WASHINGTON – It was a warm summer Wednesday, election day was just around the corner, and President Trump was even angrier than usual as he focused tirelessly on the coronavirus pandemic.
“You’re killing me! The whole thing is! We all have goddamn cases,” shouted Mr. Trump Jared Kushner, his son-in-law and senior adviser, during a best-helpers meeting in the Oval Office on Aug. 19. “I want to do that what Mexico does. They won’t give you a test until you go to the emergency room and you vomit. “
Mexico’s record for fighting the virus was hard to emulate for the United States. But for a long time the president had seen testing not as an important way to track down and contain the pandemic, but rather as a mechanism that makes it look bad by increasing the number of known cases.
And that day he was especially angry after being told by Dr. Francis S. Collins, director of the National Institutes of Health, had been informed that it would be days before the government could issue emergency approval for the use of convalescent plasma for treatment. something Mr. Trump was dying to promote as a personal victory for the Republican National Convention the following week.
“You are Democrats! You are against me!” He was convinced that the best doctors and scientists in the government had conspired to undermine him. “You want to wait!”
During late summer and fall, in the heat of a re-election campaign he was about to lose, and in the face of mounting signs of spikes in infections and deaths far worse than the spring, Mr. Trump’s management of The Crisis was – unstable, unscientific, and shaped by politics all year round – was reduced to a single question: what would that mean for him?
The result was a lose-lose situation, according to interviews with more than two dozen current and former administrators and others who have been in contact with the White House. Not only was Mr. Trump defeated by Joseph R. Biden Jr., but he missed his chance to show that he could rise to the moment in the final chapter of his presidency and face the crucial challenge of his tenure.
The efforts of his aides to convince him to encourage the wearing of masks are among the easiest and most effective methods of containing the spread of the disease. His conviction that his political base would rebel against anything that restricted their personal freedom was shattered. Even the opposite poll data from his own campaign couldn’t influence him.
His explicit call for a vaccine by Election Day – a push that came to a head at a controversial Oval Office meeting with senior health workers in late September – became a misguided replacement for warning the nation that social distancing and other mitigation efforts were not being followed would add to a slow disaster this winter.
His concern? That the man he called “Sleepy Joe” Biden and who led him in the polls would get a vaccine, not him.
Government public health experts were welcomed by the arrival of Dr. Scott W. Atlas, Stanford professor of neuroradiology hired after appearing on Fox News, was all but silenced in August.
With Dr. Deborah L. Birx, the coordinator of the White House Virus Task Force, which was declining and often on the move, became Dr. Atlas the only doctor Mr Trump listened to. His theories, which some scientists have viewed as verging on the nut, were exactly what the president wanted to hear: the virus is exaggerated, the number of deaths is exaggerated, testing is overrated, bans do more harm than good.
As the gulf between politics and science widened, the dispute that Mr Trump had been able to allow from the start widened to plague the government’s response. Dismissal threats worsened the leadership vacuum as key figures undercut each other and distanced themselves from responsibility.
The administration had some positive stories to tell. Mr. Trump’s vaccine development program, Operation Warp Speed, had helped fuel the pharmaceutical industry’s remarkably rapid strides in developing several promising approaches. Two highly effective emergency vaccines should be approved by the end of the year, which gives hope for 2021.
The White House declined any suggestion that the president’s response fell short, saying it had worked to provide adequate testing, protective equipment and hospital capacity, and that the vaccine development program had succeeded in record time.
“President Trump has led the largest public and private sector mobilization since World War II to defeat Covid-19 and save lives,” said Brian Morgenstern, a White House spokesman.
But Mr. Trump’s unwillingness to put aside his political self-centeredness when Americans are dying by the thousands every day, or to take the steps necessary to deal with the crisis, remains confusing even to some administrators. “Making masks a cultural war theme was the dumbest thing you can imagine,” said a former senior adviser.
His own battle with Covid-19 in early October made him extremely ill and dependent on care and medication unavailable to most Americans, including a still-experimental monoclonal antibody treatment, and he saw firsthand the disease through the White House and some of them passed his close allies.
His instinct, however, was not to view this experience as a learning moment or opportunity for empathy, but rather as a chance to portray himself as the Superman who had conquered the disease. On the contrary, his own experience, he assured a lot in the White House Just a week after he was hospitalized: “It’s going to go. It’s going to go.”
Weeks into his own recovery, he would still be complaining about the nation’s preoccupation with the pandemic.
“Everything you hear is Covid, Covid, Covid, Covid, Covid, Covid, Covid, Covid, Covid, Covid, Covid,” said Trump during an election freeze and uttered the word eleven times.
In the end, he couldn’t escape.
“The base will revolt”
In late July, new cases hit record highs, defying Mr Trump’s predictions in the spring that the virus was under control and deaths were rising alarmingly. Herman Cain, a 2012 Republican presidential candidate, died of the coronavirus. in the previous month he had attended a Trump rally without a mask.
After the pandemic defined the campaign, Tony Fabrizio, the president’s lead poller, came to a meeting at the Oval Office in the middle of the summer to make a surprise case: this mask was acceptable to wear even among Mr. Trump’s supporters.
Mr. Trump’s advisors stood in front of the Resolute Desk when Mr. Fabrizio presented the figures. According to his research, some of which were reported by the Washington PostVoters believed the pandemic was bad and was getting worse. They were more concerned about getting sick than about the impact the virus had on their personal financial situation. The president’s approval rating for dealing with the pandemic had hit new lows, and just over half the country did not think he was taking the situation seriously.
What sparked the debate that day, however, was Mr Fabrizio’s finding that over 70 percent of voters in the states targeted by the campaign were in favor of wearing masks in public, at least indoors, including the majority of the Republican.
Mr Kushner, who, along with Hope Hicks, another top advisor, had been trying for months to convince Mr Trump that masks can be portrayed as the key to regaining the freedom to safely go to a restaurant or sporting event. a “child’s play” wear.
Mr. Kushner had reason to be optimistic. Mr. Trump had agreed to wear one for a visit to Walter Reed National Military Medical Center shortly before after finding one that he believed looked good in: dark blue with a presidential seal.
But White House chief of staff Mark Meadows – backed by other aides including Stephen Miller – said the policy for Mr. Trump was devastating.
“The base is going to revolt,” said Mr. Meadows, adding that he wasn’t sure Mr. Trump could definitely make it legally.
That was all Mr. Trump needed to hear. “I don’t do a mask mandate,” he concluded.
Other than being sick, he was rarely seen in a mask again.
The president had other ways to show leadership instead of putting his political assets first.
With a coronavirus vaccine spreading out of the US, here are answers to some questions you may be wondering about:
- If I live in the US, when can I get the vaccine? While the exact order of vaccine recipients may vary from state to state, most doctors and residents of long-term care facilities will come first. If you want to understand how this decision is made, this article will help.
- When can I get back to normal life after the vaccination? Life will not return to normal until society as a whole receives enough protection against the coronavirus. Once countries approve a vaccine, they can only vaccinate a few percent of their citizens in the first few months. The unvaccinated majority remain susceptible to infection. A growing number of coronavirus vaccines show robust protection against disease. However, it is also possible for people to spread the virus without knowing they are infected because they have mild or no symptoms. Scientists don’t yet know whether the vaccines will also block the transmission of the coronavirus. Even vaccinated people have to wear masks for the time being, avoid the crowds indoors and so on. Once enough people are vaccinated, it becomes very difficult for the coronavirus to find people at risk to become infected. Depending on how quickly we as a society achieve this goal, life could approach a normal state in autumn 2021.
- Do I still have to wear a mask after the vaccination? Yeah, but not forever. Here’s why. The coronavirus vaccines are injected deep into the muscles and stimulate the immune system to produce antibodies. This seems to be sufficient protection to prevent the vaccinated person from getting sick. However, it is unclear whether the virus can bloom and sneeze or exhale in the nose to infect others, even if antibodies have been mobilized elsewhere in the body to prevent the vaccinated person from getting sick. The vaccine clinical trials were designed to determine whether vaccinated people are protected from disease – not to find out whether they can still spread the coronavirus. Based on studies of flu vaccines and even patients infected with Covid-19, researchers have reason to hope that people who are vaccinated will not spread the virus, but more research is needed. In the meantime, everyone – including those who have been vaccinated – must imagine as possible silent shakers and continue to wear a mask. Read more here.
- Will it hurt What are the side effects? The vaccine against Pfizer and BioNTech, like other typical vaccines, is delivered as a shot in the arm. The injection in your arm feels no different than any other vaccine, but the rate of short-lived side effects seems to be higher than with the flu shot. Tens of thousands of people have already received the vaccines, and none of them have reported serious health problems. The side effects, which can be similar to symptoms of Covid-19, last about a day and are more likely to occur after the second dose. Early reports from vaccine trials suggest that some people may need to take a day off because they feel lousy after receiving the second dose. In the Pfizer study, around half developed fatigue. Other side effects occurred in at least 25 to 33 percent of patients, sometimes more, including headache, chills, and muscle pain. While these experiences are not pleasant, they are a good sign that your own immune system is having a strong response to the vaccine that provides lasting immunity.
- Will mRNA vaccines change my genes? No. Moderna and Pfizer vaccines use a genetic molecule to boost the immune system. This molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse with a cell, allowing the molecule to slide inside. The cell uses the mRNA to make proteins from the coronavirus that can stimulate the immune system. At any given point in time, each of our cells can contain hundreds of thousands of mRNA molecules that they produce to make their own proteins. As soon as these proteins are made, our cells use special enzymes to break down the mRNA. The mRNA molecules that our cells make can only survive for a few minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a little longer, so the cells can make extra viral proteins and trigger a stronger immune response. However, the mRNA can hold for a few days at most before it is destroyed.
After recovering from his battle with the virus, some of his top aides, including Mr. Kushner and Jason Miller, a senior campaign strategist, believed that the disease offered an opportunity to show compassion and determination over the aftermath of the pandemic who have favourited Mr. Trump hadn’t shown it before.
When Mr Trump returned from the hospital, his communications assistants, with the help of Ivanka Trump, his daughter, urged him to provide a national address where he would say, “I had it. It was tough, it kicked my ass, but we’re going to make it. “
He declined and instead opted for a boisterous rally from the White House balcony overlooking the South Lawn.
It never occurred to Mr Trump that he had a responsibility to be a role model, let alone that his leadership role might require him to publicly acknowledge harsh truths about the virus – or even to stop insisting that they do Problem not a rampage was pandemic, but too many tests.
Alex M. Azar II, the secretary for health and human services, briefed the president this fall about a Japanese study documenting the effectiveness of face masks and said, “We have the evidence. They work. ”But the President resisted, criticizing Mr. Kushner for pushing them and again blaming too many tests – an area Mr. Kushner helped oversee – for its problems.
“I’m going to lose,” Trump told Kushner during the preparations for the debate. “And it will be your fault for the tests.”
Mr. Morgenstern, the White House spokesman, said the exchange between the President and Mr. Kushner “never took place”.
Mr Azar, who was sometimes one of the few to wear a mask at White House events, privately lamented an anti-mask political culture established by Mr Trump. At Christmas parties in the White House, Mr. Azar asked maskless guests to withdraw from him.
Departments and disagreements
The decision to channel the government’s response out of the west wing was made in the early days of the pandemic. The idea was to break down barriers between different authorities, pool expertise in the field of public health and encourage quick and coordinated decision-making.
It didn’t work out that way, and in the autumn the consequences were clear.
Mr Trump had always condoned, if not encouraged, clashes among subordinates, a tendency that in this case only led to political paralysis, confusion about who was responsible, and the lack of a clear, consistent message about how to reduce the risks of the pandemic can led.
Keeping decision-making power close to him was another feature of Trump, but in this case the myriad decisions the government faced were also raised to the level of the president, the process blocked in infighting, the political stakes raised and Aides encouraged to seek favor with Mr. Trump.
The result was, at times, a system-wide error that went well beyond the President.
“What we needed was a coordinated response that included input from multiple agencies,” said Dr. Scott Gottlieb, who was Commissioner for the Food and Drug Administration for the first two years of the Trump administration.
“Somebody had to get it all together early,” he said. “It wasn’t the White House’s job either. It had to be closer to the agencies. It didn’t happen in testing or a lot of other things.”
The relationship between Mr. Azar and Dr. Stephen M. Hahn, Commissioner of the Food and Drug Administration, became increasingly tense; At the beginning of November they communicated only by text and in meetings.
Dr. Birx had lost the clout she enjoyed at the start of the crisis and spent much of the summer and fall advising governors and state health officials.
Mr. Meadows disagreed with almost everyone when he tried to impose the will of the President on scientists and health professionals. In conversations with senior health officials, Mr. Meadows railed against regulatory “bureaucrats” who he believed were more interested in processes than outcomes.
Some of the task force doctors, including Dr. Anthony S. Fauci and Dr. Robert R. Redfield, hesitated to show up at the White House in person, fearing that disdain for wearing masks and social distancing would leave them at risk of infection.
Vice President Mike Pence was nominally in charge of the task force, but was so cautious about dealing with Mr. Trump as they were fighting for re-election that he became almost invisible, at least in public.
The debates in the White House increasingly revolved around Dr. Atlas, who had no formal training in infectious diseases, whose views – as Mr. Trump saw him represented on Fox News – appealed to the president’s belief that the crisis was over.
His arrival at 1600 Pennsylvania Avenue was a mystery in itself. Some aides said he was spotted by White House press secretary Kayleigh McEnany. Others said John McEntee, the president’s chief of staff, had googled for a Trump-friendly doctor who would be loyal.
Marc Short, Mr. Pence’s chief of staff, declined to hire Dr. Atlas off. But when the President and his team brought him in, Mr. Short insisted that Dr. Atlas takes a seat at the task force table, hoping not to turn him into yet another internal – and destructive – critic.
Once inside, Dr. Atlas set up an office in the west wing to shape the response. During a meeting in early fall, Dr. Atlas that college students were not at risk for the virus. We should let her go to school again, he said. It’s not a problem.
Dr. Birx exploded. What aspect of the fact that you can be asymptomatic and still spread it do you not understand? she demanded. You may not die, but you can give it to someone to die from. She was angry.
“Your strategy will literally cost us lives,” she yelled at Dr. Atlas on. She attacked Dr. Atlas’ ideas in daily emails she sent to high-ranking officials. And she was aware of a pact she had made with Dr. Hahn, Dr. Fauci and Dr. Redfield closed before Dr. Atlas came aboard: they would stick together if one of them was fired for doing what they thought was right.
Health officials often struggled to find an audience in the upper reaches of the west wing. At a task force meeting in mid-November You warned Mr. Meadows terribly about the impending wave in cases intended to devastate the country. Mr. Meadows requested data to support their claim.
One outcome of the meeting was a press conference on November 19 on the dire threat posed by the virus, the first in many weeks. But while Mr. Pence, who led the briefing, often urged Americans to “do their part” to slow the spread of the virus, he never directly questioned Mr. Trump’s hesitation about masks and social distancing. Speaking at the meeting, he said that “decision-making at the local level” is key and continues a long pattern of administration that seeks to shift responsibility to states.
Mr Azar had already been excluded from key decisions in February when Mr Pence took over the task force. Mr. Azar complained to his staff that Mr. Pence’s staff and task force members were walking around him giving orders to his subordinates.
As Mr. Azar pondered his job status, he found an opening that offered some sort of relief, drawing his attention to Operation Warp Speed, the government’s efforts to support the rapid development of a vaccine, and through the summer and fall Praise Mr. Trump and credit him with almost every advance payment.
Behind the scenes, Mr. Azar portrayed Dr. Hahn in the White House as the beating manager – a complaint he also made about Dr. Redfield expressed. In late September he announced to the White House that he was ready to meet Dr. Hahn to dismiss, so the officials familiar with the offer.
Dr. Hahn, Dr. Redfield, Dr. Birx and other senior health officials saw in Mr Azar the moral of the authorities he oversees as he tried to evade guilt for a worsening crisis and promote his own image publicly and with the White House.
Task Force health officials brought their complaints about Mr. Azar to Mr. Pence’s office several times, hoping for intervention.
Caitlin B. Oakley, a spokeswoman for Mr. Azar, said he had “always advocated balanced, scientific public health information and insisted that science and data guide decisions.”
When Dr. Desperate to visit the White House, Hahn was disillusioned with his efforts to politicize the work of the Food and Drug Administration and eventually shied away from the task force meetings because he feared his testimony would run out there.
If there was a bureaucratic winner in that cage game in the west wing, it was Dr. Atlas.
He told Mr Trump that the right way to think about the virus is by how much “excess mortality” is above what would have been expected without a pandemic.
Mr Trump took up the idea, often telling helpers that the actual number of deaths was no more than 10,000 people.
As of Thursday, 342,577 Americans had died from the pandemic.
Trump vs. Vaccine Regulators
In an Oval Office meeting with senior health officials on September 24, the president made it clear what he had long implied: he wanted a vaccine before the election, according to three people who witnessed his request.
Pfizer’s CEO had encouraged the belief that the company could deliver results by the end of October. But Mr. Trump’s aides tried in vain to make it clear that they couldn’t completely control the timing.
Dr. Fauci and Dr. Hahn reminded officials of the west wing that the results of one company’s vaccine trials were a “black box” that was only revealed when it was revealed by an independent monitoring body. A vaccine that did not go through the usual strict government approval process would be a “Pyrrhic victory,” said Azar. It would be a shot that no one would take.
Dr. Moncef Slaoui, the scientific director of Operation Warp Speed, said the president never asked him to deliver a vaccine on a schedule. But he said Mr. Trump had sometimes complained in meetings that “it wouldn’t happen until the election and it will be” Sleepy Joe “” who would ultimately get recognition.
In late October, science and regulations worked against Mr Trump’s dwindling hopes for good news ahead of Election Day. At the F.D.A. Scientists had refined the standards for approving an emergency vaccine. And at Pfizer, executives realized that the agency was unlikely to approve their vaccine because of fewer Covid-19 cases among their volunteers in clinical trials.
They decided to wait for more dates, a delay of up to a week.
When Pfizer announced on November 9 – two days after Mr Biden won his victory – that its vaccine had been an amazing success, Mr Trump was furious. He suggested the company, Dr. Hahn and the F.D.A., accusing the Deep State Regulators of conspiring with Pfizer to slow down approval until after the election.
The president’s frustration with the pace of regulatory action would linger well into December as the F.D.A. went through a time-consuming process to evaluate the Pfizer data and then the second vaccine manufacturer Moderna.
On December 11th, Mr. Meadows exploded during a morning call with Dr. Hahn and Dr. Peter Marks, the agency’s lead vaccine regulator. He accused Dr. Hahn of mismanagement and suggested they step back, then slammed down the phone. That night the F.D.A. authorized the Pfizer vaccine.
In the weeks that followed, Mr. Pence, Mr. Azar, Dr. Fauci and other health officials up their sleeves to get vaccinated for the cameras.
Mr Trump, who declared himself immune under the contract with Covid-19, has not announced any plans for vaccination.
Michael D. Shear, Noah Weiland, Sharon LaFraniere and Mark Mazzetti reported from Washington, and Maggie Haberman from New York. Katie Thomas contributed to reporting from Chicago.