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I wish someone would ask Fauci and Birx about the early interactions between health experts during the crisis. This article from the NY Times outlines a whole host of issues. But a few of them stuck out.
a. Azar was originally in charge of the response.
b. All of the experts were weighing in on travel bans, when to undertake distancing, etc.
c. As late as Feb. 21 they were all trying to decide how soon to lockdown.
It would be good to know more of what the case was from each side, and what went into their calculations.
I am sure that the COVID investigations announced by Schiff will involve the usual political wrangling. But there are some legitimate questions about the process and the decisions ultimately reached.
He Could Have Seen What Was Coming: Behind Trump’s Failure on the Virus
Initial intelligence came from the National Security Council office responsible for tracking pandemics.
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.
Public health officials started working in January on the issue. Some of their decision making on the travel ban is listed below.
Travel restrictions were usually counterproductive to managing biological outbreaks because they prevented doctors and other much-needed medical help from easily getting to the affected areas, the health officials said. And such bans often cause infected people to flee, spreading the disease further.
But on the morning of Jan. 30, Mr. Azar got a call from Dr. Fauci, Dr. Redfield and others saying they had changed their minds. The World Health Organization had declared a global public health emergency and American officials had discovered the first confirmed case of person-to-person transmission inside the United States.
The economic team, led by Treasury Secretary Steven Mnuchin, continued to argue that there were big risks in taking a provocative step toward China and moving to curb global travel. After a debate, Mr. Trump came down on the side of the hawks and the public health team. The limits on travel from China were publicly announced on Jan. 31.
The public health team, according to the above, initially thought that travel restrictions were not good. That was in line with the WHO January 10 travel advistory which indicated that they were usually costly and not effective.
However, at some point they decided they should restrict travel anyway, based on what they were seeing.
To understand the time table, even Wuhan was not locked down until Jan. 23, which is 8 days after our first known case hit our shores. And it was described as an unprecedented measure:
Wuhan lockdown 'unprecedented', shows commitment to contain virus - WHO rep in China
“The lockdown of 11 million people is unprecedented in public health history, so it is certainly not a recommendation the WHO has made,” he said, adding authorities had to wait to see how effective it is.
Here is the WHO's advice on travel from January 10:
WHO advice for international travel and trade in relation to the outbreak of pneumonia caused by a new coronavirus in China
WHO does not recommend any specific health measures for travellers. It is generally considered that entry screening offers little benefit, while requiring considerable resources. In case of symptoms suggestive to respiratory illness before, during or after travel, the travellers are encouraged to seek medical attention and share travel history with their health care provider. WHO advises against the application of any travel or trade restrictions on China based on the information currently available on this event.
This WHO travel advice was not revised until January 24
The USA started screening at the major airports with direct flights on January 17.
We now realize that travel restriction at that point was too late to stop community spread, at least in Washington where the first case is believed to have led to spread in the community as early as January 15, based on mutation data. Likewise New York, based on mutation data was primarily hit by strains from Italy, and the lockdown on travel from Italy was too late to stop this inflow.
But what it does tell us is that the experts were all discussing together, and Azar was the one in charge of that response. When the health team weighed in, Trump went with their advice.
I think based on the SARS and MERS experience, as well as the information coming out of China at the time the WHO and the US experts both underestimated how easily the virus was transmitted. The next time a novel pneumonia causing virus is found, more countries may lock down or at least screen more thoroughly early on. While it is expensive, it is a lot better than complete lockdown.
What is less clear is why they waited so long to lockdown. Wuhan locked down on Jan. 23 as noted above. Italy didn't lock down the Lombardy region until March 8, so that would not have figured into this early thinking. I think some towns locked down in late Feb. in Italy.
It was becoming clear in February that we had community spread. Even with proper testing it would be hard to track down everything at that point. And we did not have proper testing. The initial CDC test worked, but the batch for the states suffered from what is believed to have been contamination of one of the three re-agents due to improper lab procedure in the CDC manufacturing wing. This delayed the entire testing regime until they could figure out the problem, which was investigated by the FDA.
So if they knew where was community spread starting, and had seen other lockdowns, even though the scale of such actions was unprecedented, why did they wait so long?
The article details some of the interactions:
When Dr. Robert Kadlec, the top disaster response official at the Health and Human Services Department, convened the White House coronavirus task force on Feb. 21, his agenda was urgent. There were deep cracks in the administration’s strategy for keeping the virus out of the United States. They were going to have to lock down the country to prevent it from spreading. The question was: When?
Facing the likelihood of a real pandemic, the group needed to decide when to abandon “containment” — the effort to keep the virus outside the U.S. and to isolate anyone who gets infected — and embrace “mitigation” to thwart the spread of the virus inside the country until a vaccine becomes available.
Among the questions on the agenda, which was reviewed by The New York Times, was when the department’s secretary, Mr. Azar, should recommend that Mr. Trump take textbook mitigation measures “such as school dismissals and cancellations of mass gatherings,” which had been identified as the next appropriate step in a Bush-era pandemic plan.
The exercise was sobering. The group — including Dr. Anthony S. Fauci of the National Institutes of Health; Dr. Robert R. Redfield of the Centers for Disease Control and Prevention, and Mr. Azar, who at that stage was leading the White House Task Force — concluded they would soon need to move toward aggressive social distancing, even at the risk of severe disruption to the nation’s economy and the daily lives of millions of Americans.
They had all the major experts in the room, Azar was heading the effort, and yet they were still saying soon as of Feb. 21.
Then two days later they got additional data on asymptomatic spread which gave more urgency to the need for mitigation. But they decided not to talk to Trump right away since he was in India, but to wait two days.
Dr. Kadlec’s group wanted to meet with the president right away, but Mr. Trump was on a trip to India, so they agreed to make the case to him in person as soon as he returned two days later. If they could convince him of the need to shift strategy, they could immediately begin a national education campaign aimed at preparing the public for the new reality.
Then before they talked to the president Dr. Messonnier released a memo detailing mitigation measures, without the president's consent, leading to a stock crash.
But Dr. Messonnier had jumped the gun. They had not told the president yet, much less gotten his consent.
On the 18-hour plane ride home, Mr. Trump fumed as he watched the stock market crash after Dr. Messonnier’s comments. Furious, he called Mr. Azar when he landed at around 6 a.m. on Feb. 26, raging that Dr. Messonnier had scared people unnecessarily. Already on thin ice with the president over a variety of issues and having overseen the failure to quickly produce an effective and widely available test, Mr. Azar would soon find his authority reduced.
Azar had been the one who was coordinating the effort, and the group of experts had delayed up until then, didn't talk to the president right away, and then issues advice without talking to him.
The meeting that evening with Mr. Trump to advocate social distancing was canceled, replaced by a news conference in which the president announced that the White House response would be put under the command of Vice President Mike Pence.
Fauci and Birx were the one who finally went to him and recommended the measures, and per Fauci at the press conference Trump said yes. However, that was after a long delay where the experts at first did not decide to start mitigation. And then once they decided they did not secure the meeting. The memo being sent out without clearance further complicated things, as did the stock crash. And then Trump reacted to perceived mistakes by switching leadership.
However, there are some holes in this timeline. Fauci was still saying they didn't need to social distance by Feb. 29 on TV. Yet in the article above it sounds like they had decided to distance on Feb. 21, and especially on Feb. 23 were all agreed.
You can see Fauci on the 29th on video at the link below saying the risk was still low and major mitigation was not yet needed.
Dr. Fauci on coronavirus fears: No need to change lifestyle yet
So was there division among the experts on the best course of action? And when Fauci said that when they went to Trump he agreed, isn't that brushing over a lot of the internal debate of the experts?
Later Fauci indicated that China did not send all the data they had, leading to errors:
However, it sounds like the experts may have been debating how the data that was present was to be interpreted.
a. Azar was originally in charge of the response.
b. All of the experts were weighing in on travel bans, when to undertake distancing, etc.
c. As late as Feb. 21 they were all trying to decide how soon to lockdown.
It would be good to know more of what the case was from each side, and what went into their calculations.
I am sure that the COVID investigations announced by Schiff will involve the usual political wrangling. But there are some legitimate questions about the process and the decisions ultimately reached.
He Could Have Seen What Was Coming: Behind Trump’s Failure on the Virus
Initial intelligence came from the National Security Council office responsible for tracking pandemics.
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.
Public health officials started working in January on the issue. Some of their decision making on the travel ban is listed below.
Travel restrictions were usually counterproductive to managing biological outbreaks because they prevented doctors and other much-needed medical help from easily getting to the affected areas, the health officials said. And such bans often cause infected people to flee, spreading the disease further.
But on the morning of Jan. 30, Mr. Azar got a call from Dr. Fauci, Dr. Redfield and others saying they had changed their minds. The World Health Organization had declared a global public health emergency and American officials had discovered the first confirmed case of person-to-person transmission inside the United States.
The economic team, led by Treasury Secretary Steven Mnuchin, continued to argue that there were big risks in taking a provocative step toward China and moving to curb global travel. After a debate, Mr. Trump came down on the side of the hawks and the public health team. The limits on travel from China were publicly announced on Jan. 31.
The public health team, according to the above, initially thought that travel restrictions were not good. That was in line with the WHO January 10 travel advistory which indicated that they were usually costly and not effective.
However, at some point they decided they should restrict travel anyway, based on what they were seeing.
To understand the time table, even Wuhan was not locked down until Jan. 23, which is 8 days after our first known case hit our shores. And it was described as an unprecedented measure:
Wuhan lockdown 'unprecedented', shows commitment to contain virus - WHO rep in China
“The lockdown of 11 million people is unprecedented in public health history, so it is certainly not a recommendation the WHO has made,” he said, adding authorities had to wait to see how effective it is.
Here is the WHO's advice on travel from January 10:
WHO advice for international travel and trade in relation to the outbreak of pneumonia caused by a new coronavirus in China
WHO does not recommend any specific health measures for travellers. It is generally considered that entry screening offers little benefit, while requiring considerable resources. In case of symptoms suggestive to respiratory illness before, during or after travel, the travellers are encouraged to seek medical attention and share travel history with their health care provider. WHO advises against the application of any travel or trade restrictions on China based on the information currently available on this event.
This WHO travel advice was not revised until January 24
The USA started screening at the major airports with direct flights on January 17.
We now realize that travel restriction at that point was too late to stop community spread, at least in Washington where the first case is believed to have led to spread in the community as early as January 15, based on mutation data. Likewise New York, based on mutation data was primarily hit by strains from Italy, and the lockdown on travel from Italy was too late to stop this inflow.
But what it does tell us is that the experts were all discussing together, and Azar was the one in charge of that response. When the health team weighed in, Trump went with their advice.
I think based on the SARS and MERS experience, as well as the information coming out of China at the time the WHO and the US experts both underestimated how easily the virus was transmitted. The next time a novel pneumonia causing virus is found, more countries may lock down or at least screen more thoroughly early on. While it is expensive, it is a lot better than complete lockdown.
What is less clear is why they waited so long to lockdown. Wuhan locked down on Jan. 23 as noted above. Italy didn't lock down the Lombardy region until March 8, so that would not have figured into this early thinking. I think some towns locked down in late Feb. in Italy.
It was becoming clear in February that we had community spread. Even with proper testing it would be hard to track down everything at that point. And we did not have proper testing. The initial CDC test worked, but the batch for the states suffered from what is believed to have been contamination of one of the three re-agents due to improper lab procedure in the CDC manufacturing wing. This delayed the entire testing regime until they could figure out the problem, which was investigated by the FDA.
So if they knew where was community spread starting, and had seen other lockdowns, even though the scale of such actions was unprecedented, why did they wait so long?
The article details some of the interactions:
When Dr. Robert Kadlec, the top disaster response official at the Health and Human Services Department, convened the White House coronavirus task force on Feb. 21, his agenda was urgent. There were deep cracks in the administration’s strategy for keeping the virus out of the United States. They were going to have to lock down the country to prevent it from spreading. The question was: When?
Facing the likelihood of a real pandemic, the group needed to decide when to abandon “containment” — the effort to keep the virus outside the U.S. and to isolate anyone who gets infected — and embrace “mitigation” to thwart the spread of the virus inside the country until a vaccine becomes available.
Among the questions on the agenda, which was reviewed by The New York Times, was when the department’s secretary, Mr. Azar, should recommend that Mr. Trump take textbook mitigation measures “such as school dismissals and cancellations of mass gatherings,” which had been identified as the next appropriate step in a Bush-era pandemic plan.
The exercise was sobering. The group — including Dr. Anthony S. Fauci of the National Institutes of Health; Dr. Robert R. Redfield of the Centers for Disease Control and Prevention, and Mr. Azar, who at that stage was leading the White House Task Force — concluded they would soon need to move toward aggressive social distancing, even at the risk of severe disruption to the nation’s economy and the daily lives of millions of Americans.
They had all the major experts in the room, Azar was heading the effort, and yet they were still saying soon as of Feb. 21.
Then two days later they got additional data on asymptomatic spread which gave more urgency to the need for mitigation. But they decided not to talk to Trump right away since he was in India, but to wait two days.
Dr. Kadlec’s group wanted to meet with the president right away, but Mr. Trump was on a trip to India, so they agreed to make the case to him in person as soon as he returned two days later. If they could convince him of the need to shift strategy, they could immediately begin a national education campaign aimed at preparing the public for the new reality.
Then before they talked to the president Dr. Messonnier released a memo detailing mitigation measures, without the president's consent, leading to a stock crash.
But Dr. Messonnier had jumped the gun. They had not told the president yet, much less gotten his consent.
On the 18-hour plane ride home, Mr. Trump fumed as he watched the stock market crash after Dr. Messonnier’s comments. Furious, he called Mr. Azar when he landed at around 6 a.m. on Feb. 26, raging that Dr. Messonnier had scared people unnecessarily. Already on thin ice with the president over a variety of issues and having overseen the failure to quickly produce an effective and widely available test, Mr. Azar would soon find his authority reduced.
Azar had been the one who was coordinating the effort, and the group of experts had delayed up until then, didn't talk to the president right away, and then issues advice without talking to him.
The meeting that evening with Mr. Trump to advocate social distancing was canceled, replaced by a news conference in which the president announced that the White House response would be put under the command of Vice President Mike Pence.
Fauci and Birx were the one who finally went to him and recommended the measures, and per Fauci at the press conference Trump said yes. However, that was after a long delay where the experts at first did not decide to start mitigation. And then once they decided they did not secure the meeting. The memo being sent out without clearance further complicated things, as did the stock crash. And then Trump reacted to perceived mistakes by switching leadership.
However, there are some holes in this timeline. Fauci was still saying they didn't need to social distance by Feb. 29 on TV. Yet in the article above it sounds like they had decided to distance on Feb. 21, and especially on Feb. 23 were all agreed.
You can see Fauci on the 29th on video at the link below saying the risk was still low and major mitigation was not yet needed.
Dr. Fauci on coronavirus fears: No need to change lifestyle yet
So was there division among the experts on the best course of action? And when Fauci said that when they went to Trump he agreed, isn't that brushing over a lot of the internal debate of the experts?
Later Fauci indicated that China did not send all the data they had, leading to errors:
However, it sounds like the experts may have been debating how the data that was present was to be interpreted.
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