It Didn’t Have to Be This Way
Inside the Trump Administration’s Response to the Pandemic That Changed History
by Yasmeen Abutaleb and Damian Paletta
HarperCollins, 496 pp., $30
On March 29, 2020, President Donald Trump spoke to the media at a briefing of the White House Coronavirus Task Force. He praised the medical doctors on his team who had become the face of American public health expertise, Drs. Deborah Birx and Anthony Fauci, calling them “the best in the world,” and he took up their call to extend mitigation measures through April 30—a whole month after his previously touted “15 days to slow the spread” came to an end. He ended his remarks with a stirring vote of confidence in the American people and a call to band together.
With the grace of God, we are rising to the occasion. We are proving that no darkness can overshadow the eternal light of American courage. We will win. And when we do, we will rebound with astonishing force and speed. We will be stronger than ever, and we will have learned so much, where something like this can never hurt us to the extent it has—and the world—again.
In our present crisis, the strength of our people is our single most important asset, and together we will defeat this invisible curse—this invisible enemy—and rise to incredible new heights.
Yet less than three weeks later, as protesters rallied at state capitols around the nation to denounce the closures of businesses that were at the heart of those mitigation measures, Trump could not stop himself from cheering them on. “LIBERATE MINNESOTA,” “LIBERATE MICHIGAN,” and “LIBERATE VIRGINIA,” he tweeted on April 17. He was effectively announcing to the world that he had lost confidence in his own government’s official approach to the pandemic. Although his March 29 remarks had praised America’s public health officials and endorsed their efforts, by mid-April it seemed that Trump despaired of America’s ability to control the virus. He had effectively given up on the prospect of togetherness in overcoming the virus and thrown his support to the side of those who believed that social disruptions to thwart the virus were unjustified but that political disobedience—including even disobedience to policies his own government endorsed—was justified.
Nightmare Scenario, the new book from Washington Post reporters Yasmeen Abutaleb and Damian Paletta, tells the dismal tale of Trump’s transformation during this crucial time, offering White House insiders’ perspectives on how America’s pandemic response went terribly wrong. In their telling, Trump was “a president uniquely ill-suited to lead” the nation through this horrible trial, and his fundamental inability to confront the reality of the pandemic made his administration’s failure inevitable. While he did sometimes allow the country’s top public health officials to counsel him and shape his response during the early stages of the pandemic, it was, the authors argue, only a matter of time before he began to treat the virus and all who believed in its seriousness as a personal affront—transforming what could have been a unifying crucible for the United States into yet another source of bitter culture-war enmity.
By providing a glimpse of the bureaucratic struggles to define the nation’s strategy for dealing with COVID-19, which mostly ended in muddy confusion and bad feelings, Nightmare Scenario allows us to imagine an America in which the pandemic did not lead us to fall to pieces. The authors themselves believe that the best way of achieving national unity and beating the virus would have been for the whole country to get behind its scientific experts. Their brief for that position, however, is conclusory and unpersuasive.
Far more important is the way in which their book allows the attentive reader to see the limits of bureaucratic politics in action. In the course of their narrative, the White House Coronavirus Task Force attempts to figure out what should be done. Its members ably represent a number of important contrasting viewpoints, but they rarely seem to be able to hash out any of their differences. Their arguments “just kept repeating themselves on a nonstop loop,” leading one participant to walk right out of his White House job. Throughout their account, Abutaleb and Paletta make clear that the task force’s leaders, first HHS Secretary Alex Azar and then Vice President Mike Pence, did not provide a clear sense of purpose for the group; both were torn between satisfying Trump’s mercurial instincts and listening to the advice of the public health officials around the table. But the task force’s inability to resolve issues shows a profound mismatch of a decision-making body with the problems it was charged with handling. The problem was that, by framing everything as a question of public health, the participants in these debates left each other no room for compromise or creative thinking. The members of the task force dug in to litigate either side of binary options. Once they were duly entrenched, there was very little hope for making progress.
In some instances, the sensibilities of the Trump White House really do seem to have doomed the federal government’s response. What makes some of the episodes related by Abutaleb and Paletta so very painful to read is that there were capable people working hard and thinking creatively about how to combat COVID-19, but they were often stymied by those who were more interested in maintaining a narrative of complete triumph over the virus, which was (usually) the president’s preferred story.
Probably the worst of these stories features Robert Kadlec, a medical doctor with a military background who served as assistant secretary of Health and Human Services for preparedness and response throughout the Trump years. In February 2020, Kadlec believed it would be helpful to send every American household a pack of five three-ply cloth masks, so that every American would be able to start wearing a mask without any hassle. Given the doubletalk that the public health establishment was then offering on masks, Kadlec’s plan seems downright visionary. Even more impressive, he worked with garment manufacturers like Hanes to arrange for the production of 650 million masks.
Unfortunately, he never got the buy-in of others in the administration. When his boss, Secretary of Health and Human Services Alex Azar, brought a prototype of the mask to a meeting of the task force, his presentation went terribly awry. “It looks like you have a pair of underwear on your face,” says one member of the task force; no, said another, it looks more like a jockstrap. When Azar lacked ready answers for some additional questions, the task force tabled the idea as unready and it was never revived. Abutaleb and Paletta report that the masks were nevertheless manufactured, only to sit in boxes for months; they would eventually be sent to public health clinics. Just like that, we missed an opportunity to have the Trump administration stake out early support for masks. Instead, the public health community’s awkward flip-flop on recommending masking for the general public eroded their credibility, and by the summer of 2020 the issue would become hopelessly politicized. (Kadlec would also be one of the people who helped Operation Warp Speed get up and running, which Nightmare Scenario reports on as a kind of anomalous success amid a parade of failures.)
In another noteworthy case, the administration became preoccupied with securing ventilators. Abutaleb and Paletta explain this as a consequence of the capricious leadership of Jared Kushner, who periodically inserted himself into various coronavirus-fighting efforts. Seen as his father-in-law’s “de facto chief of staff,” Kushner proved able to make things happen, though not always the most helpful things. In the case of ventilators, Kushner and others reacted to news reports of shortages (which were almost all from New York) and one particularly catastrophic projection by scrambling to order as many machines as they possibly could—some 243,000. As it became clear that the ventilator shortage was not nearly as acute as advertised, about 90,000 of the orders were eventually canceled. Abutaleb and Paletta present this story as an indictment of Kushner’s unaccountable monomania, but it strikes me as a good illustration of the hazards of news-cycle-driven leadership. Kushner obsessed over ventilators because the press was doing so in the deadly, chaotic days of March and April 2020. The administration should have been using its own superior information to drive its response rather than chasing after every new story. Its own scientific advisers were only too willing to provide that perspective, and at least for a short time others in the administration were prepared to listen to them. Why then, did the administration struggle so badly?
The main theme of Nightmare Scenario is the breakdown of trust between the political operatives in Trump’s White House and the doctor-policymakers who acted as the face of the government agencies that had prepared for a pandemic. The authors believe that the blame for this lies mostly on the side of the political operatives, who stubbornly refused to acknowledge the superior expertise of the doctors and who ultimately had very little patience for the non-pharmaceutical interventions that would be necessary to stop the spread of the virus. But the doctors themselves (who were, almost certainly, the major sources for the book’s reporting) come off as bearing a good portion of the blame for the frayed relationship. At times, they seem hopelessly lacking in humility and unable to fathom that anyone could legitimately disagree with their conclusions. They were relentless in insisting that the administration “follow the science,” and insistent that they were the ones to explain what that should mean.
The doctors started out from a position of weakness because of the awful incompetence of the Centers for Disease Control and Prevention (CDC) in developing a diagnostic test for the coronavirus in February. After the task force was first convened at the end of January, it repeatedly asked about the CDC’s progress and was consistently told that success was just around the corner—forever a week away. In fact, an enormous failure was unfolding: The tests that the CDC was developing did not work; the agency badly bungled the manufacturing process, leading to a nearly month-long delay; and no good plan was in place for mass-producing and deploying the tests anyway. The agency was spinning its wheels and refusing to turn to outside help, compounding its initial failure and in the process seriously marring its reputation as a world-leading institution. Its director, Robert Redfield, would eventually deflect blame onto the Food and Drug Administration, which he said should have been allowing academic labs, hospitals, and private manufacturers to develop their own tests. According to Abutaleb and Paletta, Stephen Hahn, the FDA commissioner, “had in fact wanted to reach out to those companies in late January and early February, but FDA leaders had been split on whether it would be bad optics for Hahn to be personally calling the companies he regulated.” Sunlight, apparently, is not always the best disinfectant.
It was Trump’s chief domestic policy aide, Joe Grogan, who had the wherewithal to suggest during this time that the lack of testing was likely concealing the extent of community spread in the United States—a suggestion that Fauci reportedly shot down: “What’s the epidemiological basis of that question?” Fauci retorted, insisting that without data the group could only speculate blindly. In retrospect, it seems clear that the health agencies’ defensiveness was doubly blameworthy. Not only did apparently negligent management lead to the failed test kits, but it also became clear that even if everything had gone right in that process, the country would still not have been on track to produce and distribute anything like an adequate supply of tests. In the crucial month of February, just before the first big wave of COVID cases, the government doctors often seemed to be defending their turf.
When, finally, in late February 2020 the whole country began to appreciate how bad things were likely to get, the doctors swung into high gear and began an effort to persuade the White House to urge a nationwide shutdown. It took them until mid-March, at which point they successfully recruited Kushner to their cause. He, in turn, brought along his college friend Adam Boehler, who was serving as the head of the International Development Finance Corporation, and together with Birx, they made the decisive pitch to Trump, convincing him that the only way to save America’s economy (and, by implication, his election chances) was to take bold action in the form of a nationwide shutdown of in-person interactions. They told the president that they would need 15 days of such restrictions to be able to turn the tide.
In what may be the book’s most stunning moment, Trump answers: “That’s it?” He had expected “they were going to tell him to call in the National Guard and lock people in their homes. He immediately approved their plan,” and on March 16 announced the shutdown to the country. In Trump’s moment of maximal openness, the public health community overpromised and undershot. Birx feared that the president would be unwilling to do anything, and so she and her colleagues made a sales pitch that made Trump believe a very quick intervention would be decisive. Of course, that impression was simply wrong. Even if the shutdowns Birx had recommended worked perfectly—a dubious proposition, given the limited powers of American public health authorities and the disbelief of the American public—there was no way that 15 days in March was going to contain a virus that was spreading around the globe.
Trump’s frustration with his own choice was palpable, reflected in his tweet of March 22: “WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF. AT THE END OF THE 15 DAY PERIOD, WE WILL MAKE A DECISION AS TO WHICH WAY WE WANT TO GO!” Don’t let the all-caps fool you: That sentiment is far from unreasonable, and apparently it was not simply a way of saying that the president had already decided to give up on non-pharmaceutical interventions. Indeed, Birx and Fauci convinced the president to extend his shutdown recommendation for another month. The whole country was converging around the idea of pulling together to “flatten the curve,” and the president also accepted the contention that delaying cases was worthwhile in order to ensure that hospitals were not overrun, leading to the soaring rhetoric of shared sacrifice in his March 29 remarks.
But in convincing the president to extend prescriptions already in place, the doctors showed a disastrous lack of imagination. Yes, they believed that premature reopening would lead to increased spread of the virus and increased death, and they therefore believed that spreading out infections was therefore a worthy goal. But the debate they framed for Trump boiled down to Shutdowns: Do we need more, or enough already? In late March, “more” won the day. But if Fauci, Birx, and the other medical experts advising Trump imagined they could put off “enough already” for many months, they were wildly wrong about both Trump’s character and that of the American people. For those parts of the country that had seen barely any cases in March and April, the extension of shutdowns also seemed arbitrary, if not pointless. Choosing to urge a uniform nationwide response was almost certainly the wrong choice, in many places depleting the public’s willingness to cooperate before it was most needed. The American people were sure to lose patience with shutdowns with no end in sight.
Members of the task force who spoke to Abutaleb and Paletta agreed that “in Trump’s mind, Birx and Fauci had led him to believe that after a painful few weeks, the pandemic would be over. So when he realized that the six-week shutdown wasn’t the end, he decided that he was done with the doctors and their advice.” The doctors had missed their best opportunity to frame the live policy questions as multidimensional and amenable to creative thinking. Their pitch to Trump could have been: With your leadership and willingness to experiment, we can slow the spread of the virus, minimize the damage it will do by protecting the most vulnerable, and help Americans make needed adjustments. Instead, they proceeded as if they would always be running the show and focused their efforts on developing criteria for reopening.
Birx worried consulting the task force and its political members would inevitably politicize the crucial metrics for reopening, so she decided to draft her own criteria and deliver them to the public on her own. Birx “knew that the only way for the country to reopen safely was to do it gradually, with stringent precautions in place,” and so, in cooperation with the CDC, she devised a schedule of permissible businesses for “Phase One” calibrated to two weeks of diminishing cases, “Phase Two” for further signs of abatement, etc. This was nothing less than what the best science of public health demanded, she thought. And yet when we recall how seemingly arbitrary the classifications of different businesses were, it is clear that there were tradeoffs involved that simply could not be resolved by “following the science.”
To give one poignant example, consider churches and other houses of worship. Birx and the other doctors believed they were justified in deprioritizing reopening of churches, which, as places where large numbers of people congregate, were possible sites for superspreading events. But the political members of the task force “feared that tough restrictions on churches . . . would offend Trump’s conservative base.” When described that way, it does sound as though the CDC is being unfairly interfered with, and for base political motives. If that is how the debate actually played out, that is unfortunate. But there is nothing at all illegitimate about considering that communal prayer is deemed an indispensable part of life by tens of millions of Americans, and remembering that there are profound constitutional questions connected to church closures.
Abutaleb and Paletta report that in late May, this particular fight continued, this time focused on the question of whether the sharing of communion chalices should be singled out as an especially dangerous means of transmission. The president’s counselor Kellyanne Conway and Redfield hammered out a kind of accord, in which CDC guidance about churches would take into account their particular circumstances—larger spaces could allow more people, etc. That accord, however, was not registered when the CDC released its rules, because “the process for getting CDC guidance cleared had become so confusing and bogged down that CDC officials didn’t know what White House suggestions they had to accept and which ones they could reject. So they went ahead and posted the document with some changes intact and others ignored.” Conway, infuriated, insisted that the document be taken down and called for people to lose their jobs. (They never did.) This is a story of atrocious management, but it is difficult to understand how an agency charged only with public health could be expected to deftly manage these concerns.
Another example in which Abutaleb and Paletta show “politicization” at work concerns the guidance for restaurant reopenings. The CDC sought to recommend a strict requirement that all tables be six feet apart, but the Office of Management and Budget objected to that requirement, saying that it was arbitrary. The CDC dug in, saying that the agency had uniformly defined “social distancing” as six feet separation and could not be expected to relax that definition for restaurants. Consistency has its virtues, but in this case the public health professionals had chosen to rally around a standard based on the idea that COVID is a droplet-spread disease. Even given the droplet-based understanding, it was always clear that six feet was somewhat of an arbitrary choice; more distance would be safer, less would be more risky, and there was no natural threshold that could justify treating any particular distance as “safe.” We now know that transmission comes from aerosols that can circulate through ventilation systems, regardless of people’s spacing—and that the supposedly objective scientific community was zealously repressing those who were championing the aerosol theory.
The clash between political staff and government doctors did not lead to some happy synthesis. Issues lingered, unresolved, and public health authorities around the country who hoped to adopt a well-thought-out policy proposed by the federal government were left waiting. Eventually, on May 14, the CDC issued a brief six-page document that had not received OMB signoff, described as “a major act of defiance by the CDC.” The framework being used to debate the issues was totally inadequate to the complexities of the tradeoffs involved. And so, in practice, the issues were left to be resolved elsewhere, even as local policymakers around the country sought to portray their own judgment calls as deferring to an unimpeachable authority.
By around June 2020, the administration’s political officials had left off trying to listen to the government doctors—and instead treated them as enemies. Trump might well have fired Birx, Hahn, or Redfield, but they had made a pact to all resign if any was cast out. Firing all of them, or Fauci, was perceived as too politically costly for Trump with the election just months away. That consideration did not stop the White House from quite openly taking its opposition to the doctors to the public, with the communications team openly circulating a kind of political opposition file on Fauci in July. It also did not preclude attempting to set up an internal counterweight, which Trump did by bringing in his own handpicked doctor, radiologist Scott Atlas, who had been making the case against business closures on cable news shows. With Atlas contradicting nearly every point the other doctors sought to make, the task force became “a den of dissent,” a place to “squabble” and “fight to a draw”; there was no longer any real pretense that it would be making decisions. Birx and others turned their efforts toward communicating directly with state and local officials, whom they believed were open to their influence.
Over the summer, Trump himself kept suggesting that maybe the problem was that too much testing was leading to too many detected cases, making America’s numbers worse than other countries. At his first mass rally of the COVID era on June 20 in Tulsa, Oklahoma, where just 6,200 attendees showed up instead of the hundreds of thousands Trump expected, he said that he was instructing his administration to scale back on testing. Given his rambling and jokey delivery, it was difficult to tell how serious he was, but he insisted later to reporters that he had meant it. Abutaleb and Paletta report that Atlas did, in fact, take active measures to suppress testing, even as Birx and Fauci pushed to make use of $9 billion in unused funding appropriated to support expansion.
As ought to be obvious to any person with an unimpaired sense of logic, Trump’s fixation on manipulating an indicator rather than addressing the underlying reality was disastrously short-sighted. Back in March and April, he had seemed to understand that limiting the spread of the virus and minimize its damage was the best way to enhance his re-election chances. But by the summer, he had lost the thread. Testing couldn’t be part of the solution, it was only a way for his opponents to make his political problem worse.
Trump did remain interested in treatments for the virus—perhaps too interested. His advocacy for different treatments did sometimes speed their approval for treatment, though in the case of hydroxychloroquine this approval would eventually be rescinded.
But, if Abutaleb and Paletta’s reporting is correct, the unintended consequences of Trump’s involvement here seem to have been very costly. As they relate it, Trump had intervened in a bureaucratic dispute over whether to grant an emergency use authorization (EUA) for convalescent plasma. Dr. Francis Collins, the director of the National Institutes of Health, had discouraged the FDA from proceeding with an EUA given the uncertainty in the available data. Responding to Collins’s concerns, the FDA had repeatedly delayed. Ahead of the Republican National Convention in late August, Trump insisted that the decision get made without further delay—and tweeted that “The deep state, or whoever, over at the FDA” was delaying with the intent of damaging his political prospects. The FDA relented, and its commissioner, Hahn, was pulled into a press briefing with Trump. When it was his turn to speak, he inadvertently misrepresented the benefits suggested by the most recent data, saying that 35 out of 100 patients would be saved by convalescent plasma, when in fact what was supported was a 35 percent relative improvement in survival chances for those treated. He issued a correction later, but the whole episode left him feeling jerked around, and as if he had not been sufficiently protective of his agency’s independence and reputation.
As a result, Hahn resolved not to be pushed into hurrying along the approval of any vaccine. In the event, the approval of Pfizer’s EUA began to look highly likely in October, but the crucial data making clear that it was a success were not released until November 9, the week after the election. Abutaleb and Paletta seem impressed with the integrity that Hahn and others in the FDA showed in not speeding the vaccine any more than they did. Given the political environment in which they were operating, it is easy to be sympathetic to the FDA officials for their sense of protectiveness for their agency. But slowing the vaccine’s final EUA until December 10 almost certainly cost thousands of lives. In this case, it was right for the Trump administration to be exerting pressure to move faster—and the fact that they were motivated by wanting to win the election should not have been discrediting. Indeed, this seems like a classic case of electoral incentives pushing politicians to zealously pursue the public good. Alas, the pressure by then was experienced only as an unwelcome imposition from a hostile force.
To close their account, Abutaleb and Paletta offer a final vignette of Birx trying to convince Pence, after the election and amid the worst surge to date, to use his own bully pulpit to advocate for masking. Worried that the vice president was politely putting her off, Birx’s sense of urgency flared: “Those people only listen to you, Mr. Vice President, and the president. They don’t listen to me.” The authors think her phrase, “those people” speaks volumes; with America divided into rival camps, each side distrusting the other, it seemed it had become impossible to get the whole government on the same page. “The dynamic had made the task force’s job impossible and led to so much suffering,” the authors conclude.
That is close, but not quite right. In fact, it was the country’s reliance on the task force that had made it impossible to work to a common accord. The task force was never going to be able to bridge the divide, because its participants lacked a common sense of their enterprise, and because so often they chose to view disagreements as a failure to “follow the science.”
Abutaleb and Paletta say that their sources confided in them “in the hope that next time, we can do better. That the next pandemic has a better ending, one in which the nation rallies together to fight the pathogen, instead of each other.” We should, indeed, cherish such a hope. But if we are to realize it, we will have to figure out exactly what it is we are “rallying together” to accomplish—much more than we did in 2020. The American people cannot be expected to simply line up behind public health authorities, ready to take orders as if they were all soldiers in a war against a deadly pathogen. Americans’ desires to lead their normal lives in spite of the risks posed by the virus did not come from Trump, although his petulance and shortsightedness were major factors in his supporters’ opposition to shutdowns, social distancing, and masking.
When the next such crisis comes, we must find a way forward that treats people’s concerns as legitimate and asks them to make sacrifices only in the context of a coherent national strategy worked out by our political leaders. As much as Abutaleb and Paletta wish it, simply deferring more to the federal government’s doctors would not have resulted in the steady leadership needful during a crisis. Even if the doctors’ track record were much better than it was, their way of thinking about the pandemic would have proved grossly inadequate. What we needed to work through COVID together was a political process to shape our response. We didn’t get it. Instead, legislators in Washington made an admirable show of unity in March 2020, which led them to provide ungodly amounts of money with which to keep the virus’s economic effects at bay. Having done that, they largely disappeared from the scene, periodically resurfacing to accuse each other of blocking what was necessary to deal for even more cash. Congress barely registers in Abutaleb and Paletta’s account. But its absence speaks volumes. For if America was going to mobilize against a shared enemy—and if we are going to do it next time—it must work through difficult questions about how to distribute the immense burdens of that effort, and it would need to do so in a way that people from all over the country, and all over the political spectrum, would recognize as legitimate.