Andrew KimmelVerified account

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

03/09: As state after state imposed new restrictions on citizens’ daily lives to protect them, 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. #TrumpLiesAmericansDie

03/10: Trump pledges that the virus would “go away. Just stay calm.” 03/11: Trump orders the halt to incoming travel from Europe (excl. Britain) that his deputy nat’l sec adviser had been advocating for weeks. #TrumpKnew

Trump botches the Oval Office announcement so badly that officials spend days to correct erroneous statements that triggered a stampede by U.S. citizens overseas to get home. #TrumpKnew

“There was some coming to grips w/ the problem & 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. That’s when he took decisive action that set in motion some real payoffs.” -@LindseyGrahamSC

Trump spent weeks shuffling responsibility for leading his admin response to the crisis, putting Azar in charge of the task force at first, relying on Pottinger, the deputy nat’l security adviser, for brief periods, before finally putting Pence in the role toward the end of Feb.

Others emerged to help right the US’ course. But even as Fauci, Azar & others sought to assert themselves, Trump was turning to others w/ no credentials, experience or discernible insight in navigating a pandemic. Foremost among them was his son-in-law, Jared Kushner. #TrumpKnew

A team reporting to Kushner took space in the HHS building to pursue a series of inchoate initiatives. One plan involved having Google create a website to direct those w/ symptoms to testing facilities that were supposed to spring up, but never materialized. #KushnerIsAnIdiot

Another idea was 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 WH briefings.

The Kushner initiatives have interrupted the work of those under immense pressure to manage the response. Current & former officials say that Fauci & others have repeatedly had to divert their attentions from core operations to contend with ill-conceived requests from the WH.

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. #KushnerIsAnIdiot

“Fauci is trying to roll out the most ambitious clinical trial ever...”, said a fmr sr admin official in frequent touch w/ fmr colleagues. Yet the nation’s top health officials “are getting calls from the WH or Jared’s team asking, ‘Wouldn’t it be nice to do this w/ Oracle?’”

If the virus 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. #TrumpKnew