We're Starting to Get a Picture of What Happened and When

Throughout January-- as Trump repeatedly played down the seriousness of the virus--  an array of figures inside his government (from top White House advisers to experts 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.

Late November, 2019:  Concerns about what is now known to be the novel coronavirus pandemic were detailed in a November intelligence report by the military's National Center for Medical Intelligence (NCMI),  "Analysts concluded it could be a cataclysmic event," one of the sources said of the NCMI’s report. "It was then briefed multiple times to" the Defense Intelligence Agency, the Pentagon’s Joint Staff and the White House. 

Early January, 2020: 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. Trump would avoid such steps until March.

Politico reported that in 2016, the Obama administration created a 69-page National Security Council playbook that included hundreds of tactics and policy decisions to “prevent, slow, or mitigate the spread of an emerging infectious disease threat.”  From the start, the Trump administration ignored the step-by-step tactics laid out in the playbook.   For instance, the Trump administration waited more than a month to ask for emergency funding after the timeline laid out in the playbook.

It became obvious very quickly that vacancies and inexperience at the most senior levels of the White House, DHS, VA, FDA and the CDC had left parts of the federal government unprepared and ill equipped for what would prove to be the largest public health crisis in a century.

January 6, Monday: China shares the genetic sequence of the coronavirus with the CDC.  The agency immediately begins working on its own test for the virus.

January 20, Monday:  The CDC's test is used to verify the first U.S. case.

January 21, Tuesday:  The CDC publicly announces the first coronavirus case in the United States.

January 22, Wednesday: Trump says "We totally have it under control."

January 28, Tuesday:  The VA's Senior medical adviser Dr. Carter Mecher emailed a group of public health experts which went by the name “Red Dawn.” In the email, Mecher said,“Any way you cut it, this is going to be bad.  The projected size of the outbreak already seems hard to believe.  You guys made fun of me screaming to close the schools.  Now I’m screaming, close the colleges and universities.”

Late January:  Public health concerns often had to compete with economic and political considerations in internal White House 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.  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.

January 29, Wednesday: Coronavirus task force is formed.  Early on, the task force is consumed day after day by crises. The group grappled with how to evacuate the United States consulate in Wuhan, China, ban Chinese travelers and extract Americans from the Diamond Princess and other cruise ships.  The task force typically devoted only five or 10 minutes (often at the end of contentious meetings) to talk about testing. The CDC assured the group that it had developed a diagnostic model that would be rolled out quickly as a first step.

January 30, Thursday: The World Health Organization declares a "public health emergency of international concern," a designation reserved for extraordinary events that threaten to spread internationally.  Trump is informed about a January 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.

HHS Secretary, Alex Azar directly warned Trump of the possibility of a pandemic during a conference call--  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 Azar was being alarmist.

January 31, Friday:  Trump took his first concrete action, limiting travel from China.  Decision-making was 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.

February 6, Thursday: The CDC began shipping test kits to the states.

February 8, Saturday: The CDC is notified that there was a problem with the CDC's coronavirus test.  Dr. Redfield, head of the CDC, played down the problem in task force meetings and conversations with HHS Secretary Azar, assuring him it would be fixed quickly,  The FDA does not send an official to inspect the CDC labs until two weeks later.

February 13, Thursday: Azar publicly announced 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.

February 17, Monday: The administration’s top public health experts concluded they should recommend to 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 — a period of four weeks when the virus spread largely unimpeded.

February 22, Satursday: FDA officials visited the CDC labs to investigate a possible contamination which was causing the tests to malfunction.  The FDA would later issue its findings, saying that the "CDC did not manufacture its test consistent with its own protocol." 

By this time, the FDA had become a roadblock in expanding federal testing to private labs across the nation.  The FDA failed to reach out to manufacturers, instead deferring to internal scientists and using cumbersome methods for approving medical screening.  Even the nation’s public health labs were looking for the FDA’s help. “We are now many weeks into the response with still no diagnostic or surveillance test available outside of the CDC for the vast majority of our member laboratories,” Scott Becker, chief executive of the Association of Public Health Laboratories, wrote to the FDA in late February. “We believe a more expeditious route is needed at this time.”

Stanford researchers, who had a working test by February, based on protocols published by the WHO, decide not to seek FDA approval of their test, due to excessive FDA rules.  The Stanford clinical lab would not begin testing coronavirus samples until early March, when the FDA finally relaxed the rules.

February 25, Tuesday: The National Center for Medical Intelligence raised its warning from WATCHCON 2  to WATCHCON 1, meaning that a coronavirus pandemic was imminent. 

February 26, Wednesday:  Mike Pence was named to chair the Coronavirus task force.  The CDC confirmed the first case of COVID-19 in a patient in California with no travel history to an outbreak area, nor contact with anyone diagnosed with the virus. It was suspected to be the first instance of local transmission in the United States. 

February 27, Thursday: Under pressure from Congress, the CDC told state and local health department labs that they could finally begin testing for the virus.  Rather than awaiting new test kits, they should use their previous test kits and leave out the malfunctioning portion that produced errors.

February 29, Saturday: the FDA finally modified its standards to allow clinical and commercial labs to develop their own tests.  It was too little, too late-- many labs had already committed resources to  the CDC testing methodology and would lose valuable time if they were to backtrack and pursue other testing avenues.

March 3, Tuesday:  The CDC issues new guidance that allows anyone to be tested for the virus without restriction. Previously, only those who had traveled to an outbreak area or who had close contact with people diagnosed with COVID-19 could get tested.   However, due to the scarcity of tests, most hospitals required multiple symptoms (including a temperature exceeding 100) before allowing a patient to be tested.

March 6, Friday:  Trump says, “Anyone who wants a test can get a test.”  This turns out to be completely falso.

March 7, Saturday:  HHS Secretary Alex Azar clarified that only those who have gone through a doctor or medical professional can be approved for a test.  Due to shortages of test kits, physicians nationwide only prescribe tests when patients report having a fever in excess of 100 degrees.

March 13, Friday: Trump declared a U.S. national emergency,

March 16, Monday: Trump finally afinally agreed in mid-March to recommend social distancing across the country, effectively bringing much of the economy to a halt, he seemed shell-shocked 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.