With those inside the White House thinking of me and treating me as an outsider, I was always puzzled when people outside that world believed I was a White House insider. The effects of being an Oval Office outsider extended in many directions, most notably in my not being privy to advance information about the president’s health when he tested positive for Covid-19 the first week of October. Like the vast majority of Americans, I learned of his diagnosis by watching the news.
I was immediately concerned. He was among the many Americans with contributing comorbidities that might complicate his treatment and recovery. Out of personal respect for his privacy, and because of HIPAA regulations, I never asked anyone anything about the president’s illness beyond the information the White House released. But, I did learn, shortly before it became widely known, that he was being transferred by helicopter to Walter Reed. Tyler Ann heard this through the White House grapevine and shared it with me.
She was alarmed as was I to hear this. The president struck me as someone who would want to avoid being treated in a hospital at all costs. To me, it seemed, he always wanted to be in his own space and his own bed. When I learned he was going to Walter Reed, I presumed he was in need of treatment and monitoring beyond what he could receive at the White House. Most likely, he was in need of more than monoclonal antibodies and remdesivir. Later, Mark Meadows, after initially telling the press on Friday that the president had mild symptoms, said that the president’s vital signs were concerning. In the book Meadows wrote later, he states that the president’s oxygen levels had dipped into the mid-eighties, a serious harbinger to respiratory failure, and that he needed proactive access to significant respiratory support. In the same memoir, Meadows reported that the president had tested positive on September 26, four days before the first presidential debate with Joe Biden. He then tested negative after taking a more “accurate” test (Trump has denied Meadows’s account). Prior to this 2021 revelation, the administration had claimed that the president had entered the debate, as required, having tested negative for SARS-CoV-2. At the time, and until Mark Meadows revealed it more than a year after the fact, I had no knowledge of this potential deception.
At the time, in 2020, after the media reported that Hope Hicks was sick with COVID on October 1, a rumor had been circulating in the White House that she could have potentially infected the president. All of us in the West Wing worried about being the person who potentially infects the president. But if Mark Meadows is right about the earlier positive test of the president he could have actually been the one who infected Hope.
That the White House and the president might have engaged in deception around the timing of his infection doesn’t surprise me. The White House couldn’t keep its own Covid outbreaks under control, and contact tracing and transparency were limited. The White House never wanted to acknowledge the depth and breadth of each outbreak. (No White House would.) I found out about most White House outbreaks from the press or by seeing empty desks. Between the mixing that occurred at campaign events and indoor White House gatherings and the incredible numbers of people the Trump campaign was exposed to on the road and back at the White House, it was all but guaranteed that someone acutely infected would penetrate the sole mitigation of testing. Each of these outbreaks was a threat to the president, the vice president, and anyone with underlying conditions who worked at the White House.
I wasn’t surprised then that the president was infected. It had been one of my greatest fears for him and the vice president. This was part of the reason I routinely masked, and often distanced myself substantially from the president, whenever I was in the Oval Office. No one in the White House wanted to be linked to infecting a senior leader and go down in history as the Typhoid Mary of the 2020 White House.
I believed then, and still do, that outdoor gatherings were far safer than indoor ones. The media had categorized Amy Coney Barrett’s Rose Garden announcement gathering as a superspreader event. It’s true that eight or more attendees did later test positive. The real story was the frequency of unmasked indoor activities, both at the White House and at hotels and other locations near the White House, at that time and at other times throughout Trump’s last year in office. I am sure there were multiple intimate unmasked indoor gatherings before and after the Rose Garden event that were truly responsible for the superspreading.
Days before we learned of the president’s infection, I’d written to Marc Short imploring him to return to using Abbott’s ID NOW, a point-of-care nucleic acid test with a lag time of fifteen minutes from swab to results, to test all White House personnel, both in the West Wing and the EEOB across from the White House. I’d become so concerned about the number of infected within the White House that I never took off my mask while in the building except when alone in my office. I had very little company in this. Even with the president himself infected and hospitalized, I noticed no increase in the number of people masking up.
I tried to set an example, to make clear just how important I thought masking was to protect oneself and others. The president’s counter message and the top-down consequences of it were obvious—following his example, few people in the White House wore masks, and many of those who didn’t got infected.
I’m walking proof of the efficacy of masks and other precautions. For all the positive cases in the White House, and for as much as I traveled then and have done even more since leaving the White House, I’ve never tested positive for asymptomatic SARS-CoV-2 infection or developed Covid-19; no one in my family has, either. Though we all still worked, and were in offices and other workplaces throughout 2020 and 2021, we all followed careful guidelines.
The two people I spent the most time with in the White House, Tyler Ann McGuffee and Irum Zaidi, haven’t been infected. Masking indoors when in public, restricting any unmasked social gathering, and getting tested routinely protected my close circle of family and friends and me throughout surge after surge. These simple precautions worked for us, and they had worked elsewhere. In the example of the White House, we all saw what not adhering to them could bring.
I wrote to the task force docs, advising them to stay away from the White House or always wear a mask while there. (Even in this relatively small community, contact tracing was inadequate.) I did the same for the vice president, urging Marc Short multiple times to limit his and his boss’s exposure to that environment. I did the same in person with the vice president. Both men appreciated the warnings I was issuing and the precautions I was recommending, and the vice president did begin to wear a mask publicly.
I brought the same message to the White House security and maintenance people, to uniformed Secret Service personnel, and to the CIA employees who frequented the building and who were already masking. To anyone I came in contact with at the White House, I said, “Wear a mask. There is virus all over this complex. You need to be really careful. I can’t tell you how dangerous this place is.” I told one support staff member who I knew had inherited the trait for sickle-cell anemia that they should never take off their mask inside and that the only way to eat or drink safely was to do it outdoors. This staffer was among several others with vulnerabilities to whom I issued these strict directives. I wanted to make sure they knew how to protect themselves. All those with whom I was able to communicate directly were grateful that I had intervened and spoken honestly and that I was reinforcing the behaviors they’d already adopted to remain safe. The irony of this was not lost on me: my direct, face-to-face messaging was having a positive impact in my own workplace while the same message was either being ignored or altered for the rest of the country.
The White House was a microcosm for the rest of the nation. Those of us who worked in the West Wing were tested every morning. Despite this, people were still getting infected and passing along the virus. Why?
A test for SARS-CoV-2 is only a snapshot of your viral state at the exact moment your cells are swabbed. You could arrive at work at 9 a.m. and test negative. However, the virus could already be in your cells, using their machinery to quietly replicate itself. By 2 p.m., when the cells have burst open, shedding contagious virus, you would then test positive. This was a known limitation of testing for this virus. Testing without masking, without social distancing, and without reducing indoor gatherings wasn’t as effective at containing spread, resulting in the repeated Covid-19 surges in the White House.
I loved the way Alabama governor Kay Ivey described it: The mitigation measures were like Swiss cheese. One layer of cheese (testing) had holes, but when you added another piece of cheese (masks), some of those holes were covered up. When you added yet another slice of cheese (physical distancing and reduced gatherings), all the holes were covered. And with the arrival of vaccines, we’d be able to add another layer. (Still, vaccines alone would always have their own holes and could never be a stand-alone substitute for the more layered approach when virus was active in the community.) We had worked so hard from the outset to establish this concept as a baseline, but with a White House that, at different times, either actively defied or implicitly undercut the importance of each of these “layers,” the message was nearly impossible to get across.
The president’s quick return to the White House from Walter Reed only heightened this apparent contradiction. While his recovery was good news, his performance on the South Portico steps, the dramatic removal of his mask as he gasped for breath, provided more mixed messages. His speedy turnaround was a testament both to what medical professionals had learned about how to more effectively treat Covid-19 disease and to the therapeutics that had been developed to save lives. And yet, President Trump’s public appearance less than ten days after diagnosis spoke volumes at a time when we were asking infected Americans to isolate for ten days after symptoms and always to wear a mask around others.
Back at work, the president reverted to form, tweeting upon his release that the American people should not be afraid of the coronavirus—this when more than two hundred thousand of them had died of Covid-19. It was a blow to everything we’d been working to do and to everyone who had lost a loved one or their own life—losses that millions would continue to experience for decades. Despite benefiting personally from the best care in the country, the president was contributing to the belief that the more people who got infected, the better; that this disease wasn’t particularly deadly. Time and again, the president and the White House acted without adequately accounting for the consequences of their actions and beliefs. We were fast approaching the staggering figure of 240,000 dead, even before the fall and winter, and the White House was suggesting by their words and actions that Americans had little to fear. Indeed, openly defying commonsense public health guidance appeared to have become a point of pride.
I had hoped for more from President Trump in this moment. With the fall and winter surge coming, Bob, Tony, and I had all hoped that his experience with the virus and developing significant Covid-19 disease would serve as a wake-up call for the president, the White House, and the senior advisors to take this virus seriously and do the right thing. I knew it was far too much to expect the president to come out and say he’d never again go without a mask while in close contact with others indoors. Or, that he’d never again participate in superspreader events, like his campaign rallies. Or, that he’d never again refer to SARS-CoV-2 as “the China virus.”
Bob and I were both shocked and dismayed when, after his release from Walter Reed, Trump strode up to the South Portico, turned to the waiting press, and defiantly removed his mask. This symbolic gesture was akin to his thumbing his nose, not only at the task force and all the work we’d done for the last seven months, but also at all those Americans who’d spent months following our guidelines. I was saddened to think that this was the lesson President Trump had learned from his illness: Double down. If he was hoping to lead by example, his example terrified me. He’d dodged a bullet, and now many Americans would believe they could dodge one, too.
Trump’s defiant attitude belied the reality that his survival had been dependent on care that was not yet immediately available to most of America. The good news was that we had developed effective treatments. This meant that, from here on out in the life of the pandemic, most patients could recover from the infection. The monoclonal antibodies the president had received were made available to him only through an FDA compassionate use provision. This very effective treatment would shortly thereafter be approved for wider use for other Covid-19 patients. Trump’s “nothing to fear” remark was supported by one fact: we had come far in terms of treatment. However, while this was true for many of the infected, it was still not true for the most vulnerable. We were losing more Americans to Covid-19 disease every month than we lost during an entire annual flu season.
From the outset, we had talked about building a bridge to vaccinations. This was a very worthwhile goal, and we had used testing and early therapeutic interventions to build that span. We needed to do everything we could to help people survive until those vaccines—a preventative measure, not a treatment—came along. Also from the outset, I had warned against putting too much emphasis on the message that once vaccines arrived, all would be well. Vaccine development and deployment was only one prong of a multiprong approach to managing this pandemic, or any pandemic. At the time the president was infected, the White House was still signaling that vaccines would be available soon. Dangling the vaccine carrot while simultaneously taking a stick to the three important preventative measures was misleading and reckless then, and still is now.
As early as July, in my role as a board member for Operation Warp Speed, I had adamantly stated that it needed to be made clear to the American people that vaccines would not end the threat the SARS-CoV-2 virus posed globally. It would take at least two years to get the world immunized. Also, reports from around the world were beginning to show that prior natural infection was not preventing reinfection. The evidence was yet to be fully realized. We didn’t know the durability of protection from either infection or severe disease with either natural infection or from vaccines. The vaccines being studied were to protect against severe disease, hospitalization, and death.
From the coronavirus vaccine trials and later, we would be able to gather data on a vaccine’s effect on the path Covid-19 disease took in a person, but not on any protection it offered from asymptomatic infection. This was the case because even in the clinical trials, only symptomatic individuals were tested for Covid-19, and because the length of follow-up in the original trial was too short to evaluate the durability of immunity. As a result, from the outset of distribution, we still didn’t know if the vaccines protected from silent infection—the very thing that created the first invisible community spread.
Vaccines that protect from all infection produce what is called “sterilizing immunity,” a very high bar in the world of vaccine development. In some cases, like measles and mumps, natural infection in childhood leads to long-lived immunity and protection from any reinfection in most children. Some vaccines are designed to mimic the immune response that accompanies natural infection of measles and mumps, and these vaccines also result in long-lived immunity, known as sterilizing immunity to both infection and disease. Sterilizing immunity is almost impossible to achieve if it isn’t possible with natural infection. You are asking a vaccine to do better than a natural infection. Many vaccines work by protecting against disease; any infection is often dealt with silently, is cleared up rapidly, preventing the vaccinated person from getting seriously ill.
The vaccines in development for this pandemic were designed to provide “protective immunity,” limiting the virus’s effects (Covid-19 disease) on us. Everything else about these vaccines was an open question that would need to be answered. We also didn’t know how long that protection would last and this needed to be studied over time in real-world situations.
I then emphatically summarized: All individuals who were immunized could still potentially get infected and, even if asymptomatic, could still infect others. The vaccines if effective would provide protection from severe disease and death, but they did not create an impermeable bubble around the immunized. In time, after the vaccines were in use, we could use population-level data to determine the full extent of their protection against infection versus disease. In the meantime, if the virus was actively circulating in the community, people still had to test, wear masks indoors, socially distance, and limit the size of indoor gatherings. We couldn’t give up on public health mitigations that we knew worked while we accumulated the evidence of the new vaccines’ efficacy at the individual and population level. We needed to know the durability of protection, especially the suggestion that reinfection was happening after initial infection. I didn’t know these answers then, but I knew they needed to be addressed.
With the vaccines still months away, and with so many other matters to attend to, and believing that I’d made my points abundantly clear—I still didn’t let the matter drop. Over time, in the governor’s reports, I reinforced the message that vaccines may offer only limited protection from infection; sterilizing immunity would be a high bar. There was no genie in the vial.
It was also important for people to understand that the pharmaceutical companies and the FDA had to look at not just how effective the vaccines were, but how safe. That October was when politics entered the vaccine discussion to a greater degree than before. Prior to this, Steve Hahn had frequently shared with the other doctors on the task force the enormous pressure he felt from the administration and the enormity of the decisions his agency, the FDA, had to make during this crisis. Mark Meadows, Jared Kushner, and the president had all called Steve, urging him to speed up the emergency use authorizations for vaccines and treatments. The numbers of deaths and cases were rising, and vaccines would be a critical intervention. The FDA needed to act, but it was caught between a rock and a hard place: okay the use of vaccines that had not been fully tested, with all its potential consequences, or stick to the established approval protocols and endure the president’s wrath.
When Steve discussed the pressure he was under, it became clear he was distressed by being placed in this position by the president and his advisors. He felt Secretary Azar was conferring all the “blame” on him and not on the fact that even if things were sped up, essential procedures still needed to be followed. Once the pharmaceutical companies submitted their application to the FDA, he said, the FDA staff would work around the clock. But he went on record stating unequivocally that when it came to vaccine approval, the FDA would not sacrifice safety to speed. Whatever blowback there would be, the FDA wouldn’t budge.
The blowback was immediate. Even as the president was recovering from Covid-19 in October, he was angling for voter support by tweeting, “New FDA rules make it more difficult for them to speed up vaccines for approval before Election Day. Just another political hit job!” He wanted his base to believe that if it weren’t for the FDA, he would be able to make good on his promise to deliver vaccines at warp speed—in time for voters to go to the polls knowing that a literal shot in the arm was not months but only days or weeks away. Vaccine makers Pfizer and Moderna had also both been under personal pressure from the president, to speed vaccine production. All had remained steadfast in the face of this, stating they were putting safety first. Trump was angry that the FDA later recommended the gathering of at least two months of safety data after full immunization as part of the last phase of the vaccine trials. This would delay the submission of the data from the pharmaceutical companies by approximately fifteen to thirty days.
This data, from all the volunteers who were a part of the vaccine clinical trials, would be derived from follow-ups after they had received their second dose. It would take those two months to get a better indication of the vaccines’ benefit-risk profile. Among other considerations, we needed to see if these volunteers experienced adverse effects from the shots or if any of them developed severe Covid-19 disease. The safety window could have been made even longer, to allow for even greater caution about the vaccines’ safety, but at this point—with roughly a thousand people dying of Covid-19 disease each day—the FDA was walking a tightrope between the need to ensure safety and the need to be expedient. This was a delicate balance to strike.
Yet, in pressuring Steve Hahn and the manufacturers, the president was ignoring a very large elephant in the room—vaccine hesitancy, especially among adults. Sure, you could produce and approve an effective vaccine, but its efficacy was also dependent on our getting it into the arms of the American public. Every year, public health officials could see this substantial problem in the rates of adult vaccine uptake, including the flu vaccine. Whether it’s because people are afraid of needles, have concerns about vaccine safety, or view getting vaccinated as inconvenient, as a nation, large numbers of Americans decline to get vaccinated against the annual flu variant. The CDC, which expends a great deal of time studying the quantitative data, has noted an emerging trend. Young children and the elderly get the flu vaccine at a much higher rate than adults. When all age groups are combined, and with variations from state to state, it found that only between 33 percent and 56 percent of adults got the flu vaccine in the 2018/19 flu season (the latest data available). But the CDC didn’t study the qualitative reasons behind the low vaccine uptake and didn’t do substantial or effective work to alter the rates. We didn’t change adults’ perceptions of vaccines by age, race, ethnicity, and geography. We didn’t study the different reasons for lack of uptake of current vaccine utilizations and didn’t understand hesitancy. Without doing these things, we’d never make an impact on vaccine uptake then or now.
We couldn’t just rely on therapeutics, either. The supply of remdesivir, monoclonal antibodies, and other drugs for which we hoped to obtain expanded access authorization was finite. To be effective, many treatments required use within the earliest of days after infection—and this meant testing regularly. Also, the delivery systems and other aspects of treatment and vaccine distribution could be slow. Many of them had not been tested for use at this scale. Wearing masks, employing good hygiene, appropriately social distancing, and limiting indoor gatherings during surges were the main buttresses for the cathedral of care and common sense we’d put in place. The rest might collapse, but these structural components could not.
In my mind, by relying on therapeutics and the promise of vaccines, what the administration and the president himself were doing was dangerously akin to signaling to drivers of automobiles, You have antilock brakes. You have airbags. You have safety crumple zones. You have other state-of-the-art driver safety features. Go ahead and drive as fast as you like and take as many chances as you like. We’re betting you’ll survive the inevitable wreck. All the while, they were ignoring the fact that, to extend the metaphor, not everyone’s cars were equipped that way. But: Too bad for them. Too bad for the ones we might hit. That attitude was also a reflection of our public health care system’s bias toward treatment over prevention, something that drives up costs—in this case, the cost of human lives.
Between October 5, when the president was released from Walter Reed, and December 15, when the first newly approved vaccine dose was administered, another 105,000 Covid-19 infected Americans would not survive long enough to choose to be inoculated—and another 10 million new cases were reported. This didn’t have to happen. We knew what early community spread looked like and the sequence of events that led to inevitable hospitalization and death. When test positivity began to rise locally, instead of doing what was needed (mask up, socially distance, limit indoor gatherings), the country waited until the hospitals filled up again, failing to believe the early warning of rising test positivity in those under thirty-five and saying to ourselves, wait and watch. This time will be different.
As a result, days to weeks later, more Americans succumbed to this virus. This kind of magical thinking was what had gotten us in trouble in 2020, and it would do so again in 2021. We were very good at making excuses, at highlighting the fact that we had vaccines, at claiming that this variant was not as deadly here in comparison to other countries. We made claims that this wave would look like the wave in such-and-such country, that this time the surge would not cause our hospital beds to fill, would not cause thousands of Americans to die every day. We seemed to prefer to believe that this time would be better than before, instead of using the effective tools we had to ensure that it was.
While I was touring the states, I took every opportunity to make Trump’s Covid-19 scare a teachable moment: If the White House was experiencing outbreaks, the same thing could happen, was happening, in that state or locality. Nothing about being an American, working in the White House, conferred any special immunity. If the virus were allowed to freely circulate in your community without any mitigation, it would find its way to your vulnerable great-aunt, your grandmother, your brother with underlying conditions, your child with Down syndrome. The only way to maximize your chances of staying well, and keeping others well, was to consistently employ those three simple measures: tests, masks, social distancing by reducing indoor gatherings.
More to the point, members of the Trump administration and in the Scott Atlas camp had continued to put obstacles in front of our efforts to make clear the dangers that lay ahead as fall turned into winter and Thanksgiving and then Christmas celebrations were held. Fortunately, there were people—from those in the White House communications office, to Tucker Obenshain and others in the Office of Intergovernmental Affairs, to the vice president—who helped me get that message out.
IN THE FIRST WEEK of October, Marc Short handed off the editing of the weekly governor’s reports to John Gray, because he was busy with campaign matters. Gray was a former advisor in the Office of Management and Budget and then deputy assistant to the president and director of policy for the vice president. In his first notes to me, Gray actually asked for “a bit more ambiguity” in our next governor’s reports. He and I engaged in a line-by-line review of the wording, Gray challenging, changing, and even threatening not to send out these key reports meant to communicate a clear message about a situation that was costing lives.
At one point, Gray communicated to me not only that we needed to be more ambiguous, lest the governors think we were telling them what to do—never mind that, as I’d been reporting since spring, the governors were asking for exactly that—but that we weren’t allowed to mention the possibility of reducing indoor dining or closing bars when counties were in the red zone. When I wrote to Marc Short, explaining that all these edits were harmful, he responded that Department of Education secretary Betsy DeVos was complaining about any mention in the reports of school closures even when the pandemic was raging in that community and no one was vaccinated.
We were recommending that schools in the green and yellow zones fully reopen and stay open and that we use other mitigation in the yellow zones when the counties became red hot with the highest level of community spread and there was a risk to children’s primary care providers: grandmothers, teachers, bus drivers with underlying conditions. (A Black councilwoman had made this critical point to me during a roundtable in Virginia.) Governors and school boards needed to take this issue into account. They needed to prevent movement into the red zone by employing commonsense mitigation.
I never believed children couldn’t be infected, as was suggested early on. Indeed, not only could they be infected—we saw this in the summer of 2020, when Americans were moving around the United States on vacation and rates in children rose—but I believed they would be part of the community of primarily silent spreaders. True, children might be more likely to have mild initial disease, but we didn’t know the full impact of Covid-19 on them or the potential for long-haul Covid.
I reminded Gray that the task force didn’t want schools to close or stay closed: we wanted each school to have the mitigation measures they needed to stay open safely—as so many universities had done through testing. Marc Short had also specifically mentioned to Gray that Governor DeSantis was the most vocal critic of the reports.
No longer surprised by anything that came out of this administration, I wrote back, emphatically asking, “Does [the governor] honestly need to see what unmitigated spread looks like?” We were in the lull before the storm, and we needed to empower the governors and Americans to do what they needed to protect their families. There was a clear way to put protective measures in place and save lives, one that wouldn’t destroy the economy.
Those in charge of reviewing the weekly governor’s reports seemed not to want to acknowledge the state data or the recommendations triggered by that data. They were far more concerned about public perception of White House overreach. While I was warning of far worse days ahead, they had expanded their censoring of key public health recommendations in the lead-up to the election. Week after week, month after month, September to November, the edits escalated. In September, their edits had focused on only the common mitigation points that appeared in each and every state report. Now I was being told to remove state-specific bullet point recommendations relevant to the level of viral spread in that state, laser-focused recommendations and solutions to use at the county level.
I dug in my heels and protested. This made no sense at all—these bullet points served as a reminder to governors of what they could do either to prevent their state from slipping over into the yellow or red zone or to get their state out of those zones. Again, I was told that we couldn’t be perceived as telling the governors what to do. I tried to work around this with references to successful, strategic moves specific governors had made to effectively control local outbreaks—a classic effort to show and not tell. But these references to specific states were shot down as well. And I was back to my laptop to devise another strategy.
It was no coincidence that as Election Day approached, their censoring took on a new urgency. I couldn’t come to any other conclusion. As the seriousness of the fall surge became apparent, so did their attempts to decrease our impact. They wanted to protect the governors who didn’t want to implement the recommendations, and those governors didn’t want a record of the actions the White House thought were critical to controlling community spread in their state.
While I was engaged in this censorship battle, I reviewed the draft of a proposed national strategy document. Generally, my edits consisted of inserting the words safely and fully in front statements about returning to work and reopening child care facilities, schools, camps, and universities. Justifiably, many people had criticized the federal government’s response for a lack of clarity. That I was still having to revise documents, at this late stage, to emphasize safety reflected the White House messaging problem that, like a bad case of poison ivy, just would not go away. With the doctors on the task force having to twist ourselves into knots to release any public communication, messages became garbled and the simplest things—such as an emphasis on safe reopening—nearly fell through the cracks. I spent so much time creating work-arounds, that it was often impossible to see all those fissures. Steve Hahn and Bob Redfield were doing the same each and every day.
To combat John Gray’s edits, I used the same method as before to disguise specific language. Whereas before I sensed the reviewers were not searching for key words to find and eliminate any objectionable terms, I knew that John Gray was too busy to read the entire report. I wrote to the three other report writers and asked them to move the key recommendations to different bulleted lists and not start those lists with the recommendations. This ran the risk of making it more difficult for the intended audience to find the message quickly, but if the reports didn’t go out, then valuable information wouldn’t get disseminated.
I engaged in more open confrontation with regard to the worst purveyor of misinformation: Scott Atlas. While the president was still being treated at Walter Reed, I wrote to Mark Meadows to tell him that Atlas should be removed from the task force. He could say what he wanted to the president, but I couldn’t have him as part of the task force. Every meeting at which he was present was devolving into a fight over his faulty pronouncements. He never presented any supporting evidence and continued to invoke the president’s name to bolster his argument. The doctors were in agreement. Atlas, as he had done from the outset, was still taking my daily reports to the administration, stripping my name off the distribution list, and providing analysis that ran counter to the message I was delivering: Here are the facts. Here is what this means for the foreseeable future. Here’s what we can do to head off this surge.
Meadows asked me to give him forty-eight hours.
I found it strange that Atlas wouldn’t send his critiques to me directly. Why was he playing this childish game? He might as well have folded his arms, rolled his eyes, and said, I’m not talking to her, an attitude more appropriate in a situation comedy than a Situation Room during a national emergency.
If I couldn’t get Atlas off the task force immediately, I wanted him off the screens from which the American people got their news. I went to my allies in the White House Comms team responsible for booking media spots. (To protect them, I won’t name them here, but I have to acknowledge the work they did to help this country.) Unlike some at higher levels in the administration, and unlike the Staff Secretary and the president, the Comms people got it. Scott Atlas’s position on this virus ran counter to everything else they’d seen, read, and heard, and they agreed not to seek media opportunities for him. In fact, they told him he needed to do his own press outreach. They wouldn’t silence him, but they weren’t going to hand him a microphone to promote his as the voice of the White House Covid-19 response. Downstream, their efforts paid off in a way I couldn’t have anticipated.
AS OCTOBER 2020 PROGRESSED, my sense of déjà vu became overpowering. It didn’t help that while on that Northeastern college swing, I received communication from Vanderbilt University Hospital that they were out of remdesivir. This couldn’t be happening, not at a facility in the Southeast, where for so long the pressure of this crisis on the health care system had been relentless. This kind of crisis management intervention was common, and exhausting for all involved. I asked Dr. Bob Kadlec, of the Office of the Assistant Secretary for Preparedness and Response (ASPR), to investigate. We learned that the supplies were there, but that an administrative snafu in processing orders within the hospital’s internal pharmacy had produced the false shortage. Thank goodness. Still, with each and every such alert, the problem needed to be tracked down and resolved.
The supply chain alert system, called “Green Light,” was working. The system that Rear Adm. John Polowczyk had envisioned but the CDC wouldn’t implement was now operating effectively under HHS supervision. This was extra work for every hospital, but essential for ensuring they were getting the supplies, staffing, and therapeutics they needed. This clear and comprehensive hospital data from every hospital across the country was critical to saving lives but also became essential in understanding the full impact of each surge, the variable impact of the variants, and how to improve our pandemic response.
I also continued to go where I believed I still had some influence: the Covid Huddles. I wrote to Jared and the others in the Huddle that serious warning signs were emanating from the Upper Midwest and the Northern Plains states. The data showed that the spring surge had been driven by spread within workplaces and on public transport to workplaces, and the summer surge from friend and family gatherings. The fall surge was shaping up to be like the summer surge, as workplaces and transport became safer with masking and other precautions and the risk shifted to social gatherings indoors.
We had to make everyone aware of this. Because I couldn’t successfully do that through the censored governor’s reports, and because I couldn’t be in all places at all times throughout the fall, doing local media, I reached out again to Jared and the Covid Huddle. Like nearly everyone else in the Trump inner circle, Jared had found his attention divided between the ongoing pandemic and the upcoming election. Like me, he was often only a voice over the phone in the Huddles. Just as the number of task force meetings had dwindled, so had my level of personal interaction with him. From September on, it wasn’t so much that he and Mark Meadows and Marc Short had disappeared as much as slowly faded from view.
Still, in terms of support, Jared remained a constant, along with others in the Covid Huddle: Brad Smith, Adam Boehler, the White House Comms team, and Paul Mango from HHS. The intense coordination continued. The Comms team continued to set up hundreds of local media hits for me, Jerome Adams, and Secretary Azar. Brad and Adam helped support the coordination with FEMA and ASPR to make sure states were getting the supplies they needed in the moment and proactively in advance of the critical moments to come.
Tyler Ann remained vigilant to White House maneuvers and always had my back while I was on the road. She made sure I never missed an in-person meeting, over Zoom or the phone. The virus was out there, in every region of the country, and by the end of October, I’d travel to an additional twenty-three different locations in the Northeast, the Midwest, and the West.
Notable among the places I didn’t visit was South Dakota. Governor Kristi Noem refused to meet with us. This came as no surprise. She was the leader of a rural state and, early and often, had bought into the message the Trump administration espoused. In July, the state had hosted an Independence Day celebration at Mount Rushmore, which the president attended. Governor Noem, a rancher’s daughter, went on record as saying that, according to the science, it was “very, very difficult to spread the virus when you’re asymptomatic.” No data supported this core Atlas belief. Data did support the presence of the same viral load in the noses of the asymptomatic and symptomatic alike. Too frequently, those without symptoms were more likely to engage in social activities and spread the virus unknowingly. Noem acknowledged that mitigation was important, but insisted that it wasn’t actually possible to stop the virus from spreading.
The outcome of this misinformed message wouldn’t have been so bad if Governor Noem hadn’t also encouraged people around the country to attend the annual motorcycle rally in Sturgis, South Dakota, in August. While a motorcycle ride was low risk, what happened before, after, and around the ride was not. Many of the 366,000 people estimated to attend the rally crowded into bars from August 7 to 16, participating in a national superspreader event. Two weeks after the rally, cases of Covid-19 in South Dakota more than doubled, and hospitalizations tripled. To make matters worse, rally participants returned to their home states across the country, many of them bringing SARS-CoV-2 along for the ride. It is difficult to accurately determine the total effect of this event, but researchers at San Diego State University’s Center for Health Economics and Policy Studies projected that 260,000 cases of Covid-19 could be linked to the Sturgis rally. Governor Noem labeled the study “fiction.” The projections may have been “fiction,” but during my travels across the Northern Plains and Rocky Mountain states, hospitals there reported patients whose Covid-19 disease was specifically tied to their attendance at the rally.
Despite rising cases and fatalities, Noem had held the line against any stay-at-home orders or masking, promoted the use of hydroxychloroquine, and—a month before we called to set up a visit—announced that she would spend five million dollars of federal Covid-19 relief money on a campaign to boost tourism in her state. We had never recommended she issue stay-at-home orders after the 15 and 30 Days to Slow the Spread campaigns, but we did recommend masking and testing to see the silent invasion and prevent spread.
On October 7, freshly out of the hospital, President Trump retweeted a clip of a session of the South Dakota Legislature in which Governor Noem described lockdowns as “useless.” He captioned his tweet “Great job South Dakota.” Out of fifty states, South Dakota currently ranks among the top twenty states in deaths per capita. We continued to send Governor Noem our reports, but she never converted our recommendations into action.
Actionable steps were precisely what was needed, not just for South Dakota, but for the nation. To that end, Tony, Bob, Steve, and I worked to formulate a strategic plan for the remainder of fall and into the winter. Regardless of the outcome of the election, we needed a scheme in place to get the response back on track. The main points were familiar ones: We had to communicate directly to the American people, let them know unequivocally and with no ambiguity, that the success we’d seen at universities and colleges could be translated into a national Covid-19 response. This, of course, meant expanding testing to the asymptomatic—moving testing from convenient to impactful.
We also had to end the battle of words. The governor’s reports needed to be restored and preserved as the source for accurate data to be used in the states’ decision making. We had to continue the weekly phone calls with the governors that the vice president led while always setting the standard for professionalism and using data for decision making. Internally, I asked for the task force meetings to be held three times a week—especially after the election, when I was certain (and later had confirmed) that cases, hospitalizations, and deaths would be on the rise. As for the four core doctors on the task force, we needed to meet daily to ensure that we all agreed on what we were seeing and what needed to be done and that we continued to maintain our united front.
I also included an anti–Scott Atlas component in my postelection strategy. We needed the administration to see, once and for all, that what Atlas had been advocating was wrong, was dangerous. We had to show Atlas and, by extension, the president and vice president that our balanced approach had been working—and point to Florida, and its sevenfold increase in cases three months after Atlas’s visit with Governor DeSantis, as a cautionary tale. If Atlas’s influence spread outside Florida, an additional tens of thousands of Americans could lose their lives.
I suggested an “Atlas Summit,” a meeting during which Atlas and his herd immunity colleagues could explain what was transpiring in Florida—the rising cases, hospitalizations, and, soon, deaths occurring despite their having assured the governor his state wouldn’t experience another deadly surge. Sadly, the Atlas theory was in action. I had said his approach failed in theory; now it was failing in practice. There was a middle ground, a middle ground created by adapting the UPenn/CHOP model—keeping businesses and schools open through masking, outdoor dining, and testing. Florida’s total cases would go from about 750,000 in October 2020 to nearly 3.7 million in October 2021. Similarly, deaths in that same period would increase from 16,500 to just shy of 58,000. From June 1, 2020, to the end of October of that year, just over 15,000 Floridians succumbed to Covid-19 compared to nearly 24,000 in 2021 in that same time span. That 50 percent increase in fatalities occurred when vaccines were available.
This wasn’t a case of hindsight being twenty-twenty. It was a case of what wasn’t done in 2020 extending far into 2021—and, likely, beyond. Atlas had to be stopped. I’d later suggest that he be reassigned to work with Larry Kudlow and others on the economic side. The economy seemed to be what Atlas was actually most interested in preserving, so why not put him where his interests and abilities were best suited? Anywhere but as part of the response to a raging pandemic. We knew what worked. It was about ensuring consistent implementation across the country.
Throughout October, the task force worked toward finalizing the postelection strategic plan document. It wouldn’t be easy to convince the senior White House operatives that continued mitigation with decreased social gatherings indoors and increased testing to find the silent invasion was the way forward, something the document would lay out explicitly for them. I pushed Meadows, Short, and Kushner on the main points, probing for reactions to each of the document’s elements. It took longer than I hoped to get responses. I don’t know if they now saw things the way I did, but I was pleased when I didn’t receive any real pushback. We were hoping to institute in the fall and early winter much the same response we had instituted in late March and April. Whatever name you called it, we were once again asking Americans to “slow the spread.”
It was Halloween, another holiday on the road away from friends and family and my two amazing granddaughters, Abbie and Addie. Irum and I were in Salt Lake City, Utah. Following our meetings with the health care leaders, we decided to go for a hike. Our loss of fitness and the altitude made it rough going, and seeing other, much older hikers cruising past us up the slope soon overcame our resolve to get some exercise. Bone-weary and in no mood for Halloween pranks or merrymaking, we made an early night of it.
The sight of those sturdy Utahans on the trail didn’t surprise us. The day before we arrived, neighbors of Utah epidemiologist Dr. Angela Dunn had risen to her defense. After her personal information was leaked online, a dozen anti-mask protestors gathered outside her home. Her neighbors rallied, turning on lawn sprinklers and parking their cars in the street to discourage the protestors and block their access to Dr. Dunn’s home. Governor Gary Herbert also acted to defend her, saying that it was acceptable to protest an elected official like him, but not a state employee, and particularly not at her home. Irum and I were encouraged to see community engagement in defense of a public health official and the care and compassion Dr. Dunn’s neighbors had for one another. The protestors certainly had their right to register their displeasure, but as the governor (and Dr. Dunn’s neighbors) pointed out, a line had been crossed. Unfortunately, this wasn’t the only place in the country where that same line had been crossed or where public health officials were targeted for only trying to do everything they could to save lives.
The following morning, we woke to news that Scott Atlas had done our work for us.
In life, timing is nearly everything, and Atlas’s timing could not have been worse. Mere days before the presidential election, he had allowed himself to be interviewed for Going Underground with Afshin Rattansi, appearing from the actual White House complex without (it was later revealed) White House authorization. Worse, the television program was aired on RT, the disreputable state-controlled Russian propaganda network known for spouting anti-American rhetoric. With this faux-pas, Atlas had let his ego, his desire to be visible on TV, any TV, overrule his reason—but it was what he said that will be remembered.
While he hadn’t gotten approval for his media appearance on the Kremlin-backed news outlet, he did repeat the assertions he had been making since March 2020. Citing the media’s “gross distortion” of the pandemic, Atlas said that “there’s this frenzy of focusing on the number of cases when we see a lot of reasons to, you know, be cautiously optimistic here.” Before the deadliest surge this country would experience, he was saying he was optimistic. He also claimed that “the disease is deadly only to the elderly and the high-risk people”—in other words, millions of Americans. Yes, many of the victims of Covid-19 were elderly and at high risk, but they weren’t the only ones at high risk. Some of the highest-risk individuals were in their thirties and forties, moms and dads in the prime of their lives. Was he implying that they were expendable? Atlas then claimed, offering no rationale for his statement, that the White House Coronavirus Task Force was responsible for 233,000 excess deaths. He also said that the models predicting as many as 500,000 deaths in the United States were wrong, and generally tried to dismantle and discredit the task force. He was the one who was wrong. It wasn’t a model that had given us the figure of half a million Americans dead, but my own projection. And we reached that ghastly total by February 2021, from the deadly winter surge about which Atlas was so “optimistic.”
In a parting shot, on Twitter—which he had thought would help promote his TV appearance but that, instead, alerted more people to his dangerous influence—he tweeted, “New interview. Lockdowns, facts, frauds . . . if you can’t handle the truth, use a mask to cover your eyes and ears.” I suppose he thought this great political theater, but his appearance had the opposite effect from what he intended.
After Atlas had issued an apology for appearing on a television network that, according to the Department of Justice’s National Security Division, was a registered foreign agent representing the interests of a foreign power, he didn’t go underground, exactly, but he would never again exert the kind of influence in the White House he once had.
I had wanted Atlas gone from the task force, but I hadn’t counted on his committing this careless act of self-destruction. It wasn’t lost on me that whatever desire for attention had led him to appear on Russian-backed television was probably a function of his having been off-camera for a while, thanks to my White House Comms Office friends. They had trusted that I was right. As a result, they had helped me stanch the worst of the bleeding by keeping Atlas off as many screens as possible.
To ensure that the moment wasn’t lost on anyone in the administration, I wrote to Marc Short, Mark Meadows, and Jared Kushner, telling them that Scott Atlas had just given them the perfect reason to send him out of the White House and back to where he came from. I reminded them that they didn’t need that kind of liability just then, not with the election around the corner. This may have been gilding the lily, but in a time of crisis, you do whatever is necessary, and then some.
As it turned out, Scott Atlas faded into oblivion after the election. I didn’t know then and I don’t know now where he went or what he did. The important thing was he was no longer a physical presence in the White House. Still, I couldn’t say that sad chapter in this story was over. The impact Atlas had had in his three months in the White House was still being felt around the country in the misinformation circulating across media platforms.
Because of my fear of misinformation specifically and the state of the pandemic generally as the fall surge turned into a winter one, I was heartened when David Kessler from the Biden camp stayed in touch and inquired about my sense of the rise in cases, its trajectory, where we were, and where we were going. He wanted to know what he was looking at.
I was concerned about current White House staff and support personnel, the president, the vice president, vulnerable Americans, and everyone else in the country—and my worry included Joe Biden and his team. As a result, after not hearing from David Kessler for a little more than a week, I reached out to him. I let him know that those on the Biden team who were most at risk were his on-the-ground campaign staff. I imagined that most of them fit the profile for asymptomatic individuals who could become silent spreaders: the under-thirty-five crowd. I made the same recommendation that Irum and I had followed while on the road—Biden campaign staff across the country should stick to drive-thrus and takeout. A week later, I sent Kessler a similar reminder. Both the campaign and the pandemic were heating up.
We all needed to be vigilant and do our part to lessen the damage that had been done over the last nine months.