My back is against the wall. Literally.
I’ve just been ushered into the president’s private dining room. A too large table and a credenza are crammed into the tiny twelve-by-twelve space. Seated at the head of a table, the president dominates this space. His head and chest are visible above stacks and stacks of newspapers. It’s as if he’s behind sandbags in the trenches.
The president barely acknowledges my presence. Staffers hover around him, taking turns leaning in to speak to him. His eyes briefly dart from side to side, then are drawn again to the large TV screen opposite him. My eyes follow his and take in flashes from the four major cable news networks packaged into smaller viewing areas on the screen. He regards them briefly and then picks up his phone to speak with someone. He ends a phone call mid-sentence, asking to be connected to someone else. Not sure where to look, I scan the room for the next few minutes. Oddly, the sound of ice swirling in a glass cuts through the cacophony and draws me back to the president.
It is March 2, 2020. I’ve just flown in overnight from South Africa to take on the role of response coordinator for the White House Coronavirus Task Force, a job I didn’t seek but felt compelled to accept. I’m physically tired but mentally alert. After weeks of urging from Matthew Pottinger—President Trump’s deputy national security advisor, a task force member himself, and the husband of a former colleague and friend of mine—I finally gave in to Matt’s request that I come on board to help with the response to the coronavirus outbreak. I trusted his inside assessment that the administration’s response to date had been meandering and flawed, putting the American people at potential risk.
It wasn’t easy for me to leave my full-time position as the U.S. global AIDS coordinator. I am now dual-hatted, working for both the State Department, continuing my oversight of the President’s Emergency Plan for AIDS Relief (PEPFAR) program, and the White House. Stepping away from the daily execution of PEPFAR at a critical juncture was extremely difficult. Still, I had to go where I was most needed, and this looming public health crisis requires my attention.
I’m not anxious about meeting the president. In my forty years as a civil servant in various capacities in public health and the military, I’ve met and worked with other U.S. presidents, heads of state across the globe, generals, and chief executive officers. I am used to working behind the scenes with critical decision makers. I know how important policies are to public health, and seated across from me is the most important policy maker of the moment.
For more than a month, I’ve been sending back-channel communications to the task force through Matt. In doing so, I hoped to incite a course correction—but those efforts have produced few immediate results. Matt has become increasingly frustrated by the lack of action across the federal government. But I don’t know where the individual members of the task force are compared to where I am. From thousands of miles away, I thought the task force and coordinating agencies were like a duck on water, calm on the surface but paddling furiously underneath—building testing capacity and ensuring that PPE, ventilators, and other equipment were adequately stockpiled. Most important, I believed they were creating the essential data streams to determine where the virus was and where it was going. Matt’s urgent tone made me less certain.
Today I have two primary goals: I want to gauge the president’s sense of urgency and convey to him how strong mine is. I can wait patiently in this meeting, but in a larger sense, none of us can waste one more second. This isn’t PEPFAR, where we have had months, and sometimes years, to move political leaders to enact the policies needed to save lives. Now days, even hours, matter.
I’ve got one shot at this; it had better be a direct hit. I’ve been sharing data about the burgeoning epidemic for weeks with the White House, through Matt. The message hasn’t been getting through. I believe that the president, as a businessman, will be persuaded by the figures, will appreciate a bottom-line number. But will he be able to comprehend the numbers I am seeing now? They are at odds with what most others are forecasting. Things are much worse than he likely believes. This administration has been trying to downplay the seriousness of the virus. I wonder what the president has been told.
Has he been briefed on the level of asymptomatic silent spread? Does he understand that the majority of cases can be detected only by testing and not by symptoms? Has it been made clear to him that the virus is undoubtedly already circulating widely, below the radar, in the United States?
I’ve been reading and hearing messages coming out of the White House and the federal health agencies that the virus can be contained, that there are systems in place to isolate it and prevent it from spreading. The bearers of these messages seem adamant that this virus’s spread will be visible, that they will be able to contain the virus by merely identifying those people with symptoms and isolating them and those to whom they’ve been exposed. The belief is that if they do these things, the disease itself will be, in their estimation, no more a threat than the annual version of the flu.
They are wrong.
This virus is not flu-like. It’s not behaving or spreading in ways that mimic the seasonal flu. This virus cannot be tracked and traced only through finding those with symptoms. That may have worked for the seasonal flu or even pandemic flu, but it will not work for this virus, one that is clearly much more deadly than the seasonal flu.
If the Centers for Disease Control and Prevention, our premier public health agency, seemingly hasn’t been able to grasp this concept of silent spread, how can a layman, a real estate developer by trade, be expected to? In part, I get it. I’ve seen this cocktail of confusion, bias, and denial in the public health agencies before. I’ve also seen the devastation that viruses mete out. HIV, SARS-CoV-1, MERS-CoV, Ebolavirus—I’ve been on the front lines and have worked with many other experts in the field as the world navigated these public health crises. Handling infectious diseases ranging from tuberculosis to AIDS has been inherently political, throughout history and now.
As president, you don’t have the luxury of focusing on only one thing at a time. Yet, the presidents I served under before, George W. Bush and Barack Obama, had the ability to shift gears and direct their focused attention in a way President Trump has not.
I’m not going to get him to change.
I have to change my approach.
Experience has taught me that you have to meet people where they are. It helps if they’re willing to greet you, but I’m being held at a distance, even in this small room. I can feel it. It is a palpable presence overcrowding an already crowded, noisy room. What’s the one thing I can say that will span this distance, be heard above the buzz and hum of this private dining room?
Then the president is making a few brief remarks to the room, welcoming me. Finally, I get a chance to speak with him.
“Mr. President. This is not the flu. This is far more serious than the flu. We have to shape our response differently.”
He holds up his hand. He smiles that glib grimace of a smile.
I stop speaking. This is my commander in chief.
“Well, the people I’m talking to say that this isn’t going to be any worse than the flu,” he says.
“Mr. President, I don’t know who you are speaking with, but I have evidence to fully support the conclusion that this outbreak is not going to be like the seasonal flu or even pandemic flu. This virus is very deadly.”
“Well, these are good people. Smart people. I trust these people. They know what they’re saying.”
I reiterate my position. He nods. His eyes return to his television screens. He reaches for a remote control, and the voice of someone at Fox News enters what passed for a conversation between us.
Sources tell us that . . .
I don’t hear the rest. Someone takes a few steps toward me and gestures toward the door. I’ve had less than thirty seconds to speak with the president.
My mind shifts gears to the afternoon meeting ahead, which the president will be attending. I’ll be there with select task force members and, critically, the biotech and pharmaceutical companies. This will be my first opportunity to see where we are in the development of effective treatments and vaccines.
Will they be given short shrift like I was? “Short shrift.” Historically, the expression refers to the time between confession and execution.
It’s as fitting an expression as any for what I’m up against—indeed, what we all are.