positives as the major threat: “We obviously would not want to use anything but the most perfect possible kits.”

But the far greater danger was already apparent to anyone following the news. Days earlier, China had locked down 780 million people. The alternative to adequate testing was a blanket quarantine.

Azar declined to be interviewed. In a statement, a HHS representative said, “Secretary Azar has always insisted that the full resources of the Trump administration be marshaled to combat COVID-19. Any insinuation that Secretary Azar did not respond with needed urgency to the response or testing efforts are just plain wrong and disproven by the facts.”

Outside the administration, top health officials were exasperated. Becker tried to break the gridlock, writing to Hahn on February 24th with an “extraordinary and rare request” that the nation’s public-health labs be allowed to create their own tests — sidestepping the CDC. “We are now many weeks into the response with still no diagnostic test available,” Becker warned.

Yet this sense of alarm was not reflected at the top. In Senate testimony on February 25th, Azar insisted the administration was delivering. “I’m told the diagnostic doesn’t work,” Sen. Murray said, challenging Azar. The HHS secretary shot back. “That’s simply, flatly incorrect,” he said, pointing to the CDC’s own ability to run the test. Azar then began spouting Trumpian self-praise, celebrating the “historic” response to the virus. “No administration,” he said, “no CDC in American history, has delivered like this.”

Weems disagrees starkly. “I hope the CDC remembers this for decades,” he says, “because they failed. This is what they were built for — and they failed.”

Behind closed doors, top administration officials were starting to grapple with the seriousness of what the United States was facing — and to understand, at least intuitively, what the CDC’s failed testing regime was hiding: Containment of the coronavirus was failing, and economy-crippling mitigation would soon be necessary.

By Valentine’s Day, the National Security Council had reportedly developed a memo offering social-distancing guidelines, including school closures, “wide-spread ‘stay at home’ directives” and “cancellation of almost all sporting events, performances, and public and private meetings.” The role of asymptomatic carriers in spreading the coronavirus was becoming clearer, leading a top HHS official to warn of “a huge hole on our screening and quarantine effort.” By February 24th, the Coronavirus Task Force, Redfield included, had reportedly resolved to recommend a plan to Trump called “Four Steps to Mitigation.” But before Trump could be briefed, Messonnier had the grave misfortune of telling the truth. In a February 25th briefing with reporters, she warned of a wide coronavirus outbreak in the United States: “It’s not so much a question of if this will happen anymore, but rather more a question of exactly when.” She cautioned that under social-distancing measures, many Americans could lose income and that “disruption to everyday life may be severe.”

“Dr. Messonnier’s statements were right on,” says Frieden, the former CDC head, who says he relied on her as one of the nation’s top public-health specialists in respiratory viruses. But after Messonnier’s comments contributed to massive stock-market losses, Trump thew a fit. He exploded at Azar and reportedly threatened to fire the CDC scientist.

Trump soon announced a major change of course. Pence would be taking over the task force, sidelining Azar. Trump himself minimized the threat of the disease, calling coronavirus “a flu,” and insisted that infections had peaked: “We have a total of 15 people” diagnosed with COVID-19, he said. “The 15, within a couple of days, is going to be down to close to zero.”

Pence was a dubious choice to head the task force. As a governor, he shared Redfield’s moral objection to free needles for those living with drug addiction — a stance that inflamed an HIV epidemic among opioid users in Indiana on his watch. But with the change in leadership on the task force, the wheels of government suddenly came unstuck.

In a maddening update on February 26th, the CDC informed public labs that they could go ahead and run their original test kits — and simply disregard the problematic third prong. The original diagnostic tests, in other words, had been reliable all along. Frieden, the former CDC director, remains incredulous at how this unfolded: “It took them three weeks to say, ‘Just don’t use the third component!’”

The FDA simultaneously offered state labs a pathway to create their own tests, a route New York state used to develop its own high-speed test. Hahn had, at last, been added to the task force, and on February 29th, the FDA announced it would let private labs develop their own tests, subject to retroactive approval. “They had just taken the gate down,” Becker says, “and said, ‘Go. Run. Get started.’” The public-labs chief never got an explanation as to why. “They just changed their policy,” he says.

The testing breakdown had left the nation blind to the true scope of the outbreak. By March 1st, the CDC’s official tally of coronavirus cases had spiked from the 15 cases touted by Trump to 75. But researchers at Northeastern University have now developed models showing there were likely 28,000 infections at the time, in just five major cities, including New York and Seattle. The Seattle Flu Study — bucking red tape from the FDA and CDC — had begun a rogue effort to test swab samples it had collected using its own lab-developed test. By early March, the testing had uncovered a bevy of undiagnosed coronavirus infections. Dr. Helen Chu, the project’s lead scientist, told The New York Times that she realized then, with horror, “It’s just everywhere already.”

At this moment, shutting down the economy was inevitable — it was just a question of when the measures would be implemented. But scientists believe up to 90 percent of the human toll was still avoidable, had the government moved immediately to implement social-distancing measures. Instead, the administration persisted in its “Do nothing” message parade.

On March 6th, at the CDC headquarters in Atlanta, Redfield again stood by the president’s side. “I want to thank you for your decisive leadership, in helping us put public health first,” he told Trump, who wore a red keep america great cap. Redfield again called the risk from the coronavirus “low” and insisted the U.S. had only an “isolated number of clusters.” He then made a claim that would be comical if it were not so tragic: “It’s not as if we have multiple, multiple — hundreds and hundreds of clusters” across the country. “I mean, we’re not blind where this virus is right now in the United States.” The next day, appearing with Pence and cruise-industry executives, Redfield encouraged American travelers to keep their reservations, and even to visit Disneyland. Within the week, the administration’s denial crashed into the reality of the exploding pandemic. Disney shut its parks; Trump declared a state of emergency. Finally, on March 16th, the administration rolled out social-distancing guidelines to “slow the spread,” and the nation’s economy started grinding to a halt.

Redfield declined to be interviewed. A representative for the CDC defended his conduct, insisting that Redfield had been “closely tracking the global spread of COVID-19” from the outbreak’s early days, that his comments were “based upon available data at the time,” and that “at no time did he underestimate the potential for COVID-19 becoming a global pandemic.”

A PRESIDENT ADRIFT

Having plunged the nation headlong and unprepared into the deadliest disease outbreak in a century, President Trump is now proving to be one of the greatest obstacles to an effective national response.

Sebelius ultimately blames Trump for failing to end the infighting and fix the testing failure. “The White House has a unique way to get agencies’ attention, by making it clear that they want a solution, and everybody at the table with that solution within 24 hours,” she says. “If the president wants this to happen, it will happen.” But on his visit to the CDC in Atlanta, Trump had made an extraordinary admission: That he did not want to let passengers from a cruise ship, then suffering an outbreak off the California coast, to come on shore because the tally of patients would rise. “I like the numbers being where they are,” Trump said.

Those comments hit Sebelius like a punch in the gut. Trump plainly saw effective testing as a threat to his political messaging that the administration was containing the virus. By standing at CDC headquarters to declare that the tests were “perfect” and that he didn’t want COVID-19 numbers going up, the president was doing the exact opposite of demanding a fix. For the president’s deputies, Sebelius says, “there couldn’t be a clearer signal.”

The nation’s public labs were not fully up and running on the CDC test until March 8th, according to HHS, about the time Quest and LabCorp finally began testing in their labs. The Swiss pharmaceutical giant Roche did not receive FDA approval for its high-speed, high-volume test until March 13th. This initial delay in getting testing off the ground didn’t just set the country back in real time, says Johns Hopkins’ Adalja: “That’s still why we’re playing catch up. If you constrain our biggest source for diagnostic expertise and capacity, it’s no surprise that we ended up in the situation that we’re in.”

Trump has extraordinary powers to set the country on a better course — but he hasn’t used them. “What has been really terrifying to watch is that the federal government has refused to use the unique purchasing authority, the unique production authority, that no state can mobilize,” Sebelius says. What’s more, rather than supporting governors, Trump has been undermining them, “creating a system of chaos and competition, as opposed to collaboration, that has made the situation worse for most states.”

That includes states with Republican governors. Charlie Baker of Massachusetts had a shipment of medical equipment seized at customs by FEMA, and was forced to rely on a private plane, owned by the New England Patriots, to fly in a shipment of masks from China. In Maryland, Gov. Larry Hogan resorted to buying 500,000 coronavirus tests from South Korea and stashing them in an undisclosed location under watch by the National Guard.

Frieden, the former CDC chief, says that what’s required to contain the pandemic — and begin reopening the economy — is a “box it in” approach, with four components: widespread testing; isolating positive cases; contact tracing to identify people likely to have been infected; and quarantining those same people. The White House put this strategy into practice after a top aide to the vice president, Katie Miller, tested positive, and several Coronavirus Task Force members, including Redfield and Hahn, put themselves in quarantine on May 9th.

Rolling out this practice nationally would be a sophisticated undertaking, requiring coordination that had not, into May, materialized from the White House. After failing to provide anything more than a gesture at a framework for reopening in late April, the administration began pushing states to rev up their economies. It did this despite internal CDC projections that COVID-19 deaths were on track to hit 3,000 a day by June 1st, while blocking release of a science-based CDC playbook for opening schools, restaurants, churches, and mass transit.

Sen. Murray says Trump and Pence have abdicated their responsibility in this crisis: “No one is putting together a plan!” She recalls a recent conversation with Pence. “He couldn’t even tell me how many tests they need. If you don’t have a goal, how do you produce it?” Experts believe the country needs a minimum of 1 million tests a day to safely reopen; through April, it rarely exceeded 200,000 a day.

Sebelius, herself a former governor of Kansas, insists that it is mission-critical for the United States to begin acting like the United States. “We absolutely have to have a plan of what happens between now and when we finish a national vaccination campaign,” Sebelius says. “If every state is on their own trying to figure this out, we’ll have a total nightmare.”

In the event that Trump is still president when a vaccine becomes available, Sebelius argues that the loose confederations that have formed in the Northeast, Midwest, and Pacific states to coordinate their reopenings may need to band together in a shadow government to sidestep Trump. “Maybe governors will put together their own system,” she says, “and ignore what’s happening in the White House.”