When former vice president Biden was declared the winner of the 2020 election, I’d set a goal for myself—to hand over responsibility for the pandemic response, with all its many elements, in the best possible place. I therefore felt duty bound, by regulation and by character, to continue to do my best, even in the midst of the tiered exodus that is part of the orderly transition of power culminating in the swearing in of the new president.
If precedent had held, I wouldn’t still have been in the White House for the task force meeting scheduled for January 7. As a detailee, I would normally have been among the first tier to move out of the West Wing and would normally have spent that week packing up my office, relinquishing my White House–provided computer and phone, and returning to the State Department. But the winter surge was raging, and even one day lost was not one we could afford. I wasn’t about to stop providing my daily update, nor the weekly governor’s reports, so I lobbied Matt Pottinger and National Security Advisor Robert O’Brien to be able to ignore the customary protocol for departure. They cleared my request, and I remained in the White House until January 19.
For the first few days of the New Year, I went about my usual work. I wrote to a key person at the CDC and copied Brett Giroir on an email I’d sent to that agency the previous week, about expanding testing and making better use of the university systems’ successes in remaining open. I pointed out areas of significant deterioration across the Sun Belt and the cold northern regions. Texas and California were particularly worrisome: 25 percent of the nation’s Covid-19 deaths were occurring in those states.
On January 3, 2021, I thought briefly of the BBC piece I’d read exactly one year before: “China Pneumonia Outbreak: Mystery Virus Probed in Wuhan.” What had been described as a “mysterious illness” had, over the past twelve months, lost much of its mystery. We knew so much more about the virus now—and crucially, so much more about how to combat it.
And yet, so many were still getting sick, so many dying.
A year ago, we had been caught off-guard. Whether from the FDA, ASPR, BARDA, the CDC, or the White House, there was enough blame, enough missteps, to go around. Pointing fingers earlier or even at this point would only derail my efforts and dishonor the work so many had done so faithfully. By August, we had had a firm grasp on the solutions that worked. By fall, we had demonstrable evidence of the importance of sentinel testing from the universities and various other businesses—film production, restaurants and bars, sports (for example, Tony Fauci’s favorite, baseball)—all of which had had to shut down but now remained safely in operation using the tools we had. Governor Doug Burgum of North Dakota—always on top of the data and forever innovating—found that if all students were masked, you wouldn’t need to quarantine all students just because one had tested positive. Students were able to stay in school. Tools we had developed in partnership with states were working, and vaccines would protect from severe illness.
For every news report of what went wrong—for every overrun hospital, every superspreader event—I was privileged to be able to see, across the country at the local level, what went “right.” I had stood witness to what state and federal workers were doing every day to adapt to the evolving crisis and adopt innovations—something we were able to include in the governor’s reports. I wanted to be able to trumpet these efforts to the world, to acknowledge the herculean efforts of the private sector—rolling out tests to the tune of nearly two million per day; developing, delivering, adapting, and adopting therapeutics like remdesivir and monoclonal antibodies—and the courageous, self-sacrificing labors of the country’s essential workers. Now, with the addition of the vaccines to the mix of mitigations, we were closer to managing this virus, yet that goal remained just out of reach.
One area where we were still lacking was in our fundamental messaging. Weeks short of the new administration’s taking over, the Trump White House stubbornly refused to acknowledge that we had the means and the methods—if not the motivation—to bring down case numbers and deaths, to bring an end to this crisis with routine, clear, consistent communication to the American people, simple, straightforward, commonsense actions that would save lives.
The behavior of the White House continued to confound me. I figured that, by this point—with Congress due to count the electoral votes on January 6 and the results a virtual certainty—they would want to fully address this crisis with best practices and hand the effort off to the Biden administration with the necessary momentum to carry our best practices forward. I thought that, if for no other reason than to provide some baseline to the president’s legacy, this would be the aim. Unfortunately, it wasn’t.
In late December, I’d lobbied Mark Meadows again to let me hit the road in January to go where I’d seen bumps in the vaccine rollout. He refused to let me go because there wasn’t staff to support it. What was there to gain from forbidding me to visit with state officials? An image from my childhood kept intruding—kids with their fingers stuck in their ears, chanting, “La, la, la! I can’t hear you!”
The Oval Office didn’t want to hear me, had failed to listen. I would struggle to understand what motivated this right up until my last day in the White House. As much as I vehemently disagreed with their decision to prevent me from communicating nationally the urgency of our situation in the fall, at least that rationale was rooted in a clear, election-related, politically driven strategy. They wanted to win, and my pointing out the wave that was about to hit the country would have made that harder. It may have been calculating, but it was discernable. Much harder to comprehend was why, once the election was over and former vice president Joe Biden was declared a winner, they continued this behavior. I’d assumed that the senior advisors would stop trying to censor me and would further support the comprehensive response they had agreed to at the end of October. They didn’t. It got worse.
It. Just. Didn’t. Make. Sense.
What followed, on January 6, made even less sense. The behaviors exhibited that day and the day before were the most troubling I’d ever seen. Let me put this in context.
Since 1995, as part of my State Department, Department of Defense, and CDC assignments, I’ve traveled and worked in countries around the world. In some of them, democratic principles were newly in place. In others, the governments preached democracy but practiced authoritarianism. I’d seen free and fair elections contested, both peacefully and violently. In my work in Africa, where violent targeting of candidates, their supporters, and polling places spilled over, catching many in the crossfire, I was often forced to take extra safety precautions pre- and postelection. In other countries where I worked, colleagues involved in suspicious car accidents believed they were targeted due to their support for one politician over another.
I never expected to see a violent uprising, an insurrection, take place on American soil, never expected to see my fellow citizens, individually or in groups, behaving as they did at the U.S. Capitol that horrifying day. Crucially, I never thought I’d see acts of domestic violence watched by the highest official in the land, a man who had sworn to preserve, protect, and defend the Constitution and the founding principles of our democracy, without immediate action and intervention. For all the times over the course of my life I had watched news of unrest from around the world and thought, That can’t happen here, I was never shaken as badly as I was on January 6, 2021. It could happen here. It had.
Periodically, through the summer—particularly in the wake of the George Floyd murder and the rise of the Black Lives Matter movement—I’d seen the perimeter of the White House complex come to resemble a fortress, something you’d normally have seen in a high-threat area like Baghdad’s Iraq War–era Green Zone. Security around the White House was always tight, but in the approach to the congressional vote count, these efforts had been redoubled. Barricades were being erected; streets were closed off. Armed troops moved in.
The night before the Capitol riot, in anticipation of leaving the White House for good, I was walking out in the darkness of the city. Because I had spent so much time at the White House, I’d brought many pairs of high heels to change into after walking in in my “reasonable” shoes. On the evening of January 5, I left the office carrying a boxful of them. My usual route, now lengthened due to our being rerouted to an exit nearer the Ellipse, took me through a labyrinth of high chain-link fencing and improvised outdoor corridors. Generators thrummed, and temporary lights on stands illuminated clusters of armed security forces, their shadows splashed darkly across the ground. Walking out the back way, closer to the Ellipse, I could hear the ongoing rally. The crowd there was loud, and although I couldn’t see how large it was, the volume of the noise they generated vibrated my chest. From a distance, cries of “Stop the steal!” were carried over the cold breeze. I quickened my pace, the sound of my footfalls competing with the distant, pounding voices.
In that moment, I decided that I would work from home the next day. What was that evening a relatively peaceful protest had an edge to it. What my gut told me was confirmed by the events of the next day. I was glad I trusted my gut; it had saved me many times overseas. You just never know.
Still, nothing could prepare me, or the rest of the country, for what transpired on January 6; nor for the risk to life and limb the vice president would face. In conversation with others, I had trouble voicing all the thoughts cascading through my mind, or articulating what the riot at the Capitol meant for me—as a military veteran, a forty-year civil servant, a citizen, and someone who loved her country. In the end, my thoughts returned to the pandemic. I wondered how different its trajectory of loss and pain might have been if all the fury and determination behind the president’s words that awful afternoon—“You’ll never take back our country with weakness. You have to show strength and you have to be strong”—had been applied to his approach to responding to Covid-19.
Later, I would also wonder how different things might have been if some in the administration and the president hadn’t gone on ignoring the pandemic in the days following their insurrection. To his great credit, Matt Pottinger resigned the same afternoon, as protestors stormed the Capitol Building. He had brought me on board, convincing me that my country needed me. It still did, and in the days that followed, I would go on serving the American people, but I would have even fewer allies on whom I could rely.
I’d never found it easy to adjust to the presence of heavily armed police and military, and what I saw every evening in DC was no exception. There were now more police and military troops deployed across the city, and the White House had become an armed camp overnight. Getting to work each day required going through armed checkpoints—as you would see in an a U.S. Embassy in unstable areas around the globe. But this was Washington, DC.
THE EVENTS OF JANUARY 6 disrupted, but did not halt, the orderly transition of power. Meanwhile, I kept my attention focused on one part of that transition: the task force had only a few days left, and there was much to be done to help the incoming administration, and even more urgency.
Back on November 30, I had had my first meeting with members of President-elect Biden’s transition team: Vivek Murthy, who would take over as surgeon general; Jeffrey Zients, the Biden administration’s coronavirus response coordinator; Zients’s deputy coordinator, Natalie Quillian; and a small contingent of transition team members. Given how widespread Covid-19 infections had been in the White House, the team made the wise choice to meet via a Zoom call. David Kessler, the chief science officer for the response, was on the call as well, though neither of us acknowledged that we’d already been regularly communicating and that I’d been sharing data packages for weeks. For roughly ninety minutes, I filled everyone in on all aspects of the response, including the current data and the harrowing rise in slope of new cases.
I went through all the data products from the data streams we had created from scratch, to familiarize them with the picture and see if we needed to create others that better met their needs. I wanted them to have everything they needed to hit the ground running and fully execute the Biden Covid-19 plan. I told them about the governor’s reports, my daily data analyses, the White House Covid-19 summary we had created for the Covid Huddles, the hospital database, and the HHS community profile we had quietly posted on a publicly available website so they and the rest of America would have constant access to daily data to aid their decision making. The new team didn’t engage me in a lot of back-and-forth, but they asked a few pertinent questions.
I would meet only once after that with representatives of the Biden team, to review the data again. In the first week of January, I met over Zoom with the Biden data team’s version of Irum Zaidi, Dr. Cyrus Shahpar. Until our very last day, Irum would keep in close touch with him. Because of the absolute lack of comprehensive national data we had inherited when we first arrived at the White House back in March, we had created a new, integrated system for data collection and analysis, and we wanted to make sure Dr. Shahpar was up to speed on it. Different data analysis people often like their information delivered to them in particular differing ways. Dr. Shahpar would know what the new team needed and wanted. This meeting was very much about the nuts and bolts of the current system.
In the New Year, I became increasingly concerned that a mere ninety minutes with the new administration’s response leaders wouldn’t be sufficient. I didn’t see how, in that brief meeting, they could have gotten much beyond a glimpse of the current situation. The way the transition works is very one-sided: As a part of the outgoing administration, I couldn’t contact anyone on the Biden team directly, to ask them if they needed more information, wanted to meet again, or had any questions. This had been the case for both presidential transitions I had already been through. The only way the meeting I desired could take place was if the incoming administration initiated it.
With no one else to turn to, I shared my concerns with Jared. He told me he would see what he could do, ultimately suggesting I work with Pete Gaynor, the head of FEMA. I told Administrator Gaynor my concerns: “They don’t have a full grasp of just how many moving parts there are to all this.” Pete told me he’d try to find a work-around.
The only public communication coming out of the Biden team was their frustration over the Trump people not being very forthcoming with information. Politics was clearly at play. I didn’t like that this impression was out there, but there wasn’t much I could do about it publicly or within the White House. No matter what was being said, the outgoing team was still responsible, and we needed to make sure the incoming team had everything they needed.
The political reality was that very few people involved in the Trump administration’s response to the pandemic would carry over into the Biden White House. Maintaining continuity in the transition of power is always difficult, but I sensed that this time it would be especially so. After that initial contact, I didn’t hear directly from any of the participants on that Zoom call or from their data person. The message was clear: Thanks. We’ve got this. We don’t need your insights.
I’m not sure how Administrator Gaynor managed it, but the week of January 11, the outgoing response team gathered in person at FEMA headquarters for a second, comprehensive Covid-19 Zoom call with the incoming response team. It was a productive exchange, but I got the impression the Biden team felt we had failed in our response to the crisis and, therefore, had nothing of real value to offer them. They paid particular attention to, and asked more questions about, the vaccine program. Because of this, I believed the Biden response would be firmly centered primarily on vaccines.
In the summer, I had read the Biden administration’s Covid-19 plan. Its emphasis on testing, masking, vaccines, and clear, consistent communication assured me that the new team would finally resolve the long-standing issues over the role of asymptomatic spread and the aggressive testing needed to find the earliest cases. Now, though, the Biden team seemed much more focused on vaccines. The more I saw, and the more I heard from Bob and Tony—who were also meeting with various Biden people—the stronger my disquiet grew. For, as much as their plan relied on increasing testing and enhancing mitigation, their emphasis on vaccines heightened my fears. I wanted to attribute this focus to timing; the vaccine rollout was a recent development. Still, we’d seen how the Trump administration’s shift in emphasis from testing to vaccines, in August 2020, had harmed the response and cost so many more lives. We couldn’t let the same thing happen here.
Even in January, my early fears about the CDC vaccine guidance were being realized. Their multiple tier distribution plan was too complex; they didn’t have a mechanism in place to put their personnel on the ground in the states to help monitor the situation; and without their direct, eyes-on observation and assessment, they couldn’t effectively evolve and adapt the guidance to improve the immunization rates of those at the highest risk. Any new people heading into this already problematic situation would be operating at a deficit not of their own making. Taking time to smooth the rollout bumps would further delay getting shots into arms.
Before the winter holidays, I had spent a week in the field, going to five or six states to talk about the current surge, suggest solutions, and do everything possible to simplify state-level vaccination programs. I urged the states to consider a simpler, age-based prioritization of available doses, in place of the more complicated, CDC-endorsed plan. Still, for as much time as had been spent in advance of the vaccines’ approval back in November, we were still dealing with evolving issues in January.
Secretary Azar and HHS believed that the Walgreens and CVS drugstores across the country could aid in immunizing the most vulnerable in LTCFs. I was worried about speed. The National Guard was extraordinary at tackling the hard implementation issues we had encountered over the past eleven months, and I lobbied to have Guard troops sent to these facilities to support on-site immunization.
Bob, Tony, Steve, and I brainstormed, coming up with other ideas for working around the kinks in the CDC-approved state plans. With the Janssen/Johnson and Johnson vaccine nearing approval, we factored in how to make best use of this one-shot vaccine. We were drawing a road map to at least one million immunizations before January 20, when President-elect Biden was sworn in. It would be a slow start—all new initiatives are—but we thought if we pushed the system, we could flatten the learning curve and ramp up immunizations, so the new administration could accelerate the response. In the clinical trials, the single-shot Janssen vaccine had been shown to be slightly less effective than Moderna’s or Pfizer’s shot at preventing disease. Perhaps it would be better suited to inoculating those younger and less vulnerable to severe disease. The FDA would need to gather efficacy data by age group. If we could use the J&J dose for those under age forty-five (including health care workers), we’d preserve the supply of the two-shot mRNA vaccines for the over-seventy group. We even considered administering half doses with the first shot of the Moderna vaccine for the under-forty-fives, as the tested Moderna dose was found to have three times the mRNA of the Pfizer-BioNTech vaccine.
We considered every possible option to provide protection for severe disease, using the right vaccine based on age and vulnerability. We needed to ensure that every dose not utilized for health care workers was immediately made available where it was most needed—in those over seventy. On the day of the insurrection, 230,000 new cases were reported; two days later, the winter surge peaked, at 250,000 cases per day. The ensuing downward trend would continue until mid-March before the Alpha variant emerged, producing a surge in the Upper Midwest. What followed were the predictable peaks and valleys throughout 2021 mirroring 2020’s regional surges.
The docs and I agreed that the product of our brainstorming session on the vaccine rollout should be formalized. We decided to prepare a vaccine position paper for the vice president, discussing our concerns and offering solutions. On January 7, Alex Azar learned of our efforts and called me in a huff. We weren’t going over his head: days before this I had sent him a draft of the recommendations we hoped to share at the next task force meeting. Still, the secretary was angry—angry that I had taken the rollout issues to the task force for discussion, angry that I had alerted the vice president to mine and the other doctors’ concerns. His angry phone call to me was on a par with President Trump’s fury back in August. But with the CDC under the umbrella of HHS, he viewed the position paper as our tramping across a clearly established border and into his territory.
I pushed back. If the rollout was not working as planned, I said, we should brainstorm and suggest other solutions. Our paper wasn’t a criticism, I told him, but an acknowledgment that the rollout was not going perfectly and that precious doses of the vaccines were sitting around unused.
“That’s bullshit, and you know it,” the secretary said.
“I don’t want to see doses sitting unused,” I said, “like we already have in many hospital freezers.”
General Perna had shipped enough vaccine doses for 100 percent of all hospital personnel, regardless of their age, but only 60 percent of them had been used on this group, with some very young hospital workers hesitant to be first in line. (There were still questions about the vaccines’ safety in early pregnancy in January 2021 due to limited data from the original trials.) In their minds, they weren’t at risk for serious Covid-19 disease and could wait until there was more data on the shots. Yet, General Perna was already sending the full complement of second doses now, regardless of how many of the supply of first doses had been administered. To make matters worse, the doses were being sent to the same hospitals in the same quantities, despite their not all being used. Large numbers of unused doses sat in freezers instead of going into the arms of the second prioritized group, those over age seventy. I’d argued and argued that the decision to put health care workers at the head of the line for vaccines was wrong. Now, this major flaw in the rollout plan was coming to light in the middle of a deadly surge.
The secretary and I went back and forth for a good ten minutes. In the end, I toned down the paper based on his comments, and it went to the vice president.
I didn’t know then, and I don’t know now, if Secretary Azar was aware that even though I’d been told I couldn’t visit the states in January, I’d been working the phones every day to check in with them on all aspects of their response, putting special emphasis on vaccines. I prioritized speaking with the governors of states that had been particularly hard hit, with older populations and more vulnerable residents, such as North Dakota, Tennessee, and Arizona, and with governors who had reached out to me personally, as was the case for Governor Andy Beshear of Kentucky and Governor Jim Justice of West Virginia. Governor Justice was being innovative and was prioritizing vaccination rollout by age group. I made sure he was in on the governors’ call to convey his practical approach. Age, age, age, he said over and over.
I was gratified when, on January 12, the Executive Office of the President and the Office of Intergovernmental Affairs (the same group that had been so instrumental, particularly Tucker Obenshain, in coordinating Irum’s and my state visits) issued an “Analysis of State Vaccination Administration Programs.” Prepared by IGA as a guide for Operation Warp Speed to interface with the states, the document identified the ten states that had vaccinated the most citizens per one hundred thousand people. Included on that list were the five states I’ve just mentioned: Arizona, Kentucky, North Dakota, Tennessee, and West Virginia. Many of IGA’s top ten had simplified the CDC guidance and were focusing on getting the doses they had into the arms of those greatest in need. I was particularly heartened that IGA mentioned the best practices these states had used to earn their place among the top ten.
This was why I had been reaching out to governors, state health officials, and others since the summer. Despite so many people telling me it wasn’t our role to “tell the governors what to do,” for me, it was never about that. It was about learning what was working on the ground. Yes, while in the states, I had said bluntly what I was seeing and how the response could be improved, even when they contradicted what the White House was saying or wanted to believe. But more important, I engaged in productive dialogue, to see what was working and what wasn’t. We accounted for the unique characteristics and needs of each state, each tribal nation, each racial and ethnic group, each college and university community, and spoke about how these best approaches could be adapted to those needs. We learned how this virus operated, how it mutated, and we flexed our approaches and our actions to counter it.
IN THAT LAST WEEK prior to January 20 and the inauguration, I saw the vice president for one of the last times. He called me into his office, thanked me, and told me I should tell the story of the response. Without directly stating it, he was giving me permission to go out and do press hits. I think he understood that what I’d been saying all along, the direction I wanted to take the response, had been the right one. Now, with the transition days away, he and I both wanted to make clear what had worked and what hadn’t.
I agreed to participate in a CNN taping and do a spot on CBS’s Face the Nation. I delivered the same message, expressing hope that past failures would not be repeated and that present successes and solutions would be maximized. I wanted to keep getting the word out. We needed to remain vigilant. We needed to keep learning. We needed to stay in close contact with the states to learn from them.
Unfortunately, the tone of the CNN interview, which wouldn’t air until March 28, 2021, was a familiar one: part of the usual pattern in the media of looking to the past to pin blame rather than the future and the corrective action we had taken based on the lessons we’d learned. I had hoped that my appearing on national television could help point the way to a better future. There was plenty of blame to go around, but there were also solutions found during the Trump administration that shouldn’t be ignored, that needed to be followed, and new interventions to be discovered.
Along with working the phones to contact governors, I spent the days before Christmas and then up to the New Year speaking with colleagues and friends across the United States, and calling in favors, to get the living former U.S. presidents immunized. The past presidents wanted to use footage from their vaccinations, and their famous faces and voices, as part of a broader pro-vaccine ad campaign. The ad campaign they had planned was great. I wanted to ensure the past presidents and the First Ladies got shots in the arms now. I was particularly concerned about the Bushes, the Clintons, and the aged but vibrant Carters. It was important for the past presidents to be at the pending inauguration, especially in the wake of the insurrection. Having past presidents from both parties standing side by side, united as Americans, was important for the public to see. Having them show their bipartisan support and cooperation in action would be important at this perilous moment in our country’s history.
Although Biden’s swearing in would take place outdoors, the president-elect and Jill Biden and the former presidents and First Ladies would be gathered indoors prior to the inauguration, where the virus could be present. The Bushes and Clintons, all outgoing and social, would be interacting with many people that day, so I wanted to be sure they were vaccinated with both doses before January 20. The clock was ticking.
Getting the former presidents and First Ladies their jabs proved to be quite difficult, but I had friends in some of the presidents’ states whom I had met on my travels, and I had support in Texas (the Bushes) and Georgia (the Carters). In particular, New York (the Clintons) was a problem. I tried three different approaches through my colleagues and friends, but each promising lead took me to a dead end. I had run out of ideas when my go-to Jared told me to contact Adam Boehler, who was taking a few days off with his family. Adam, who seemingly knew every hospital organization’s chief executive officer, came through, and within twenty-four hours, days before the New Year, the Clintons were immunized and had added their taped voices to the others’.
This type of behind-the-scenes work always gave me hope. Across the country, I had seen solutions. I had seen red counties and their leadership supporting blue counties, and vice versa. I had seen private-sector leadership focus on solutions, not profits. And I had personally experienced moments when people saw a need and helped.
With the former presidents over age seventy protected from the virus, I took a few hours with my family, cooking a Christmas dinner for less than half of them; an additional son and daughter were in DC, within a few short miles of us. Not letting our guards down, we employed the usual strict practices to protect my daughter, who was eight months pregnant, and my parents, who were in their nineties. There was no communal Christmas dinner for us. Just takeout plates handed outside, just as we’d done at Thanksgiving. Like many Americans, we also opened presents and emptied stockings apart from those who gave them—another family gathering fallen victim to the virus circulating in our community.
TO THE VERY END, I remained inflexible in my determination to do the job I had been assigned. I continued to send out my daily reports, and my team and I sent out our last batch of governor’s reports on Monday, January 18, including in it vaccination reports and distribution recommendations. We again emphasized the importance of sharing information across the states—what was working and what wasn’t.
It was too soon for the inoculated population to have any great effect on the overall numbers, but county by county and state by state, the nation as a whole was stabilizing through the week of January 11. As before, I remained concerned about the most populous states, California, Texas, and New York—we had to ensure that they were at a true plateau and that cases there were on the decline. Between twenty and thirty million people were infected—likely more, as the numbers would never reflect the number of untested asymptomatic.
In my last week, the pattern of good news/bad news continued. I received some heartfelt thank-you emails from people whose work I valued (Jared Kushner, Tony Fauci, Brad Smith, Tucker Obenshain, and Adam Boehler among them).
I had been including in the governor’s reports my concerns about evolving variants expanding here as well as imported variants and to be alert and sequence more. I raised this alert in the governor’s report because I couldn’t get the CDC to expand sequencing. The CDC was not genetically sequencing enough virus samples, which meant it would be easier for new, more virulent strains of SARS-CoV-2 to arise silently and unseen and to spread. I fielded an inquiry from NBC News to shed light on an Ohio State University study that had isolated and identified a new variant of the virus. I wrote back, off the record, giving my assessment and pointing out that I’d already addressed this in a prior governor’s report. I explained that some less-fit mutations made it harder for the virus to replicate, while other, fitter mutations made replication easier and the virus more transmissible. At the time, we didn’t know if this variant had a competitive advantage over the previous one. It had been identified and was still being studied.
I was both encouraged and dismayed by this turn of events. It was good news that the Ohio State researchers had stepped up in terms of genetic sequencing. I still couldn’t understand why the CDC hadn’t: Back in July 2020, we had asked the CDC to expand sequencing and work with Illumina, a private-sector biotechnology company. But the CDC decided that a cooperative effort at the scale I had recommended wouldn’t be needed. They could handle it internally, with their own laboratory and through a few contracts with public health and research labs. With our access to the private sector and additional research laboratories, national capacity was within reach, but taking advantage of the private-sector labs at our disposal was never deemed a priority, as it was in other countries. The United Kingdom was a world leader in genetic sequencing and testing (and remains so to this day), sequencing at a rate nearly ten times that of the United States, so we were forced to rely on them to get this important job done. We didn’t want to be caught flat-footed again.
Even though the United States had more capacity and reach, I often had to rely on other countries for data and answers that we should have had at our fingertips from the outset—whether it was the original mortality and morbidity data that allowed me to warn the elderly and Americans with comorbidities in March 2020, the breadth of asymptomatic spread at universities, the evolution of new strains, or the durability of our vaccines. I could never push the CDC to do the countrywide data collection, the science, to determine mask effectiveness or better understand vaccine hesitancy and how to overcome it.
MY TIME IN THE White House and as a formal civil servant was at an end. I couldn’t at this point even return to my old post at the CDC in any official capacity; I would adapt to my new circumstances.
I was pleased that, in my final daily report on January 18, I was able to say that we were seeing mostly significant improvements. I had wanted to hand over a surge in retreat, and we did. But as I stated earlier in this book, worry is endemic to an epidemiologist’s work.
On January 16, a Saturday, I had to remove all my belongings from my old State Department/Global Ambassador’s office. The building exterior was completely covered in plywood, with a small plywood door on temporary hinges. I was grateful that the guard at the entrance had allowed me, my daughter, and Irum into the building in the first place. Over the next hours, we packed up and carried box after box out to our cars, parked blocks away. The streets were eerily empty.
I decided to take a drive toward downtown DC. I was concerned. The city was one of the metropolitan areas I had had to report as problematic. In advance of the Biden swearing-in ceremony, National Guard troops had arrived from hot spots around the country and were comingling with DC Metro police officers. These troops huddled close together in tents to eat and, sometimes, sleep. After the inauguration, they would return home, and I worried that, in ushering in the new administration, we would create a superspreader event. In my final act, I contacted several members of the new administration to recommend that all National Guard and active-duty troops in DC be tested for the virus.
In far too many ways, we were all being tested. We couldn’t give up hope. We couldn’t stop working. We couldn’t stop learning. We had to stop repeating the mistakes of the past. I was out of the White House, and would soon be out of federal service, but I was definitely not out of the fight.