The rising corona virus finds a vacuum in the federal leadership

WASHINGTON – When senior Food and Drug Administration officials made their morning call one day this week, they received a sobering warning from the agency’s chief, Dr. Stephen M. Hahn, who had just spoken to the White House on the phone, “block out all the craziness” going on and stay focused on fighting the pandemic, he said.

There are lots of distractions. President Trump is pushing for election results to be turned upside down, and his only public remarks about the coronavirus in recent days has been to make it clear that good news about a vaccine didn’t come in until after election day – even at the average number New daily infections topped 123,000, the average daily deaths topped 1,000, and Covid-19 hospital admissions hit a record high of 61,964.

Vice President Mike Pence canceled a vacation at the last minute when virus numbers worsened, but the White House coronavirus task force he leads has been largely silent. Mark Meadows, the White House chief of staff infected with the virus, stated last month “We are not going to control the pandemic” and said the focus should instead be on the longer-term goals of vaccine and treatment development.

(White House Political Director Brian Jack was the youngest government official to test positive for the virus. Two people familiar with the diagnosis, revealed on Wednesday, attended a White House election night along with three other officials who have since tested positive, Mr. Meadows, Ben Carson, the housing secretary, and David Bossie, an adviser to Mr. Trump.)

Meanwhile, the Strategic National Stockpile, the country’s emergency reserve, has only 115 million N95 masks, far less than the 300 million the government amassed by the winter, counteradministrator John Polowczyk, who was in command of the national supply chain on Monday retired, said in a recent interview, although he added that the government is continuing to expand its supply of protective equipment.

The pandemic hit the nation flat in March, but epidemiologists have been warning of an autumn and winter wave for months as people are driven indoors, schools resume their personal classes, and Americans are tired of months of precautionary measures. However, the lack of personal protective equipment is back, especially in rural hospitals, nursing homes and private medical practices that lack access to the supply networks that serve larger hospital chains.

Dr. Shikha Gupta, the managing director of Get us PPE, According to a voluntary campaign to adjust supplies available to healthcare providers, 70 percent of those who asked for help from the organization in the last month said they ran out of critical equipment. Masks, gloves, and disinfectant wipes were high on the list.

“Health care workers are exhausted and frustrated, and it’s really hard to believe November 10th will feel like mid-March again,” she said. “We have the highest number of cases we have ever seen and we have the same problems we have since day 1.”

The governors and large hospital chains are again competing for scarce equipment. Nursing homes are struggling with staff shortages, which means that hospitals are no longer able to release patients into their care. So serious is the situation in Wisconsin that health officials are considering a plan to train family members of nursing home residents to work in facilities that are short of manpower.

“We blame the state for every idea we can think of, but we really need bold action by the federal government,” said John Sauer, president of LeadingAge Wisconsin, an association that represents nonprofit nursing homes and long-term care facilities. “We can’t mess this up on our own.”

The United States is a little better off now than it was in the earliest days of the pandemic. States and hospitals have their own inventory, and Admiral Polowczyk said the federal government has achieved its goal of acquiring 153,000 ventilators.

But as the country enters what is perhaps the most intense phase of the pandemic, the Trump administration remains largely decoupled. President-elect Joseph R. Biden Jr. is trying to take on a leadership cloak by appointing a coronavirus advisory board and urging all Americans to wear masks. Until his inauguration on January 20, however, he lacks the authority to mobilize a response from the federal government.

“Two jumbo jets fall from the sky, killing 1,000 a day,” said Dr. Carlos del Rio, an infectious disease specialist at Emory University, the Dr. Deborah L. Birx, the White House’s coronavirus response coordinator. “If two jumbo jets fell from the sky every day and killed them all, don’t you think everyone would panic? But somehow we don’t. Somehow we are not outraged as a nation.”

“We need a Churchill,” he added. “We need someone to step into the vacuum and lead the nation.”

A White House spokesman Brian Morgenstern said Trump and his administration “remain focused on saving lives,” referring to their efforts to make a vaccine and therapeutics. He added that the task force “is in constant contact with state and local officials” to provide assistance when needed.

But Mr Trump is at war with his own health officials. He was furious after drug maker Pfizer announced Monday that early data from clinical trials suggested its coronavirus vaccine was more than 90 percent effective. In a conversation with Dr. Hahn, a senior administrative official said the president accused the company and the F.D.A. conspiring to delay news that might have increased his chances of re-election.

Aides said the president believed Pfizer could have announced the success of its clinical trial before Nov. 3, but made a conscious decision to hold off the news and possibly not tarnish the company’s vaccine at the last minute to kill the Offer to save re-election of Mr Trump. White House staff were particularly outraged that Mr Biden publicly said his public health advisors knew of Pfizer’s findings on Sunday before staff said the news had reached the White House.

Beyond Mr. Trump’s Twitter feed, the federal bullying pulpit – an essential part of an effective infectious disease response – has largely fallen silent. Dr. Anthony S. Fauci, the government’s leading infectious disease expert, said in an interview Tuesday that the vaccine would be “a game changer” over time.

A vaccine is not an immediate panacea, however, and by the time the doses are widely available – likely by mid-2021 – the nation is in a “difficult situation” where Americans are being told to wear masks and social distancing and avoid overcrowding attitudes especially indoors.

“My message to the American public is: wait, help is coming, a vaccine is on the way, we all have to pull ourselves together,” said Dr. Fauci.

Washington’s lack of leadership is causing fear in states and cities.

“We are in dire straits as we head into the fall and winter,” said Casey Katims, federal liaison officer for Washington State Governor Jay Inslee.

New York City Governor Andrew M. Cuomo said Wednesday that private indoor gatherings are limited to 10 people nationwide and that gyms, bars and restaurants must close at 10 p.m. every night.

Maryland cut the indoor dining limit to 50 percent capacity on Wednesday and limited indoor gatherings to 25 people.

In Ohio, Governor Mike DeWine, a Republican, canceled his usual Tuesday afternoon virus press conference and instead planned to give a nationwide address as local officials early Wednesday evening reported a daily case number of more than 6,500 – Almost 1,000 more than Saturday’s record.

North Dakota Governor Doug Burgum said this week that state hospitals were full and that even health workers who tested positive for the virus but showed no symptoms are allowed to work on wards dedicated to coronavirus patients.

“Leadership is important,” said Dr. Howard Markel, a professor of history of medicine at the University of Michigan who helped shape federal social distancing policy during the George W. Bush administration. “What your leaders do, like flaunting the mask or throwing parties without a mask, almost encourages people to do the same.”

Dr. del Rio said federal health officials like Minister of Health Alex M. Azar II or Dr. Robert R. Redfield, director of the Centers for Disease Control and Prevention, must begin holding daily press conferences to provide public health guidelines.

In the absence of guidance, local officials feel like they are fighting alone. According to R. Tamara Konetzka and Rebecca J. Gorges, University of Chicago researchers who analyzed the data from, new weekly cases among nursing home residents quadrupled from late May to late October, and deaths increased in 20 states than doubled the CDC

“The depressing news is that not much has changed since spring,” said Professor Konetzka.

Even many large hospital chains that claim they have adequate medical care continue to operate in crisis mode. This often means that employees have to repeatedly reuse the respirators, which must be disposed of after each use.

Deborah Burger, a president of National Nurses United, the largest organization of registered nurses, said the C.D.C. had allowed hospitals to create their own standards for the reuse of single-use protective equipment, putting hospital workers and patients at increased risk of infection.

“We have been in the pandemic for 11 months and the administration is still not adequately addressing the safety of health workers and the safety of our communities,” she said. “I’ve been a nurse for over 45 years and I’ve never seen anything like it. It’s like we’re in the Twilight Zone.”

The White House has focused on Operation Warp Speed, the government’s crash vaccine and therapy development program, while the Coronavirus Task Force has reduced to weekly meetings in the Situation Room. But far from celebrating the Pfizer news on Monday, the government launched a round of allegations.

in the a Twitter message on MondayMr Trump said that Pfizer deliberately postponed announcing its good news and that the F.D.A. had supported this delay.

In a meeting of the coronavirus task force on Monday afternoon, Mr. Azar confronted Dr. Hahn with the announcement from Pfizer, saying the FDA’s coordination with Pfizer and their comprehensive vaccination guidelines had delayed news of the breakthrough, according to senior government officials who witnessed the exchange.

He introduced Dr. Hahn’s schedule for an emergency approval of the Pfizer vaccine in question.

The President’s allies suspected Pfizer could have obtained results from its process earlier, but decided against it. In fact, Pfizer originally planned to request the results from an independent safety oversight committee once 32 of its clinical trial participants who received either the vaccine or a placebo received Covid-19. This would have been the company’s first barometer of its effectiveness.

But weeks ago, Pfizer officials said F.D.A. Regulators had indicated that they were unlikely to issue emergency approval for Pfizer’s vaccine based on just 32 cases in a trial involving nearly 44,000 people.

Pfizer decided to wait for more cases. By last weekend, 94 subjects had tested positive for Covid-19, a sample that appeared to be more than sufficient to get the F.D.A. The company said early analysis showed the vaccine was more than 90 percent effective.

Pfizer has announced that it will apply for an emergency permit by the end of November, and experts expect the F.D.A. to be decided in mid-December. But Pfizer has said it made only a few million doses, and experts hope the government can step in to speed up manufacturing. A second vaccine manufacturer, Moderna, may soon have F.D.A. review the results of clinical trials. request.

On Monday the F.D.A. Eli Lilly granted emergency approval for antibody treatment similar to therapy that Mr. Trump was given shortly after he contracted the coronavirus. The company has a limited number of doses and the treatment is only approved for newly infected patients who have not been hospitalized.

Some in the agency took Dr. Hahn’s Tuesday warning to his senior officials of “madness” as a sign that the president might fire him. Others said the commissioner only acknowledged the obvious: the by-election period would be difficult.

Sheryl Gay Stolberg, Sharon LaFraniere and Noah Weiland reported from Washington and Andrew Jacobs from New York. The coverage was contributed by Maggie Haberman and Jo Becker from New York, Katie Thomas from Chicago and Sheila Kaplan from San Francisco.