Andrew KimmelVerified account

Early February: the admin was draining a $105M congressional fund to respond to infectious disease outbreaks. The threat to the US still seemed distant to the public. But to health officials charged w/ stockpiling supplies for worst-case-scenarios, disaster appeared inevitable.

The nat’l stockpile of N95 protective masks, gowns, gloves & other supplies was already 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. #TrumpKnew

Most manufacturing for that equipment had long since migrated to China, where factories were now shuttered b/c workers were ordered to stay home. At this time, China was buying up masks & other gear for its own coronavirus outbreak, driving up costs & monopolizing supplies.

Late Jan/Early Feb: HHS sends 2 letters to the WH Office of Mgmt & Budget asking to use its authority to shift $136M of funds to combat the virus. WH budget hawks argued that appropriating too much money at once when there were only a few US 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. #TrumpKnew

Alex Azar of HHS then spoke to Russell Vought, the acting director of the WH Office of Mgmt & Budget, during Trump’s State of the Union speech on Feb. 4. Vought seemed amenable, and told Azar to submit a proposal. Azar submitted a $4B proposal the very next day. #TrumpKnew

02/05: Azar arrives at the WH for a tense meeting in the Situation Room that erupted in a shouting match, according to three people. The $4B was a sum that OMB officials & others at the WH greeted as an outrage. #TrumpKnew

A deputy in the budget office accuses Azar of preemptively lobbying Congress for a sum the WH had no interest in granting. Azar defended the need for an emergency infusion. WH officials relented to a degree weeks later as the surge in the US began to materialize. #TrumpKnew

The Office of Mgmt & Budget team whittled Azar’s demands down to $2.5B, money that would be available only in the current fiscal year. Congress ignored that figure & approved an $8B supplemental bill that Trump signed into law on March 7. #TrumpKnew

The delays meant that the US missed a narrow window to stockpile ventilators, masks & other protective gear before the admin was bidding against many other desperate nations, and state officials fed up with federal failures began scouring for supplies themselves. #TrumpKnew

In late March, the admin ordered 10K ventilators - far short of what public health officials & governors said was needed. And many will not arrive until the summer or fall, when models expect the pandemic to be receding. #TrumpKnew

The first setback w/ testing came when China refused to share samples, depriving researchers of supplies to bombard w/ drugs & therapies for ways to defeat it. But even when samples had been procured, the US effort was hampered by systemic problems & institutional hubris.

Among the costliest errors was a misplaced assessment by top health officials that the outbreak would be limited in scale inside the US — as had been the case with every other infection for decades — and that the CDC could be trusted on its own to develop a diagnostic test.

But the CDC was not built to mass-produce tests. The agency fostered an institutional arrogance, that even in the face of a potential crisis there was no pressing need to involve private labs, academic institutions, hospitals & global health orgs also capable of developing tests.

Stephen Hahn, the FDA commissioner, sought authority in early Feb to begin calling private diagnostic & pharma companies to enlist their help. But when FDA officials consulted leaders at HHS, Hahn, who had led the agency for about two months, was told to stand down. #TrumpKnew

Azar of HHS was committed to a plan that would keep his agency at the center of the response effort: securing a test from the CDC & then building a nat’l surveillance system by relying on an existing network of labs used to track the ordinary flu. #TrumpKnew

In task force meetings, Azar pushed for $100M to fund the plan, but was shot down because of cost. Yet the scale of the epidemic, and the need for mass testing far beyond the capabilities of the flu network, would have overwhelmed Azar’s plan no matter what. #TrumpKnew

The CDC failed its basic assignment to create a working test & the task force rejected Azar’s plan. 02/06: The WHO reports shipping of 250K test kits to labs around the world, as the CDC begins distributing 90 kits to a smattering of state-run health labs. #TrumpKnew

Almost immediately, the facilities encounter problems. The results are inconclusive in trial runs at more than half the labs, & therefore can’t be relied upon to diagnose actual patients. The CDC instructs labs to send tests to its Atlanta HQ, further delaying results by days.

The scarcity of tests led officials to impose constraints on when/how to use them, delaying surveillance testing. Guidelines were so restrictive that states were discouraged from testing patients w/ symptoms unless they traveled to China or were in contact w/ a confirmed case.

But by that point, the pathogen had almost certainly spread more broadly into the general population and the limits left top officials largely blind to the true dimensions of the outbreak. #TrumpKnew

In a meeting in the Situation Room in mid-February, Fauci and Redfield told WH officials that there was no evidence yet of person-to-person transmission in the US. In hindsight, it appears almost certain that the virus was taking hold in communities at that point. #TrumpKnew

02/10: Trump holds a political rally in NH, attended by thousands, where he declares that, “by April, you know, in theory, when it gets a little warmer, it miraculously goes away.” Trump’s subordinates were growing increasingly alarmed, as he continues to exhibit little concern.

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. #TrumpKnew

Late Feb: US officials discover that the CDC lab is failing to meet basic quality-control standards. 02/27: On a call w/ health officials, an FDA official yells @ the CDC for repeated lapses, & if it were subjected to the same scrutiny as a private lab, “I would shut you down.”

02/29: A Washington state man becomes the first American to die of a coronavirus infection. That same day, the FDA releases guidance, signaling that private labs were now free to proceed in developing their own diagnostics, resulting in another four-week stretch being squandered.

03/06: Trump tours CDC facilities wearing a red “Keep America Great” hat. He boasts that the tests were nearly perfect & that “anybody who wants a test will get a test,” a promise that nearly a month later remains unmet. #TrumpKnew

Trump professes to have a keen medical mind. “I like this stuff. I really get it. 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 were either a result of/exacerbated by, Trump

For weeks, Trump barely utters a word about the crisis that didn’t downplay its severity or propagate false information. He dismissed the warnings of intel officials & top public health officials in his campaign own administration. #TrumpLiesAboutCoronavirus

He voiced far more authentic concern about the trajectory of the stock market than the spread of the virus in the US, railing at the chairman of the Fed Reserve & others with an intensity that he never seemed to exhibit about the possible human toll of the outbreak. #TrumpLies