- As the coronavirus outbreak worsened, a number of public health experts both within and outside of the federal government sounded the alarm about the severity of the crisis.
- Nearly 80 pages of the emails were obtained via public records requests and published in full by The New York Times.
- The emails show how as the outbreak unfolded, the nation's top experts were expressing serious concerns and frustration about the government's lack of a clear, coordinated mitigation strategy.
- "We are making every misstep leaders initially made in tabletops at the outset of pandemic planning in 2006," wrote one infectious diseases specialist. "We have thrown 15 years of institutional learning out the window"
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As the coronavirus outbreak rapidly spread across the world and into the United States, a number of public health experts both within and outside of the federal government sounded the alarm about the severity of the crisis on an email chain they called "Red Dawn."
Nearly 80 pages of the emails were obtained via public records requests and published in full by The New York Times.
The correspondence was initially started by the Department of Homeland Security's top medical officer Duane Caneva eventually expanded to include top officials from the Department of Homeland Security, Health & Human Services, the Centers for Disease Control and Prevention, the Department of Veterans Affairs, Trump's former Homeland Security Advisor Tom Bossert, and a number of top academics and infectious disease specialists.
In addition to the "Red Dawn" emails, The Times also published a lengthy, investigative review of all the instances Trump brushed aside warnings of the severity of the coronavirus crisis, failed to act, and was belabored by significant infighting and mixed messages from the White House over what action to take and when.
Meanwhile, both government and independent health experts were sharing data, doing in-depth modeling and research on the virus, and expressing serious concerns about the government's lack of a clear, coordinated mitigation strategy.
On January 28, senior Veterans Affairs medical adviser Dr. Carter Mecher, who was instrumental in crafting the George W. Bush's pandemic preparedness plans, warned that the World Health Organization was already "behind the curve."
"The chatter on the blogs is that WHO and CDC are behind the curve. I'm seeing comments from people asking why WHO and CDC seem to be downplaying this. I'm certainly no public health expert (just a dufus from the VA), but no matter how I look at this, it looks bad. If we assume the same case ascertainment rate as the spring wave of 2009 H1N1, this looks nearly as transmissible as flu (but with a longer incubation period and greater Ro)," Mecher warned.
He added: "Any way you cut it, this is going to be bad. You guys made fun of me screaming to close the schools. Now I'm screaming, close the colleges and universities."
Dr. James Lawler, an infectious disease specialist at the University of Nebraska and former National Security Council official, jokingly compared the idea that the coronavirus was just like a bad flu to other historical understatements.
"Great under-statements in History: Napoleon' s retreat from Moscow - 'just a little stroll gone bad'. Pompeii - " a bit of a dust storm'. Hiroshima - 'summer heatwave' AND Wuhan- 'just a bad flu season.'"
In the following email, Col. Matthew Hepburn said "I am dealing with a very similar scenario, in terms of not trying to overreact and damage credibility. My argument is that we should treat this as the next pandemic for now, and we can always scale back if the outbreak dissipates, or is not as severe."
In a February 9 email, Col. Hepburn suggested that the government "strategically roll out some of the social distancing recommendations. This can be part of the public messaging. I think different communities have different willingness to start. It doesn't hurt them and sense of comfort and awareness."
'A quarantine nightmare'
The experts then turned to the outbreak onboard the Diamond Princess cruise ship, which would eventually report 712 confirmed cases between 2,666 passengers and 1,045 crew members, as a small case study showing how fast the virus could spread - and how much the US needed to enact mitigation strategies.
"Diamond Princess - as I said from the start - offers the biggest opportunity to study in multiple levels and I am afraid it has become a quarantine nightmare with missing opportunities and missteps," Dr. Eva Lee, an expert infectious disease modeler from Georgia Tech University, wrote.
"The case count aboard cruise ship is now up to 136. This is unbelievable," Dr. Mecher responded.
"Over a span of 21 days (from 20-Feb 10), this outbreak has expanded to 136 confirmed cases. Thatis a prevalence of 3.7 % over the span of 3 weeks. That is unbelievable. But go back and compare the dynamics of the nCov outbreak to the spring wave of H1N1, this outbreak is even faster," he added, saying, "We are so far behind the curve. I would drop almost everything we are now doing and prepare for implementing [non-pharmaceutical interventions]."
In a subsequent March 17 email, Mecher warned that non-pharmaceutical interventions (NPIs) like social distancing "are going to be central to our response to this outbreak."
"We predicted the Diamond Princess infection totality before they announced it. What it shows-- is that intervention (NPI) must be done timely. A delayed intervention cannot reverse the course and can be catastrophic. They have far more positive infected cases than they should have, [had] they intervened differently and swiftly. The health system burden can't be overemphasized," Dr. Lee responded on February 18.
Ten days later, Mecher worried that the US was on track to turn out like Italy, which was hit particularly hard by COVID-19, comparing the situation to how differently St. Louis and Philadelphia implemented mitigation measures during the 1918 flu pandemic.
"We would estimate that the outbreak in Wuhan had about a 2-week head start on the rest of Hubei. So the measures China implemented to slow transmission happened about two later in the course of the outbreak in Wuhan compared to the rest of Hubei Province. That comparison looks a lot like Philadelphia and St. Louis. So we have a relatively narrow window and we are flying blind," Mecher wrote. "Looks like Italy missed it."
On March 1, Mecher wrote, "Should have pulled all the triggers for NPls by now - they are already later than they realize. I fear we are about to see a replay of Italy. Other cities need to learn from Seattle," raising concern about preliminary research on asymptomatic carriers.
By that point, the experts were sounding the alarm that the US was falling hopelessly behind the curve and was running out of time to mitigate the virus' spread.
In one March 4 message, Mecher predicted that if policymakers "miss the window to act, they don't get a do-over. Can't take a Mulligan with NPIs. There is no reset button to play the game again. You only get one shot...this is exactly what happened in 1918. A while back I shared some slides on the lessons learned from 1918. Unfortunately, we have to learn some lessons again and again."
Dr. Richard Hatchett, the CEO of the Coalition of Epidemic Preparedness, expressed frustrations at officials not taking bold enough action, writing the same day, "it is remarkable that leaders are reluctant to implement interventions that they will have to implement anyway when they lose control. Do they think the virus is magically going to behave differently when it gets to their community? Why can't they look at the successful examples and emulate these?"
On March 5, UNC Professor Ralph Baric, an epidemiologist and expert in the study of coronaviruses, called the CDC recommending against closing schools as a preventive measure to mitigate the spread of the virus "very unfortunate."
'We are making every misstep'
But by March 11 when Trump finally announced some coronavirus mitigation measures, he did so in a botched Oval Office address in which he significantly misrepresented several key aspects of the White House's coronavirus response.
In his speech, Trump said that the United States would take the drastic step of banning all travel from most of Europe for 30 days to limit the spread of the coronavirus from abroad.
Shortly after his speech, however, the Department of Homeland Security issued major clarifications to Trump's remarks, announcing that the travel ban would not apply to US citizens or permanent residents abroad and would only include 26 members of the Schengen Area travel agreement that covers most of mainland Europe but excludes the UK and Ireland.
In an email the next day, Bossert wondered, "Can anyone justify the European travel restriction, scientifically? Seriously, is there any benefit? I don't see it, but I'm hoping there is something I don't know."
"I do not see it. No use now. I saw it for China. But not now. We should focus on targeted, layered community mitigation measures," replied Gerald W. Parker, an associate Dean for the College of Veterinary Medicine and Biomedical Sciences at Texas A&M and the Director of the Institute for Infectious Animal Diseases.
Dr. Lawler more bluntly responded, "F- no. This is the absolute wrong move."
Hatchett too said, "No justification that can see, unless we to put up similar geographic cordons in the US- there is plenty of disease already in the US to cause spread domestically."
"We are making every misstep leaders initially made in tabletops at the outset of pandemic planning in 2006. We had systematically addressed all of these and had a plan that would work - and has worked in Hong Kong/Singapore," Lawler also wrote on March 12.
He added: "We have thrown 15 years of institutional learning out the window and are making decisions based on intuition. Pilots can tell you what happens when a crew makes decisions based on intuition rather than what their instruments are telling them. And we continue to push the stick forward..."
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