In a weekend report, the New York Times detailed all the real-time warnings Donald Trump ignored as far back as January as a group of public health experts across the country tried to impart to the administration’s top health officials the severity of what was coming.
The flashing red lights from the emails circulating within that group of experts show just how derelict Trump was, particularly when contrasted with actions taken by local public health officials in the San Francisco Bay Area who faced comparable circumstances. Ultimately, those Bay Area officials issued the nation’s very first shelter-in-place legal order, several days before the state's governor, Gavin Newsom, issued the first statewide stay-at-home order.
Investigative reporter Eric Lipton highlighted several key email exchanges within the group of public health experts that had somewhat cheekily named itself "Red Dawn," after an '80s-era movie about a small cadre of Americans trying to save the nation from a takeover following a foreign incursion.
The emails from two of the group’s members stood out: Carter Mecher, a senior medical adviser at the Veterans Affairs Department who had taken part in writing a Bush-era pandemic plan; and Dr. James Lawler, an infectious-disease expert at the University of Nebraska and former National Security Council official, who had also participated in a pandemic exercise in 2006. Several of the hair-on-fire missives from Mecher and Lawler to the group highlight the imperative of what Bay Area officials decided to do, how they arrived there, and the extreme difficulty of their decision to effectively shut down six counties that include some 6.7 million residents.
The first key point is that both Lawler and Mecher had pandemic planning experience during the Bush administration (though it’s admittedly unclear whether they collaborated on the same project). The same was true of Dr. Sara Cody, the Santa Clara County Public Health Officer who led the charge on issuing the Bay's early shelter-in-place order. A profile of Cody in the San Jose Mercury News recounts how quickly she kicked into gear after the county got its first confirmed coronavirus case on Jan. 31 (the third confirmed case in the state after two others surfaced in Los Angeles several days earlier).
One of Cody's first actions was to dust off a plan she had helped formulate for the county shortly after 9/11 to guide it through a "massive, coordinated emergency response" to either a bioterrorism attack or pandemic. The plan included drastic social distancing measures like shuttering schools and businesses and issuing stay-at-home orders. Cody also immediately contacted two former colleagues with whom she had conceived the plan and who had since retired from the health department, Marty Fenstersheib and Karen Smith. They returned to the roadmap they had created in the early aughts, as Draconian as it seemed, because it was really the only option for which they had thought through all the contingencies.
“None of us really believed we would do it,” Smith, 63, told the Mercury News of the original mitigation steps they thought might be needed. “I was slightly terrified to think we were putting in place stay-at-home orders, tools that we think work but don’t really know.”
But just as Bay Area officials were reviewing their old pandemic plan and preparing to implement it, top Trump officials were ignoring all the lessons of the Bush-era 2006 planning. In particular, they were extremely resistant to enacting nonpharmaceutical interventions (NPIs) like closing businesses because Trump was so fixated on the economy. In fact, a lot has been reported about the White House's two warring factions of public health experts and economic advisers, and how the economic aides initially won the early battles over whether to continue on with business as usual. Trump was personally obsessed with messaging (instead of saving lives) and reassuring Americans that the coronavirus would soon pass with little-to-no disruption at all. He consequently spent nearly two months—from late January to mid-March—talking about the coronavirus's imminent demise and what a "good job" his administration had done.
On February 17, almost a full month before Trump issued any national distancing guidelines, Mecher sent an email to the Red Dawn group anticipating the reluctance to instituting NPI's. "NPIs are going to be central to this outbreak," Mecher wrote. "Looking ahead, I anticipate we might encounter pushback over the implementation of NPIs and would expect similar concerns/arguments as were raised back in 2006 when this strategy first emerged."
Mecher was exactly right about the ongoing debate in the West Wing, where public health advocates were losing a major battle. And Trump's reluctance to do the right thing also highlights how heroic the actions taken in the Bay Area actually were. At least at the federal level, Trump and Congress could—and eventually did—pass legislation to help mitigate the personal economic blow that would surely result from widespread closures.
But at the local level, county officials could only deliver the bad news without any promise that help was on its way, precisely because they were taking action well ahead of the federal response.
“I was thinking about the people who live in our county,” Cody said, “the people that run small business, the people who are living right on the edge and how what I was doing was going to profoundly impact them personally and professionally.” Despite the weight of doing something so disruptive, Cody and other officials pushed ahead.
Meanwhile, throughout the Red Dawn emails, list participants became increasingly disillusioned with what they were witnessing from the Trump administration. One of the most distressed series of exchanges came on March 11/12, as they realized the battle was all but lost. Trump had suddenly and precipitously banned travel from Europe (remember all the American students abroad jamming overcrowded airports to get home?). Former Trump Homeland Security adviser Tom Bossert was desperately trying to find any rationale for the policy.
"Can anyone justify the European travel restriction, specifically?" Bossert wrote to the group on March 11. "Seriously, is there any benefit? I don't see it, but I'm hoping there is something I don't know."
"Fuck no," Lawler responded on March 12. "This is the absolute wrong move." Several other people chimed in, noting the total lack of benefit along with the missed opportunity to do something useful since "plenty of disease" had already arrived in the U.S.
Lawler responded again. "We are making every misstep leaders initially made in table-tops at the outset of pandemic planning in 2006," he wrote. "We had systematically addressed all of these and had a plan that would work—and has worked in Hong Kong/Singapore," he added, referencing two locales that had executed pretty successful mitigation and testing regimes. "We have thrown 15 years of institutional learning out the window and are making decisions based on intuition,” Lawler continued. “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."
On March 13, Trump would hold what has come to be a rather infamous Rose Garden press conference in which he made a bunch of promises about widespread testing that all failed to come to fruition. During that press conference, Trump was also asked whether he took any responsibility for the early lag in making testing widely available.
"No," Trump responded. "I don't take responsibility at all." At that point, Trump had issued no social distancing orders to compensate for the lack in testing, and he never would.
Three days later, Cody and her colleagues did the opposite—taking responsibility and pulling back the metaphorical stick Lawler had referred to above. It was a decision born of knowledge, conscience, and a keen awareness of the consequences of not acting. Their decision-making process had been kicked into overdrive on Feb. 28 by the "sentinel case" of a woman in her 60s, who became the third positive in Santa Clara County. Importantly, the woman had no recent travel history or contact with anyone who had traveled, so "community transmission" was the clear culprit.
Evelyn Ho, who was handling coronavirus communications for the county, did a check in with Cody at the time to ask how she was coping with the burgeoning crisis. “She talked about having very clear reminders for herself of how to stay centered in the moment, that the enormity of the decisions can’t be overwhelming,” Ho told the Mercury News. “She tried to center on breathing. She mentioned childbirth, taking that breath and breathing through the moment.”
On March 15, Cody and her colleagues analyzed the trend lines between the Bay Area case load and those in Italy a week and a half earlier. In those trend lines, they saw the outlines of their future if they failed to act. “It was clear to me already how quickly it was moving, and that’s what gave me a sense of urgency,” Cody said. “We just needed to embrace the risk and do it.”
And so embrace the risk they did. On March 16, the Bay Area pulled the trigger on a multi-county warning system designed precisely for emergency situations. "New Health Order ... for COVID-19," read the cell phone text titled Public Safety Alert. "Stay Home – No Gatherings."
Cody certainly wasn't the only official who moved fast. It was a team effort among the six-county expanse. San Francisco Mayor London Breed also issued an order the next day closing all non-essential businesses. The city still had fewer than 50 confirmed cases while New York, with more than 2,000 cases, remained open for business. "By the time New York City fully shut down on March 22, more than 10,000 cases were reported across its five boroughs," writes The Atlantic.
Likewise, California Gov. Gavin Newsom issued the first statewide stay-at-home order on March 19, restricting the movement of some 40 million residents. As of Tuesday evening, California had recorded 25,605 cases, including 775 deaths, with the Bay Area at 5,313 cases and 146 deaths.
In separate addresses on Tuesday, both Newsom and Cody struck a note of cautious optimism. “We are not spiking the ball,” Newsom said, as he began laying out a framework for when and how California might begin to ease some of its restrictions one locale at a time. Cody similarly said Santa Clara was “not out of the woods” but noted the county had made progress in slowing new transmissions to a “somewhat stable” 50 to 100 per day.
On Thursday, the first-in-the-nation order Cody helped spearhead will turn one month old, and California, within that rather brief timeframe, is largely being looked upon as one of the few states that acted quickly enough to bend its curve in the direction of saving lives.