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what the administration should have been doing in January to prepare us for today.

She cites the delay on tests, without which “cases go undetected and people continue to circulate” as a leading issue along with other missed federal government responses—many of which are still not fully operational

The prescient recommendations from experts across disciplines in the period before COVID-19 reached American shores—about testing, equipment, and distancing—make clear that more than any single factor, it was Trump’s squandering of out lead-time which should have been used to prepare for the pandemic that has exacerbated this crisis.

What follows is an annotated timeline revealing the warning signs the administration received and showing how slow the administration was to act on these recommendations.

The Early Years: Warnings Ignored

2017: Trump administrations officials are briefed on an intelligence document titled “Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents.” That’s right. The administration literally had an actual playbook for what to do in the early stages of a pandemic

February 2018: The Washington Post writes “CDC to cut by 80 percent efforts to prevent global disease outbreak.” The meat of the story is “Countries where the CDC is planning to scale back include some of the world’s hot spots for emerging infectious disease, such as China, Pakistan, Haiti, Rwanda and Congo.”

May 2018: At an event marking the 100 year anniversary of the 1918 pandemic, Borio says “pandemic flu” is the “number 1 health security issue” and that the U.S. is not ready to respond.

One day later her boss, Rear Adm. Timothy Ziemer is pushed out of the administration and the global health security team is disbanded

Beth Cameron, former senior director for global health security on the National Security Council adds: “It is unclear in his absence who at the White House would be in charge of a pandemic,” Cameron said, calling it “a situation that should be immediately rectified.” Note: It was not

January 2019: The director of National Intelligence issues the U.S. Intelligence Community’s assessment of threats to national security. Among its findings:

A novel strain of a virulent microbe that is easily transmissible between humans continues to be a major threat, with pathogens such as H5N1 and H7N9 influenza and Middle East Respiratory Syndrome Coronavirus having pandemic potential if they were to acquire efficient human-to-human transmissibility.”

Page 21: “We assess that the United States and the world will remain vulnerable to the next flu pandemic or large scale outbreak of a contagious disease that could lead to massive rates of death and disability, severely affect the world economy, strain international resources, and increase calls on the United States for support.”

September, 2019: The Trump Administration ended the pandemic early warning program, PREDICT, which trained scientists in China and other countries to identify viruses that had the potential to turn into pandemics. According to the Los Angeles Times, “field work ceased when funding ran out in September,” two months before COVID-19 emerged in Wuhan Province, China.

2020: COVID-19 Arrives

anuary 3, 2020: The CDC is first alerted to a public health event in Wuhan, China

January 6, 2020: The CDC issues a travel notice for Wuhan due to the spreading coronavirus

Note: The Trump campaign claims that this marks the beginning of the federal government disease control experts becoming aware of the virus. It was 10 weeks from this point until the week of March 16 when Trump began to change his tone on the threat.

January 10, 2020: Former Trump Homeland Security Advisor Tom Bossert warns that we shouldn’t “jerk around with ego politics” because “we face a global health threat…Coordinate!”

January 18, 2020: After two weeks of attempts, HHS Secretary Alex Azar finally gets the chance to speak to Trump about the virus. The president redirects the conversation to vaping, according to the Washington Post. 

January 21, 2020: Dr. Nancy Messonnier, the director of the National Center for Immunization and Respiratory Disease at the CDC tells reporters, “We do expect additional cases in the United States.”

January 27, 2020: Top White House aides meet with Chief of Staff Mick Mulvaney to encourage greater focus on the threat from the virus. Joe Grogan, head of the White House Domestic Policy Council warns that “dealing with the virus was likely to dominate life in the United States for many months.”

January 28, 2020: Two former Trump administration officials—Gottlieb and Borio—publish an op-ed in the Wall Street Journal imploring the president to “Act Now to Prevent an American Epidemic.” They advocate a 4-point plan to address the coming crisis:

(1) Expand testing to identify and isolate cases. Note: This did not happen for many weeks. The first time more than 2,000 tests were deployed in a single day was not until almost six weeks later, on March 11.

(3) Prepare hospital units for isolation with more gowns and masks. Note: There was no dramatic ramp-up in the production of critical supplies undertaken. As a result, many hospitals quickly experienced shortages of critical PPE materials. Federal agencies waited until Mid-March to begin bulk orders of N95 masks.

January 29, 2020: Trump trade advisor Peter Navarro circulates an internal memo warning that America is “defenseless” in the face of an outbreak which “elevates the risk of the coronavirus evolving into a full-blown pandemic, imperiling the lives of millions of Americans.”

January 30, 2020: Dr. James Hamblin publishes another warning about critical PPE materials in the Atlantic, titled “We Don’t Have Enough Masks.”

January 29, 2020: Republican Senator Tom Cotton reaches out to President Trump in private to encourage him to take the virus seriously.

Late January, 2020:  HHS sends a letter asking to use its transfer authority to shift $136 million of department funds into pools that could be tapped for combating the coronavirus. White House budget hawks argued that appropriating too much money at once when there were only a few U.S. cases would be viewed as alarmist.

Trump’s Chinese travel ban only banned “foreign nationals who had been in China in the last 14 days.” This wording did not—at all—stop people from arriving in America from China. In fact, for much of the crisis, flights from China landed in America almost daily filled with people who had been in China, but did not fit the category as Trump’s “travel ban” defined it.

January 31, 2020: On the same day Trump was enacting his fake travel ban, Foreign Policy reports that face masks and latex gloves are sold out on Amazon and at leading stores in New York City and suggests the surge in masks being sold to other countries needs “refereeing” in the face of the coming crisis.

February 4, 2020: Gottlieb and Borio take to the WSJ again, this time to warn the president that “a pandemic seems inevitable” and call on the administration to dramatically expand testing, expand the number of labs for reviewing tests, and change the rules to allow for tests of people even if they don’t have a clear known risk factor.

Note: Some of these recommendations were eventually implemented—25 days later.

February 5, 2020: HHS Secretary Alex Azar requests $2 billion to “buy respirator masks and other supplies for a depleted federal stockpile of emergency medical equipment.” He is rebuffed by Trump and the White House OMB who eventually send Congress a $500 million request weeks later.

February 4 or 5, 2020: Robert Kadlec, the assistant secretary for preparedness and response, and other intelligence officials brief the Senate Intelligence Committee that the virus poses a “serious” threat and that “Americans would need to take actions that could disrupt their daily lives.”

February 5, 2020: Senator Chris Murphy tweets: Just left the Administration briefing on Coronavirus. Bottom line: they aren't taking this seriously enough. Notably, no request for ANY emergency funding, which is a big mistake. Local health systems need supplies, training, screening staff etc. And they need it now.

February 9, 2020: The Washington Post reports that a group of governors participated in a jarring meeting with Dr. Anthony Fauci and Dr. Robert Redfield that was much more alarmist than what they were hearing from Trump. “The doctors and the scientists, they were telling us then exactly what they are saying now,” Maryland Gov. Larry Hogan (R) said.

the administration lifted CDC restrictions on tests. This is a factually true statement. But it elides that fact that they did so on March 3—two critical weeks after the third Borio/Gottlieb op-ed on the topic, during which time the window for intervention had shrunk to a pinhole.

February 20, 2020: Borio and Gottlieb write in the Wall Street Journal that tests must be ramped up immediately “while we can intervene to stop spread.”

February 23, 2020: Harvard School of Public Health professor issues warning on lack of test capability: “As of today, the US remains extremely limited in#COVID19 testing. Only 3 of ~100 public health labs haveCDC test kits working and CDC is not sharing what went wrong with the kits. How to know if COVID19 is spreading here if we are not looking for it.

February 24, 2020: The Trump administration sends a letter to Congress requesting a small dollar amount—between $1.8 billion and $2.5 billion—to help combat the spread of the coronavirus. This is, of course, a pittance

February 25, 2020: Messonier says she expects “community spread” of the virus in the United States and that “disruption to everyday life might be severe.” Trump is reportedly furious and Messonier’s warnings are curtailed in the ensuing weeks.

Trump mocks Congress in a White House briefing, saying “If Congress wants to give us the money so easy—it wasn’t very easy for the wall, but we got that one done. If they want to give us the money, we’ll take the money.”

February 26, 2020: Congress, recognizing the coming threat, offers to give the administration $6 billion more than Trump asked for in order to prepare for the virus.

February 27, 2020: In a leaked audio recording Sen. Richard Burr, chairman of the Intelligence Committee and author of the Pandemic and All-Hazards Preparedness Act (PAHPA) and the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (reauthorization of PAHPA), was telling people that COVID-19 “is probably more akin to the 1918 pandemic.”

March 4, 2020: HHS says they only have 1 percent of respirator masks needed if the virus became a “full-blown pandemic.”

March 3, 2020: Vice President Pence is asked about legislation encouraging companies to produce more masks. He says the Trump administration is “looking at it.”

March 7, 2020: Fox News host Tucker Carlson, flies to Mar-a-Lago to implore Trump to take the virus seriously in private rather than embarrass him on TV. Even after the private meeting, Trump continued to downplay the crisis

March 9, 2020: Tom Bossert, Trump’s former Homeland Security adviser, publishes an op-ed saying it is “now or never” to act. He advocates for social distancing and school closures to slow the spread of the contagion.

Trump says that developments are “good for the consumer” and compares COVID-19 favorably to the common flu.

March 17, 2020: Facing continued shortages of the PPE equipment needed to prevent healthcare providers from succumbing to the virus, Oregon Senators Jeff Merkeley and Ron Wyden call on Trump to use the Defense Production Act to expand supply of medical equipment

March 18, 2020: Trump signs the executive order to activate the Defense Production Act, but declines to use it

At the White House briefing he is asked about Senator Chuck Schumer’s call to urgently produce medical supplies and ventilators. Trump responds: “Well we’re going to know whether or not it’s urgent.” Note: At this point 118 Americans had died from COVID-19.

March 20, 2020: At an April 2nd White House Press Conference, President Trump’s son-in-law Jared Kushner who was made ad hoc point man for the coronavirus response said that on this date he began working with Rear Admiral John Polowczyk to “build a team” that would handle the logistics and supply chain for providing medical supplies to the states. This suggestion was first made by former Trump Administration officials January 28th

March 22, 2020: Six days after calling for a 15-day period of distancing, Trump tweets that this approach “may be worse than the problem itself.”

March 24, 2020: Trump tells Fox News that he wants the country opened up by Easter Sunday (April 12)

As Trump was speaking to Fox, there were 52,145 confirmed cases in the United States and the doubling time for daily new cases was roughly four days.

They worried that a vaccine would initially elude scientists, that weary citizens would abandon restrictions despite the risks, that the virus would be with us from now on.

Most experts believed that once the crisis was over, the nation and its economy would revive quickly. But there would be no escaping a period of intense pain.

Exactly how the pandemic will end depends in part on medical advances still to come. It will also depend on how individual Americans behave in the interim. If we scrupulously protect ourselves and our loved ones, more of us will live. If we underestimate the virus, it will find us.

More Americans may die than the White House admits.

The epidemiological model often cited by the White House, which was produced by the University of Washington’s Institute for Health Metrics and Evaluation, originally predicted 100,000 to 240,000 deaths by midsummer. Now that figure is 60,000.

The institute’s projection runs through Aug. 4, describing only the first wave of this epidemic. Without a vaccine, the virus is expected to circulate for years, and the death tally will rise over time.

Fatality rates depend heavily on how overwhelmed hospitals get and what percentage of cases are tested. China’s estimated death rate was 17 percent in the first week of January, when Wuhan was in chaos, according to a Center for Evidence-Based Medicine report, but only 0.7 percent by late February.

Various experts consulted by the Centers for Disease Control and Prevention in March predicted that the virus eventually could reach 48 percent to 65 percent of all Americans, with a fatality rate just under 1 percent, and would kill up to 1.7 million of them if nothing were done to stop the spread.

A model by researchers at Imperial College London cited by the president on March 30 predicted 2.2 million deaths in the United States by September under the same circumstances.

China has officially reported about 83,000 cases and 4,632 deaths, which is a fatality rate of over 5 percent. The Trump administration has questioned the figures but has not produced more accurate ones.

The tighter the restrictions, experts say, the fewer the deaths and the longer the periods between lockdowns. Most models assume states will eventually do widespread temperature checks, rapid testing and contact tracing, as is routine in Asia.

In this country, hospitals in several cities, including New York, came to the brink of chaos.

Only when tens of thousands of antibody tests are done will we know how many silent carriers there may be in the United States. The C.D.C. has suggested it might be 25 percent of those who test positive. Researchers in Iceland said it might be double that.

China is also revising its own estimates. In February, a major study concluded that only 1 percent of cases in Wuhan were asymptomatic. New research says perhaps 60 percent were.

The virus may also be mutating to cause fewer symptoms. In the movies, viruses become more deadly. In reality, they usually become less so, because asymptomatic strains reach more hosts. Even the 1918 Spanish flu virus eventually faded into the seasonal H1N1 flu.

The lockdowns will end, but haltingly.

it is likely a safe bet that at least 300 million of us are still vulnerable.

Until a vaccine or another protective measure emerges, there is no scenario, epidemiologists agreed, in which it is safe for that many people to suddenly come out of hiding. If Americans pour back out in force, all will appear quiet for perhaps three weeks.

The gains to date were achieved only by shutting down the country, a situation that cannot continue indefinitely. The White House’s “phased” plan for reopening will surely raise the death toll no matter how carefully it is executed.

Every epidemiological model envisions something like the dance

On the models, the curves of rising and falling deaths resemble a row of shark teeth.

Surges are inevitable, the models predict, even when stadiums, churches, theaters, bars and restaurants remain closed, all travelers from abroad are quarantined for 14 days, and domestic travel is tightly restricted to prevent high-intensity areas from reinfecting low-intensity ones.

In his wildly popular March 19 article in Medium, “Coronavirus: The Hammer and the Dance,” Tomas Pueyo correctly predicted the national lockdown, which he called the hammer, and said it would lead to a new phase, which he called the dance, in which essential parts of the economy could reopen, including some schools and some factories with skeleton crews.

Even the “Opening Up America Again” guidelines Mr. Trump issued on Thursday have three levels of social distancing, and recommend that vulnerable Americans stay hidden. The plan endorses testing, isolation and contact tracing — but does not specify how these measures will be paid for, or how long it will take to put them in place.

On Friday, none of that stopped the president from contradicting his own message by sending out tweets encouraging protesters in Michigan, Minnesota and Virginia to fight their states’ shutdowns.

China did not allow Wuhan, Nanjing or other cities to reopen until intensive surveillance found zero new cases for 14 straight days, the virus’s incubation period.

Compared with China or Italy, the United States is still a playground.Americans can take domestic flights, drive where they want, and roam streets and parks. Despite restrictions, everyone seems to know someone discreetly arranging play dates for children, holding backyard barbecues or meeting people on dating apps.

Even with rigorous measures, Asian countries have had trouble keeping the virus under control

But if too many people get infected at once, new lockdowns will become inevitable. To avoid that, widespread testing will be imperative.

Reopening requires declining cases for 14 days, the tracing of 90 percent of contacts, an end to health care worker infections, recuperation places for mild cases and many other hard-to-reach goals.

Immunity will become a societal advantage.

Imagine an America divided into two classes: those who have recovered from infection with the coronavirus and presumably have some immunity to it; and those who are still vulnerable.

“It will be a frightening schism,” Dr. David Nabarro, a World Health Organization special envoy on Covid-19, predicted. “Those with antibodies will be able to travel and work, and the rest will be discriminated against.”

Soon the government will have to invent a way to certify who is truly immune. A test for IgG antibodies, which are produced once immunity is established, would make sense

Dr. Fauci has said the White House was discussing certificates like those proposed in Germany. China uses cellphone QR codes linked to the owner’s personal details so others cannot borrow them.

As Americans stuck in lockdown see their immune neighbors resuming their lives and perhaps even taking the jobs they lost, it is not hard to imagine the enormous temptation to join them through self-infection

My daughter, who is a Harvard economist, keeps telling me her age group needs to have Covid-19 parties to develop immunity and keep the economy going,”

It would be a gamble for American youth, too. The obese and immunocompromised are clearly at risk, but even slim, healthy young Americans have died of Covid-19.

The virus can be kept in check, but only with expanded resources.

Resolve to Save Lives, a public health advocacy group run by Dr. Thomas R. Frieden, the former director of the C.D.C., has published detailed and strict criteria for when the economy can reopen and when it must be closed.

once a national baseline of hundreds of thousands of daily tests is established across the nation, any viral spread can be spotted when the percentage of positive results rises.

To keep the virus in check, several experts insisted, the country also must start isolating all the ill — including mild cases.

“If I was forced to select only one intervention, it would be the rapid isolation of all cases,”

In China, anyone testing positive, no matter how mild their symptoms, was required to immediately enter an infirmary-style hospital — often set up in a gymnasium or community center outfitted with oxygen tanks and CT scanners.

There, they recuperated under the eyes of nurses. That reduced the risk to families, and being with other victims relieved some patients’ fears.

Still, experts were divided on the idea of such wards

Ultimately, suppressing a virus requires testing all the contacts of every known case. But the United States is far short of that goal.

In China’s Sichuan Province, for example, each known case had an average of 45 contacts.

The C.D.C. has about 600 contact tracers and, until recently, state and local health departments employed about 1,600, mostly for tracing syphilis and tuberculosis cases.

China hired and trained 9,000 in Wuhan alone. Dr. Frieden recently estimated that the United States will need at least 300,000.

There will not be a vaccine soon.

any effort to make a vaccine will take at least a year to 18 months.

the record is four years, for the mumps vaccine.

for unclear reasons, some previous vaccine candidates against coronaviruses like SARS have triggered “antibody-dependent enhancement,” which makes recipients more susceptible to infection, rather than less. In the past, vaccines against H.I.V. and dengue have unexpectedly done the same.

A new vaccine is usually first tested in fewer than 100 young, healthy volunteers. If it appears safe and produces antibodies, thousands more volunteers — in this case, probably front-line workers at the highest risk — will get either it or a placebo in what is called a Phase 3 trial.

It is possible to speed up that process with “challenge trials.” Scientists vaccinate small numbers of volunteers, wait until they develop antibodies, and then “challenge” them with a deliberate infection to see if the vaccine protects them.

Normally, it is ethically unthinkable to challenge subjects with a disease with no cure, such as Covid-19.

“Fewer get harmed if you do a challenge trial in a few people than if you do a Phase 3 trial in thousands,” said Dr. Lipsitch, who recently published a paper advocating challenge trials in the Journal of Infectious Diseases. Almost immediately, he said, he heard from volunteers.

The hidden danger of challenge trials, vaccinologists explained, is that they recruit too few volunteers to show whether a vaccine creates enhancement, since it may be a rare but dangerous problem.

if a vaccine is invented, the United States could need 300 million doses — or 600 million if two shots are required. And just as many syringes.

“People have to start thinking big,” Dr. Douglas said. “With that volume, you’ve got to start cranking it out pretty soon.”

Treatments are likely to arrive first.

The modern alternative is monoclonal antibodies. These treatment regimens, which recently came very close to conquering the Ebola epidemic in eastern Congo, are the most likely short-term game changer, experts said.

as with vaccines, growing and purifying monoclonal antibodies takes time. In theory, with enough production, they could be used not just to save lives but to protect front-line workers.

Having a daily preventive pill would be an even better solution, because pills can be synthesized in factories far faster than vaccines or antibodies can be grown and purified.

Goodbye, ‘America First.’

A public health crisis of this magnitude requires international cooperation on a scale not seen in decades. Yet Mr. Trump is moving to defund the W.H.O., the only organization capable of coordinating such a response.

And he spent most of this year antagonizing China, which now has the world’s most powerful functioning economy and may become the dominant supplier of drugs and vaccines. China has used the pandemic to extend its global influence, and says it has sent medical gear and equipment to nearly 120 countries.

This is not a world in which “America First” is a viable strategy, several experts noted.

“If President Trump cares about stepping up the public health efforts here, he should look for avenues to collaborate with China and stop the insults,”

If we alienate the Chinese with our rhetoric, I think it will come back to bite us,” he said.“What if they come up with the first vaccine? They have a choice about who they sell it to. Are we top of the list? Why would we be?”

Once the pandemic has passed, the national recovery may be swift. The economy rebounded after both world wars, Dr. Mulder noted.

In one of the most provocative analyses in his follow-up article, “Coronavirus: Out of Many, One,” Mr. Pueyo analyzed Medicare and census data on age and obesity in states that recently resisted shutdowns and counties that voted Republican in 2016.

He calculated that those voters could be 30 percent more likely to die of the virus.

In the periods after both wars, Dr. Mulder noted, society and incomes became more equal. Funds created for veterans’ and widows’ pensions led to social safety nets, measures like the G.I. Bill and V.A. home loans were adopted, unions grew stronger, and tax benefits for the wealthy withered.

If a vaccine saves lives, many Americans may become less suspicious of conventional medicine and more accepting of science in general — including climate change

Within a week of its first confirmed case, South Korea’s disease control agency had summoned 20 private companies to the medical equivalent of a war-planning summit and told them to develop a test for the virus at lightning speed. A week after that, the first diagnostic test was approved and went into battle, identifying infected individuals who could then be quarantined to halt the advance of the disease.

Some 357,896 tests later, the country has more or less won the coronavirus war. On Friday only 91 new cases were reported in a country of more than 50 million.

The US response tells a different story. Two days after the first diagnosis in Washington state, Donald Trump went on air on CNBC and bragged: “We have it totally under control. It’s one person coming from China. It’s going to be just fine.”

Though the decision to allow private and state labs to provide testing has increased the flow of test kits, the US remains starkly behind South Korea, which has conducted more than five times as many tests per capita. That makes predicting where the next hotspot will pop up after New York and New Orleans almost impossible.

Today, 86,012 cases have been confirmed across the US, pushing the nation to the top of the world’s coronavirus league table – above even China.

Most worryingly, the curve of cases continues to rise precipitously, with no sign of the plateau that has spared South Korea.

Jeremy Konyndyk, who led the US government’s response to international disasters at USAid from 2013 to 2017, frames the past six weeks in strikingly similar terms. He told the Guardian: “We are witnessing in the United States one of the greatest failures of basic governance and basic leadership in modern times.”

It was not until 29 February, more than a month after the Journal article and almost six weeks after the first case of coronavirus was confirmed in the country that the Trump administration put that advice into practice. Laboratories and hospitals would finally be allowed to conduct their own Covid-19 tests to speed up the process.

If Trump’s travel ban did nothing else, it staved off to some degree the advent of the virus in the US, buying a little time. Which makes the lack of decisive action all the more curious.

In the absence of sufficient test kits, the US Centers of Disease Control and Prevention (CDC) initially kept a tight rein on testing, creating a bottleneck. “I believe the CDC was caught flat-footed,” was how the governor of New York, Andrew Cuomo, put it on 7 March. “They’re slowing down the state.”The CDC’s botched rollout of testing was the first indication that the Trump administration was faltering as the health emergency gathered pace. Behind the scenes, deep flaws in the way federal agencies had come to operate under Trump were being exposed.

In 2018 the pandemic unit in the national security council – which was tasked to prepare for health emergencies precisely like the current one – was disbanded. “Eliminating the office has contributed to the federal government’s sluggish domestic response,” Beth Cameron, senior director of the office at the time it was broken up, wrote in the Washington Post.

It was hardly a morale-boosting gesture when Trump proposed a 16% cut in CDC funding on 10 February – 11 days after the World Health Organization had declared a public health emergency over Covid-19.

The Food and Drug Administration (FDA), which regulates the diagnostic tests and will control any new treatments for coronavirus, has also shown vulnerabilities. The agency recently indicated that it was looking into the possibility of prescribing the malaria drug chloroquine for coronavirus sufferers, even though there is no evidence it would work and some indication it could have serious side-effects.

As the former senior official put it: “We have the FDA bowing to political pressure and making decisions completely counter to modern science.”

Trump has designated himself a “wartime president”. But if the title bears any validity, his military tactics have been highly unconventional. He has exacerbated the problems encountered by federal agencies by playing musical chairs at the top of the coronavirus force.

The president began by creating on 29 January a special coronavirus taskforce, then gave Vice-President Mike Pence the job, who promptly appointed Deborah Birx “coronavirus response coordinator”, before the federal emergency agency Fema began taking charge of key areas, with Jared Kushner, the president’s son-in-law, creating a shadow team that increasingly appears to be calling the shots.“There’s no point of responsibility,” the former senior official told the Guardian. “It keeps shifting. Nobody owns the problem.”

So it has transpired. In the wake of the testing disaster has come the personal protective equipment (PPE) disaster, the hospital bed disaster, and now the ventilator disaster.Ventilators, literal life preservers, are in dire short supply across the country. When governors begged Trump to unleash the full might of the US government on this critical problem, he gave his answer on 16 March.In a phrase that will stand beside 20 January 2020 as one of the most revelatory moments of the history of coronavirus, he said: “Respirators, ventilators, all of the equipment – try getting it yourselves.”

In the absence of a strong federal response, a patchwork of efforts has sprouted all across the country. State governors are doing their own thing. Cities, even individual hospitals, are coping as best they can.

For months, Trump himself referred to the illness as “the coronavirus.” In early March, though, several conservative media figures began using Wuhan virus or Chinese virus instead. On March 16, Trump himself began to refer to it as the “Chinese Virus,” prompting commentators to charge that he was racializing the epidemic

Even before Trump’s adoption of Chinese virus, Asian Americans had been facing a wave of discrimination, harassment, and violence in response to the epidemic. The president’s rhetoric did not start this backlash, but the decision to embrace the term Chinese virus reinforced the association between a worldwide pandemic and people of a particular national origin.

Legitimizing that link with all the authority of the office of the president of the United States is not just morally abhorrent, but dangerous.

The president’s now-constant use of Chinese virus is the latest example of a conservative phenomenon

Trump and his acolytes are never more comfortable than when they are defending expressions of bigotry as plain common sense, and accusing their liberal critics of being oversensitive snowflakes who care more about protecting “those people” than they do about you. They seek to reduce any political dispute to this simple equation whenever possible.

“I want them to talk about racism every day,” the former Trump adviser Steve Bannon told The American Prospect in 2017. “If the left is focused on race and identity, and we go with economic nationalism, we can crush the Democrats.”

n this instance, though, the gambit served two additional purposes: distracting the public from Trump’s catastrophic mishandling of the coronavirus pandemic, and disguising the fact that Trump’s failures stemmed from his selfishness and fondness for authoritarian leaders, which in turn made him an easy mark for the Chinese government’s disinformation

Trump understands that overt expressions of prejudice draw condemnation from liberals, which in turn rallies his own base around him. Calling the coronavirus the “Chinese virus” not only informs Trump’s base that foreigners are the culprits, it also offers his supporters the emotional satisfaction of venting fury at liberals for unfairly accusing conservatives of racism.

Since that report, Chinese officials have engaged in a propaganda offensive, expelling American journalists, minimizing their early missteps, and putting forth a conspiracy theory that the virus was engineered by the U.S. military. Compared with all this, the president’s defenders argue, Trump referring to the coronavirus as the “Chinese virus” seems trivial.

The point is to turn a pandemic that threatens both mass death and the collapse of the American economy into a culture-war argument in which the electorate can be polarized along partisan lines.

Lost in that comparison, however, is the fact that the most effective target of CCP disinformation has been Trump himself.

According to The Washington Post, at the same time that Trump was stating that Beijing had the disease under control, U.S. intelligence agencies were already warning him that “Chinese officials appeared to be minimizing the severity of the outbreak.”

Administration officials directly warned Trump of the danger posed by the virus, but “Trump’s insistence on the contrary seemed to rest in his relationship with China’s President Xi Jingping, whom Trump believed was providing him with reliable information about how the virus was spreading in China,” The Washington Post reported, “despite reports from intelligence agencies that Chinese officials were not being candid about the true scale of the crisis.”

The right’s rhetorical shift then, is not just another racism rope-a-dop

It is also an attempt to cover up the fact that the Chinese government’s propaganda campaign was effective in that it helped persuade the president of the United States not to take adequate precautionary measures to stem a tide of pestilence that U.S. government officials saw coming.

Now faced with the profound consequences of that decision, the right has settled on a strategy that does little to hold Beijing accountable for its mishandling of the coronavirus, but instead plays into Beijing’s attempt to cast any criticism of the Chinese government’s response as racism

The term makes no distinction between China’s authoritarian government and people who happen to be of Chinese origin, and undermines the unified front the Trump administration would want if it were actually concerned with countering Chinese-government propaganda.

Instead, the Trump administration has chosen a political tactic that strengthens the president’s political prospects by polarizing the electorate, and covers up his own role as Xi’s patsy, while making its own pushback against CCP propaganda less effective

This approach reflects the most glaring flaws of Trumpist governance, which have become only more acute during the coronavirus crisis: It exacerbates rather than solves the underlying problem, placing the president’s political objectives above all other concerns, even the ones both the president and his supporters claim to value.

Find everyone they interact with by deploying contact tracing on a scale America has never attempted before.

focus restrictions more narrowly on the infected and their contacts so the rest of society doesn’t have to stay in permanent lockdown.

Instead, the president and his top advisers have fixated almost exclusively on plans to reopen the U.S. economy by the end of the month, though they haven’t detailed how they will do so without triggering another outbreak

Administration officials, speaking on the condition of anonymity to describe internal deliberations, say the White House has made a deliberate political calculation that it will better serve Trump’s interest to put the onus on governors — rather than the federal government — to figure out how to move ahead.

without substantial federal funding, states’ efforts will only go so far

The next failure is already on its way, Frieden said, because “we’re not doing the things we need to be doing in April.”

In recent days, dozens of leading voices have coalesced around the test-trace-quarantine framework, including former FDA commissioners for the Trump and George W. Bush administrations, Microsoft founder Bill Gates and top experts at Johns Hopkins, Columbia and Harvard universities.

On Wednesday, former president Barack Obama weighed in, tweeting, “Social distancing bends the curve and relieves some pressure … But in order to shift off current policies, the key will be a robust system of testing and monitoring — something we have yet to put in place nationwide.”

And Friday, Apple and Google unveiled a joint effort on new tools that would use smartphones to aid in contact tracing.

What remains unclear is whether this emerging plan can succeed without the backing of the federal government.

“It’s mind-boggling, actually, the degree of disorganization,” said Tom Frieden, former Centers for Disease Control and Prevention director. The federal government has already squandered February and March, he noted, committing “epic failures” on testing kits, ventilator supply, protective equipment for health workers and contradictory public health communication.

Experts and leaders in some states say remedying that weakness should be a priority and health departments should be rapidly shored up so that they are ready to act in coming weeks as infections nationwide begin to decrease

In America, testing — while still woefully behind — is ramping up. And households across the country have learned over the past month how to quarantine. But when it comes to the second pillar of the plan — the labor-intensive work of contact tracing — local health departments lack the necessary staff, money and training.

In South Korea, Taiwan, China and Singapore, variations on this basic strategy were implemented by their national governments, allowing them to keep the virus in check even as they reopened parts of their economy and society

In a report released Friday, the Johns Hopkins Center for Health Security and the Association of State and Territorial Health Officials — which represents state health departments — estimate 100,000 additional contact tracers are needed and call for $3.6 billion in emergency funding from Congress.

“We can’t afford to have multiple community outbreaks that can spiral up into sustained community transmission,” he said in the interview.

Unless states can aggressively trace and isolate the virus, experts say, there will be new outbreaks and another round of disruptive stay-at-home orders.

“All people are talking about right now is hospital beds, ventilators, testing, testing, testing. Yes, those are important, but they are all reactive. You are dealing with the symptoms and not the virus itself,”

The nonprofit Partners in Health quickly put together a plan to hire and train 1,000 contact tracers. Working from their homes making 20 to 30 calls a day, they could cover up to 20,000 contacts a day.

Testing on its own is useless, Nyenswah explained, because it only tells you who already has the virus. Similarly, tracing alone is useless if you don’t place those you find into quarantine. But when all three are implemented, the chain of transmission can be shattered.

Until a vaccine or treatment is developed, such nonpharmaceutical interventions are the only tools countries can rely on — besides locking down their cities.

to expand that in a country as large as the United States will require a massive dose of money, leadership and political will.

“You cannot have leaders contradicting each other every day. You cannot have states waiting on the federal government to act, and government telling the states to figure it out on their own,” he said. “You need a plan.”

When Vermont’s first coronavirus case was detected last month, it took two state health workers a day to track down 13 people who came into contact with that single patient. They put them under quarantine and started monitoring for symptoms. No one else became sick.

He did the math: If each of those 30 patients had contact with even three people, that meant 90 people his crew would have to locate and get into quarantine. In other words, impossible.

Since 2008, city and county health agencies have lost almost a quarter of their overall workforce. Decades of budget cuts have left the them unable to mount such a response. State health departments have recently had to lay off thousands more — an unintended consequence of federal officials delaying tax filings until July without warning states.

In Wuhan, a city of 11 million, the Chinese had 9,000 health workers doing contact tracing, said Frieden, the former CDC director. He estimates authorities would need roughly one contact tracer for every four cases in the United States.

“In the second wave, we have to have testing, a resource base, and a contact-tracing base that is so much more scaled up than right now,” he said. “It’s an enormous challenge.”

Gov. Charlie Baker (R) partnered with an international nonprofit group based in Boston

“You will never beat a virus like this one unless you get ahead of it. America must not just flatten the curve but get ahead of the curve.”

The group is paying new hires roughly the same salary as census takers, more than $20 an hour. As of Tuesday — just four days after the initial announcement — the group had received 7,000 applicants and hired 150.

“There’s a huge untapped resource of people in America if we would just ask.”

“There needs to be a crash course in contact tracing because a lot of the health departments where this is going to need to happen are already kind of flat-out just trying to respond to the crisis at hand,”

Experts have proposed transforming the Peace Corps — which suspended global operations last month and recalled 7,000 volunteers to America — into a national response corps that could perform many tasks, including contact tracing.

On Wednesday, the editor in chief of JAMA, a leading medical journal, proposed suspending the first year of training for America’s 20,000 incoming medical students and deploying them as a medical corps to support the “test, trace, track, and quarantine strategy.”

The national organization for local STD programs says $200 million could add roughly 1,850 specialists, more than doubling that current workforce.

Technology could also turn out to be pivotal. But the invasive nature of cellphone tracking and apps raises concerns about civil liberties.

Such technology could take over some of what contact tracers do in interviews: build a contact history for each confirmed patient and find those possibly exposed. Doing that digitally could speed up the process — critical in containing an outbreak — and less laborious.

In China, authorities combined the nation’s vast surveillance apparatus with apps and cellphone data to track people’s movements. If someone they came across is later confirmed as infected, an app alerts them to stay at home.

In the United States, about 20 technology companies are trying to create a contact tracing app using geolocation data or Bluetooth pings on cellphones

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.

Mr. 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.

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.

But dozens of interviews with current and former officials and a review of emails and other records revealed many previously unreported details and a fuller picture of the roots and extent of his halting response as the deadly virus spread:

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. Mr. Trump would avoid such steps until March.

Despite Mr. Trump’s denial weeks later, he was told at the time about a Jan. 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.

The health and human services secretary, Alex M. Azar II, directly warned Mr. Trump of the possibility of a pandemic during a call on Jan. 30, 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 Mr. Azar was being alarmist

Mr. Azar publicly announced in February that the government was establishing a “surveillance” system

the task force had gathered for a tabletop exercise — a real-time version of a full-scale war gaming of a flu pandemic the administration had run the previous year. That earlier exercise, also conducted by Mr. Kadlec and called “Crimson Contagion,” predicted 110 million infections, 7.7 million hospitalizations and 586,000 deaths following a hypothetical outbreak that started in China.

By the third week in February, the administration’s top public health experts concluded they should recommend to Mr. 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 — time when the virus spread largely unimpeded.

When Mr. Trump finally agreed in mid-March to recommend social distancing across the country, effectively bringing much of the economy to a halt, he seemed shellshocked 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.

He only regained his swagger, the associate said, from conducting his daily White House briefings, at which he often seeks to rewrite the history of the past several months. He declared at one point that he “felt it was a pandemic long before it was called a pandemic,” and insisted at another that he had to be a “cheerleader for the country,” as if that explained why he failed to prepare the public for what was coming.

Mr. Trump’s allies and some administration officials say the criticism has been unfair.

The Chinese government misled other governments, they say. And they insist that the president was either not getting proper information, or the people around him weren’t conveying the urgency of the threat. In some cases, they argue, the specific officials he was hearing from had been discredited in his eyes, but once the right information got to him through other channels, he made the right calls.

“While the media and Democrats refused to seriously acknowledge this virus in January and February, President Trump took bold action to protect Americans and unleash the full power of the federal government to curb the spread of the virus, expand testing capacities and expedite vaccine development even when we had no true idea the level of transmission or asymptomatic spread,” said Judd Deere, a White House spokesman.

Decision-making was also complicated by a long-running dispute inside the administration over how to deal with China

The Containment IllusionBy the last week of February, it was clear to the administration’s public health team that schools and businesses in hot spots would have to close. But in the turbulence of the Trump White House, it took three more weeks to persuade the president that failure to act quickly to control the spread of the virus would have dire consequences.

There were key turning points along the way, opportunities for Mr. Trump to get ahead of the virus rather than just chase it. There were internal debates that presented him with stark choices, and moments when he could have chosen to ask deeper questions and learn more. How he handled them may shape his re-election campaign. They will certainly shape his legacy.

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 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

A 20-year-old Chinese woman had infected five relatives with the virus even though she never displayed any symptoms herself. The implication was grave — apparently healthy people could be unknowingly spreading the virus — and supported the need to move quickly to mitigation.

The following day, Dr. Kadlec and the others decided to present Mr. Trump with a plan titled “Four Steps to Mitigation,” telling the president that they needed to begin preparing Americans for a step rarely taken in United States history.

a presidential blowup and internal turf fights would sidetrack such a move. The focus would shift to messaging and confident predictions of success rather than publicly calling for a shift to mitigation.

These final days of February, perhaps more than any other moment during his tenure in the White House, illustrated Mr. Trump’s inability or unwillingness to absorb warnings coming at him.

He instead reverted to his traditional political playbook in the midst of a public health calamity, squandering vital time as the coronavirus spread silently across the country.

A memo dated Feb. 14, prepared in coordination with the National Security Council and titled “U.S. Government Response to the 2019 Novel Coronavirus,” documented what more drastic measures would look like, including: “significantly limiting public gatherings and cancellation of almost all sporting events, performances, and public and private meetings that cannot be convened by phone. Consider school closures. Widespread ‘stay at home’ directives from public and private organizations with nearly 100% telework for some.”

his friend had a blunt message: You need to be ready. The virus, he warned, which originated in the city of Wuhan, was being transmitted by people who were showing no symptoms — an insight that American health officials had not yet accepted.

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.

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.

The push to convince Mr. Trump of the need for more assertive action stalled. With Mr. Pence and his staff in charge, the focus was clear: no more alarmist messages. Statements and media appearances by health officials like Dr. Fauci and Dr. Redfield would be coordinated through Mr. Pence’s office

It would be more than three weeks before Mr. Trump would announce serious social distancing efforts, a lost period during which the spread of the virus accelerated rapidly.Over nearly three weeks from Feb. 26 to March 16, the number of confirmed coronavirus cases in the United States grew from 15 to 4,226

The China FactorThe earliest warnings about coronavirus got caught in the crosscurrents of the administration’s internal disputes over China. It was the China hawks who pushed earliest for a travel ban. But their animosity toward China also undercut hopes for a more cooperative approach by the world’s two leading powers to a global crisis.

It was early January, and the call with a Hong Kong epidemiologist left Matthew Pottinger rattled.

Mr. Trump was walking up the steps of Air Force One to head home from India on Feb. 25 when Dr. Nancy Messonnier, the director of the National Center for Immunization and Respiratory Diseases, publicly issued the blunt warning they had all agreed was necessary.

It was one of the earliest warnings to the White House, and it echoed the intelligence reports making their way to the National Security Council

some of the more specialized corners of the intelligence world were producing sophisticated and chilling warnings.

In a report to the director of national intelligence, the State Department’s epidemiologist wrote in early January that the virus was likely to spread across the globe, and warned that the coronavirus could develop into a pandemic

Working independently, a small outpost of the Defense Intelligence Agency, the National Center for Medical Intelligence, came to the same conclusion.

By mid-January there was growing evidence of the virus spreading outside China. Mr. Pottinger began convening daily meetings about the coronavirus

The early alarms sounded by Mr. Pottinger and other China hawks were freighted with ideology — including a push to publicly blame China that critics in the administration say was a distraction

And they ran into opposition from Mr. Trump’s economic advisers, who worried a tough approach toward China could scuttle a trade deal that was a pillar of Mr. Trump’s re-election campaign.

Mr. Pottinger continued to believe the coronavirus problem was far worse than the Chinese were acknowledging. Inside the West Wing, the director of the Domestic Policy Council, Joe Grogan, also tried to sound alarms that the threat from China was growing.

The Consequences of ChaosThe chaotic culture of the Trump White House contributed to the crisis. A lack of planning and a failure to execute, combined with the president’s focus on the news cycle and his preference for following his gut rather than the data cost time, and perhaps lives.

the hawks kept pushing in February to take a critical stance toward China amid the growing crisis. Mr. Pottinger and others — including aides to Secretary of State Mike Pompeo — pressed for government statements to use the term “Wuhan Virus.”Mr. Pompeo tried to hammer the anti-China message at every turn, eventually even urging leaders of the Group of 7 industrialized countries to use “Wuhan virus” in a joint statement.

Others, including aides to Mr. Pence, resisted taking a hard public line, believing that angering Beijing might lead the Chinese government to withhold medical supplies, pharmaceuticals and any scientific research that might ultimately lead to a vaccine.

Mr. Trump took a conciliatory approach through the middle of March, praising the job Mr. Xi was doing.

That changed abruptly, when aides informed Mr. Trump that a Chinese Foreign Ministry spokesman had publicly spun a new conspiracy about the origins of Covid-19: that it was brought to China by U.S. Army personnel who visited the country last October.

On March 16, he wrote on Twitter that “the United States will be powerfully supporting those industries, like Airlines and others, that are particularly affected by the Chinese Virus.”

Mr. Trump’s decision to escalate the war of words undercut any remaining possibility of broad cooperation between the governments to address a global threat

Mr. Pottinger, backed by Mr. O’Brien, became one of the driving forces of a campaign in the final weeks of January to convince Mr. Trump to impose limits on travel from China

he circulated a memo on Jan. 29 urging Mr. Trump to impose the travel limits, arguing that failing to confront the outbreak aggressively could be catastrophic, leading to hundreds of thousands of deaths and trillions of dollars in economic losses.

The uninvited message could not have conflicted more with the president’s approach at the time of playing down the severity of the threat. And when aides raised it with Mr. Trump, he responded that he was unhappy that Mr. Navarro had put his warning in writing.

From the time the virus was first identified as a concern, the administration’s response was plagued by the rivalries and factionalism that routinely swirl around Mr. Trump and, along with the president’s impulsiveness, undercut decision making and policy development.

Even after Mr. Azar first briefed him about the potential seriousness of the virus during a phone call on Jan. 18 while the president was at his Mar-a-Lago resort in Florida, Mr. Trump projected confidence that it would be a passing problem.

“We have it totally under control,” he told an interviewer a few days later while attending the World Economic Forum in Switzerland. “It’s going to be just fine.”

The efforts to sort out policy behind closed doors were contentious and sometimes only loosely organized.

That was the case when the National Security Council convened a meeting on short notice on the afternoon of Jan. 27. The Situation Room was standing room only, packed with top White House advisers, low-level staffers, Mr. Trump’s social media guru, and several cabinet secretaries. There was no checklist about the preparations for a possible pandemic,

Instead, after a 20-minute description by Mr. Azar of his department’s capabilities, the meeting was jolted when Stephen E. Biegun, the newly installed deputy secretary of state, announced plans to issue a “level four” travel warning, strongly discouraging Americans from traveling to China. The room erupted into bickering.

A few days later, on the evening of Jan. 30, Mick Mulvaney, the acting White House chief of staff at the time, and Mr. Azar called Air Force One as the president was making the final decision to go ahead with the restrictions on China travel. Mr. Azar was blunt, warning that the virus could develop into a pandemic and arguing that China should be criticized for failing to be transparent.

Stop panicking, Mr. Trump told him.That sentiment was present throughout February, as the president’s top aides reached for a consistent message but took few concrete steps to prepare for the possibility of a major public health crisis.

As February gave way to March, the president continued to be surrounded by divided factions even as it became clearer that avoiding more aggressive steps was not tenable.

the virus was already multiplying across the country — and hospitals were at risk of buckling under the looming wave of severely ill people, lacking masks and other protective equipment, ventilators and sufficient intensive care beds. The question loomed over the president and his aides after weeks of stalling and inaction: What were they going to do?

Even then, and even by Trump White House standards, the debate over whether to shut down much of the country to slow the spread was especially fierce.

In a tense Oval Office meeting, when Mr. Mnuchin again stressed that the economy would be ravaged, Mr. O’Brien, the national security adviser, who had been worried about the virus for weeks, sounded exasperated as he told Mr. Mnuchin that the economy would be destroyed regardless if officials did nothing.

in the end, aides said, it was Dr. Deborah L. Birx, the veteran AIDS researcher who had joined the task force, who helped to persuade Mr. Trump. Soft-spoken and fond of the kind of charts and graphs Mr. Trump prefers, Dr. Birx did not have the rough edges that could irritate the president. He often told people he thought she was elegant.

During the last week in March, Kellyanne Conway, a senior White House adviser involved in task force meetings, gave voice to concerns other aides had. She warned Mr. Trump that his wished-for date of Easter to reopen the country likely couldn’t be accomplished. Among other things, she told him, he would end up being blamed by critics for every subsequent death caused by the virus.

He praised Republican Gov. Mike DeWine for taking bold steps early, including declaring a state of emergency when there were only three reported cases on March 9, four days before the federal government followed suit. Thirty states had declared a state of emergency by the time Trump declared a national emergency on March 13.

“They didn’t move fast enough,” said Crossley, of the federal government. “And what you’ve seen is more local and state officials sounding the alarm. “We needed a national response to this event.”

With seven reported infections in the United States by the end of the day, Health and Human Services Secretary Alex Azar declared a public health emergency on Jan. 31, and Trump announced strict travel restrictions, barring most foreign visitors coming from China. He also imposed the nation’s first mandatory quarantine in 50 years.

Officials spent three hours war-gaming how they would respond. The drill prompted the state to send 300 employees home early to test their remote work capability. That unmasked a serious problem: A quarter of the team could not perform their jobs at home because they needed access to secure computer systems.

Then he heard the news: The United States had identified its first case of person-to-person transmission involving someone who had not traveled overseas. Also, the World Health Organization classified the coronavirus as a public health emergency of international concern.

Chicago Jan. 31: 9,927 cases worldwide, seven cases in the United States

Tallahassee Jan. 30: 8,234 cases worldwide, five cases in the United States

“We are concerned about our public health system’s capacity to implement these measures, recognizing they may inadvertently distract us from our ongoing tried-and-true efforts to isolate confirmed cases and closely monitor their contacts,” according to a previously unreported Feb. 6 letter. “We also worry about the potential to again overwhelm laboratory capacity, recognizing that national capacity has not been adequate to quickly test our highest-risk individuals.”

“In the first few sets of conversations, we were not hearing answers to those questions,” Lightfoot, a Democrat, said of her talks with federal officials. “It was kind of like, either silence, or ‘Do the best you can,’ which was obviously not acceptable.”

she drafted a letter to Trump on behalf of the mayors from Detroit, Los Angeles, New York, San Francisco and Seattle. They insisted on clear, written directions from the federal government, according to the letter, and worried about diverting health-care resources during flu season, when hospitals were already stretched.

Americans who had visited China’s Hubei province would be forced to quarantine for 14 days, and those who visited other parts of China would be screened for symptoms and asked to isolate themselves for two weeks. Chicago Mayor Lori Lightfoot was caught off guard. The directive came with little guidance. Where were local governments supposed to quarantine the travelers? What would they do if someone refused to quarantine? Who was going to pay for the resources needed to quarantine people?

Mount Kisco, N.Y. Feb. 9: 40,150 cases worldwide, 11 cases in the United States

Weeks earlier, Amler had started fitting employees for personal protective equipment and training them on how to use the gear. In January, she watched what was happening in Wuhan with growing concern: “It seemed impossible that it wouldn’t eventually spill out of China into the rest of the world.”

San Francisco Feb. 24: 79,561 cases worldwide, 51 cases in the United States

Trump continued to reassure the public that there was little to worry about. On Feb. 24, he tweeted, “The Coronavirus is very much under control in the USA.”

But Colfax and his public health staff in San Francisco were seeing something else when they studied the “curves” of the pandemic — graphs showing how many cases were reported in other regions over time.

Wuhan’s curve was climbing exponentially, and other countries, such as Italy, were seeing soaring infection rates as well. Colfax noticed that in every infected region, officials were more and more aggressive about restricting their populations

“It became apparent that no jurisdiction that was where the virus was being introduced, was sort of, in retrospect, thinking, ‘Oh, we overreacted,’ ” Colfax said.

On Feb. 24, Colfax and other health officials assembled their research and met with Mayor London Breed. They made an urgent request: Declare a state of emergency

by the end of the meeting, Breed was convinced. They needed to declare a state of emergency so that they could tap into state and federal funds and supplies, and redeploy city employees. The next day, San Francisco became one of the first major cities in the United States to do so, after Santa Clara and San Diego counties did earlier in the month.

It would take another 17 days, as the virus infected people in nearly every state, before Trump declared a national emergency.

In New Orleans, officials moved ahead with Mardi Gras festivities in late February that packed people into the streets. It was a decision the mayor would later defend as coronavirus cases traced to the celebration piled up.

On Feb. 27, at a White House reception, Trump predicted that the coronavirus would disappear. “Like a miracle,” he said.

“No red flags were given,” by the federal government, New Orleans Mayor LaToya Cantrell, a Democrat, later said in a CNN interview. “If we were given clear direction, we would not have had Mardi Gras, and I would’ve been the leader to cancel it.

San Antonio Feb. 29: 86,011 cases worldwide, 68 cases in the United States

The last day of February marked a major turning point for the coronavirus in the United States: The first American who had been diagnosed with the illness died

In a Saturday news conference, Trump described the patient from the Seattle area as a “medically high-risk” person who had died overnight. A CDC official said that the man, who was in his 50s, had not traveled recently — another sign that the virus was snaking through local communities.

During the announcement, Trump asked the media to avoid inciting panic as there was “no reason to panic at all.”

“We’re doing really well,” he said. “Our country is prepared for any circumstance. We hope it’s not going to be a major circumstance, it’ll be a smaller circumstance. But whatever the circumstance is, we’re prepared.”

That same afternoon in San Antonio, the CDC mistakenly released a woman from quarantine who was infected. The woman was one of dozens of evacuees from Wuhan whom the federal government had brought to a nearby military base and then isolated at the Texas Center for Infectious Disease.

the woman had been dropped off at a Holiday Inn near the San Antonio airport and headed to a mall where she shopped at Dillard’s, Talbots and Swarovski and ate in the food court.

As local officials learned details about the infected woman’s movements and how she had been transported at 2 a.m. back to the Texas Center for Infectious Disease, they waited for the CDC to issue a statement. Hours passed, but they heard nothing. “They were like quiet little mouses,” Wolff said. “They were all scared to talk because I think they felt they were going to get in trouble with the president of the United States because he was saying there was not a problem.”

The next day, San Antonio officials declared a public health emergency and filed a lawsuit to prevent the CDC from releasing the 120 people in quarantine until they were confirmed negative for the virus or completed a 28-day quarantine. A judge denied the motion, but the CDC agreed that evacuees must have two consecutive negative tests that are 24 hours apart and that no one with a pending test can be released.

In Oklahoma City, the coronavirus became a reality for Mayor David Holt, a Republican, when the NBA abruptly canceled a Thunder basketball game after a Utah Jazz player tested positive on March 11. Until then, Holt said, the coronavirus felt “distant on many levels.”

Mount Kisco, N.Y. March 3: 92,840 cases worldwide, 118 cases in the United States

Within days, state authorities set up an emergency operations center in New Rochelle and created a one-mile containment zone. Inside the perimeter, schools and community centers shuttered and large gatherings were prohibited.

Through it all, local officials faced backlash from some community leaders who thought they were overreacting.

San Francisco March 5: 97,886 cases worldwide, 217 cases in the United States

Days after San Francisco’s emergency declaration, Breed stood in front of news cameras to announce the city’s first two cases of the coronavirus.

They were not related, had not traveled to any coronavirus-affected areas and had no contact with known coronavirus patients: It was spreading in the community.

By then, Miami Mayor Francis X. Suarez, a Republican, had announced the cancellation of the Ultra Music festival, a three-day celebration that draws about 50,000 people. Miami was the first city to call off a major music festival, and Suarez faced tremendous backlash

When he tried to order more masks, none were immediately available. By then the entire country was scrambling for protective gear.

Days later, Holt huddled on the phone with other leaders from the United States Conference of Mayors. For about 20 minutes, Seattle Mayor Jenny Durkan, a Democrat, detailed the crisis seizing her city

“She sounded like the main character in a Stephen King novel,” Holt recalled. “She had hundreds of cases, she had dozens of deaths.”

“Any struggles that we’re having, whether it be testing or other issues, or even just convincing our public of the seriousness of the matter, there are some roots back to the time period in January and February, when not all national leadership was expressing how serious this was,” Holt said.

While the mayors held their conference call on March 13, Trump declared a national emergency to combat the coronavirus.

By then, Suarez had tested positive for the coronavirus and was in quarantine. As of Sunday, he remained in isolation, leading the city by phone calls and video chats. He wanted to stop flights into Miami and the governor to order residents to shelter in place as California and other states had already done.

Ventilation systems in schools, nursing homes, residences and businesses may need to minimize recirculating air and add powerful new filters.

in an open letter to the W.H.O., 239 scientists in 32 countries have outlined the evidence showing that smaller particles can infect people, and are calling for the agency to revise its recommendations

Whether carried aloft by large droplets that zoom through the air after a sneeze, or by much smaller exhaled droplets that may glide the length of a room, these experts said, the coronavirus is borne through air and can infect people when inhaled

But the infection prevention and control committee in particular, experts said, is bound by a rigid and overly medicalized view of scientific evidence, is slow and risk-averse in updating its guidance and allows a few conservative voices to shout down dissent.

“If we started revisiting airflow, we would have to be prepared to change a lot of what we do,” she said. “I think it’s a good idea, a very good idea, but it will cause an enormous shudder through the infection control society.”

In early April, a group of 36 experts on air quality and aerosols urged the W.H.O. to consider the growing evidence on airborne transmission of the coronavirus. The agency responded promptly, calling Lidia Morawska, the group’s leader and a longtime W.H.O. consultant, to arrange a meeting.

But the discussion was dominated by a few experts who are staunch supporters of handwashing and felt it must be emphasized over aerosols, according to some participants, and the committee’s advice remained unchanged.

Dr. Morawska and others pointed to several incidents that indicate airborne transmission of the virus, particularly in poorly ventilated and crowded indoor spaces. They said the W.H.O. was making an artificial distinction between tiny aerosols and larger droplets, even though infected people produce both.

We’ve known since 1946 that coughing and talking generate aerosols,

Scientists have not been able to grow the coronavirus from aerosols in the lab.

Most of the samples in those experiments have come from hospital rooms with good air flow that would dilute viral levels.

In most buildings, she said, “the air-exchange rate is usually much lower, allowing virus to accumulate in the air and pose a greater risk.”

The W.H.O. also is relying on a dated definition of airborne transmission, Dr. Marr said. The agency believes an airborne pathogen, like the measles virus, has to be highly infectious and to travel long distances.

Dr. Marr and others said the coronavirus seemed to be most infectious when people were in prolonged contact at close range, especially indoors, and even more so in superspreader events — exactly what scientists would expect from aerosol transmission.

Experts all agree that the coronavirus does not behave that way.

“We have this notion that airborne transmission means droplets hanging in the air capable of infecting you many hours later, drifting down streets, through letter boxes and finding their way into homes everywhere,”

The agency lagged behind most of its member nations in endorsing face coverings for the public. While other organizations, including the C.D.C., have long since acknowledged the importance of transmission by people without symptoms, the W.H.O. still maintains that asymptomatic transmission is rare.

Many experts said the W.H.O. should embrace what some called a “precautionary principle” and others called “needs and values” — the idea that even without definitive evidence, the agency should assume the worst of the virus, apply common sense and recommend the best protection possible.

“There is no incontrovertible proof that SARS-CoV-2 travels or is transmitted significantly by aerosols, but there is absolutely no evidence that it’s not,

So at the moment we have to make a decision in the face of uncertainty, and my goodness, it’s going to be a disastrous decision if we get it wrong,” she said. “So why not just mask up for a few weeks, just in case?”

he agency also must consider the needs of all its member nations, including those with limited resources, and make sure its recommendations are tempered by “availability, feasibility, compliance, resource implications,” she said.

if the W.H.O. were to push for rigorous control measures in the absence of proof, hospitals in low- and middle-income countries may be forced to divert scarce resources from other crucial programs.

That’s the balance that an organization like the W.H.O. has to achieve,” he said. “It’s the easiest thing in the world to say, ‘We’ve got to follow the precautionary principle,’ and ignore the opportunity costs of that.”

In interviews, other scientists criticized this view as paternalistic. “‘We’re not going to say what we really think, because we think you can’t deal with it?’ I don’t think that’s right,”

Even cloth masks, if worn by everyone, can significantly reduce transmission, and the W.H.O. should say so clearly, he added.

The W.H.O. tends to describe “an absence of evidence as evidence of absence,” Dr. Aldis added. In April, for example, the W.H.O. said, “There is currently no evidence that people who have recovered from Covid-19 and have antibodies are protected from a second infection.”

The statement was intended to indicate uncertainty, but the phrasing stoked unease among the public and earned rebukes from several experts and journalists. The W.H.O. later walked back its comments.

In a less public instance, the W.H.O. said there was “no evidence to suggest” that people with H.I.V. were at increased risk from the coronavirus. After Joseph Amon, the director of global health at Drexel University in Philadelphia who has sat on many agency committees, pointed out that the phrasing was misleading, the W.H.O. changed it to say the level of risk was “unknown.”

But W.H.O. staff and some members said the critics did not give its committees enough credit.“Those that may have been frustrated may not be cognizant of how W.H.O. expert committees work, and they work slowly and deliberately,”

we see the classic “Confucian values” (or “Asian values”) argument that has historically been deployed to explain everything from the economic success of East Asian nations to the prevalence of authoritarian single-party rule in Asia, and even, most recently, China’s supposed edge in AI research.

So, yeah, kudos to Taiwan for keeping its people safe, but here in America we’re going to do what we always do in a crisis—line up at a gun store and accuse the opposing political party of acting in bad faith. Not for us, those Asian values.

But the truth is that Taiwan, one of Asia’s most vibrant and boisterous democracies, is a terrible example to cite as a cultural other populated by submissive peons

Taiwan’s self-confidence and collective solidarity trace back to its triumphal self-liberation from its own authoritarian past, its ability to thrive in the shadow of a massive, hostile neighbor that refuses to recognize its right to chart its own path, and its track record of learning from existential threats.

There is no doubt that in January it would have been difficult for the US to duplicate Taiwan’s containment strategy, but that’s not because Americans are inherently more ornery than Taiwanese

It’s because the United States has a miserable record when it comes to learning from its own mistakes and suffers from a debilitating lack of faith in the notion that the government can solve problems—something that dates at least as far back as the moment in 1986 when Ronald Reagan said, “The nine most terrifying words in the English language are: ‘I’m from the government and I’m here to help.’”

The Taiwan-US comparison is the opposite of a clash of civilizations; instead, it’s a deathly showdown between competence and incompetence.

To be fair, there are some cultural aspects of East Asian societies that may work in Taiwan’s favor

There is undeniably a long tradition in East Asia of elevating scholars and experts to the highest levels of government,

The country’s president Tsai Ingwen, boasts a PhD from the London School of Economics, and the vice president, Chen Chien-jen, is a highly regarded epidemiologist

The threat of SARS put Taiwan on high alert for future outbreaks, while the past record of success at meeting such challenges seems to have encouraged the public to accept socially intrusive technological interventions.

First, and most important was Taiwan’s experience battling the SARS outbreak in 2003, followed by the swine flu in 2009

“Taiwan actually has a functioning democratic government, run by sensible, well-educated people—the USA? Not so much.”)

Taiwan’s commitment to transparency has also been critical

In the United States, the Trump administration ordered federal health authorities to treat high-level discussions on the coronavirus as classified material.

In Taiwan, the government has gone to great lengths to keep citizens well informed on every aspect of the outbreak, including daily press conferences and an active presence on social media

“Do not forget that Taiwan has been under China’s threat constantly,” wrote Wang Cheng-hua, a professor of art history at Princeton, “which has raised social consciousness about collective action. When the collective will supports government, then all of the strict measures implemented by the government make sense.”

Over the past quarter-century, Taiwan’s government has nurtured public trust by its actions and its transparency.

The democracy activists who risked their lives and careers during the island nation’s martial law era were not renowned for their willingness to accept government orders or preach Confucian social harmony

some of the current willingness to trust what the government is telling the people is the direct “result of having experienced the transition from an authoritarian government that lied all the time, to a democratic government and robust political dialogue that forced people to be able to evaluate information.”

Because of the opposition of the People’s Republic of China, Taiwan is not a member of the United Nations or the World Health Organization

“The reality of being isolated from global organizations,” wrote Tung, “also makes Taiwanese very aware of the publicity of its success in handling a crisis like this. The more coverage from foreign media, the more people feel confident in government policy and social mobilization.”

Given what we know about Taiwan’s hard-won historical experience, could the US have implemented a similar model?

The answer, sadly, seems to be no

it would be impossible for the US to successfully integrate a health care database with customs and travel records because there is no national health care database in the United States. “The US health care system is fragmented, making it difficult to organize, integrate, and assess data coming in from its various government and private-sector parts,”

more tellingly, continued Fidler, “the manner in which the United States has responded to Covid-19 demonstrates that the United States did not learn the lessons from past outbreaks and is struggling to cobble together a semblance of a strategy. ”

There’s where the contrast between the United States and Taiwan becomes most salient. The US is not only bad at the act of government but has actively been getting worse.

But Taiwan’s own success at building a functional democracy is probably the most potent rebuke to the Asian values thesis.

But over that same period, powerful political and economic interests in the US have dedicated themselves to undermining faith in government action, in favor of deregulated markets that have no capacity to react intelligently or proactively to existential threats.

And instead of learning from history, US leaders actively ignore it, a truth for which there could be no better symbolic proof than the Trump administration’s dismantling of the National Security Council pandemic office created by the Obama administration in the wake of the Ebola outbreak

Finally, instead of seeking to keep the public informed to the best of our ability, some of our political leaders and media institutions have gone out of their way to muddy the waters.

In Taiwan, one early government response to the Covid-19 outbreak was to institute a fine of $100,000 for the act of spreading fake news about the epidemic.

In the US the most popular television news network in the country routinely downplayed or misrepresented the threat of the coronavirus, until the severity of the outbreak became too large to ignore.

If there is any silver lining here, it’s that the disaster now upon us is of such immense scope that it could finally expose the folly of the structural forces that have been wreaking sustained havoc on American governmental institutions

So maybe we are finally about to learn that competence matters, that educated leaders are a virtue, and that telling the truth is a responsibility

Americans might have to learn this the hard way, like we did in Hong Kong and Singapore.”

We’re about to find out how hard it’s going to be. But will we learn?