Nightmare Scenario

Inside the Trump Administration's Response to the Pandemic That Changed History

Yasmeen Abutaleb, Damian Paletta

• Publisher: Harper
• Year: 2021
• ISBN:
  9780063066076
• Topic: Politics & International Relations
• Subtopic: Public Policy
• Index: Politics & International Relations

Instant #1 New York Times and Wall Street Journal bestseller

From the Washington Post journalists Yasmeen Abutaleb and Damian Paletta—the definitive account of the Trump administration's tragic mismanagement of the COVID-19 pandemic, and the chaos, incompetence, and craven politicization that has led to more than a half million American deaths and counting.

Since the day Donald Trump was elected, his critics warned that an unexpected crisis would test the former reality-television host—and they predicted that the president would prove unable to meet the moment. In 2020, that crisis came to pass, with the outcomes more devastating and consequential than anyone dared to imagine.Nightmare Scenario is the complete story of Donald Trump's handling—and mishandling—of the COVID-19 catastrophe, during the period of January 2020 up to Election Day that year. Yasmeen Abutaleb and Damian Paletta take us deep inside the White House, from the Situation Room to the Oval Office, to show how the members of the administration launched an all-out war against the health agencies, doctors, and scientific communities, all in their futile attempts to wish away the worst global pandemic in a century.

From the initial discovery of this new coronavirus, President Trump refused to take responsibility, disputed the recommendations of his own pandemic task force, claimed the virus would "just disappear, " mocked advocates for safe-health practices, and encouraged his base and the entire GOP to ignore or rescind public health safety measures. Abutaleb and Paletta reveal the numerous times officials tried to dissuade Trump from following his worst impulses as he defied recommendations from the experts and even members of his own administration. And they show how the petty backstabbing and rivalries among cabinet members, staff, and aides created a toxic environment of blame, sycophancy, and political pressure that did profound damage to the public health institutions that Americans needed the most during this time. Even after an outbreak in the fall that swept through the White House and infected Trump himself, he remained defiant in his approach to the virus, very likely costing him his own reelection.

Based on exhaustive reporting and hundreds of hours of interviews from inside the disaster zone at all levels of authority, Nightmare Scenario is a riveting account of how the United States government failed its people as never before, a tragedy whose devastating aftershocks will linger and be felt by generations to come.

Part I

Chapter 1

The Invisible Enemy

January 24, 2020

CONFIRMED US COVID-19 CASES: 2

CONFIRMED US COVID-19 DEATHS: 0

Alex Azar quietly backed out of the Oval Office and then sprinted across the West Wing, trying to outrun President Trump’s tweet. The fifty-two-year-old health and human services secretary burst into national security advisor Robert O’Brien’s White House workroom. “Robert, you’ve got to stop this,” Azar told him. “You can’t let him tweet praising President Xi. It’s premature. It’s not accurate. We can’t do this.”

Just minutes earlier, Azar had sat across the Resolute Desk from Trump, hoping to finally convince him that the new virus in China was a major problem. “Mr. President, this is really bad,” he had said. “This is getting really bad in China, and this is coming to us.”

Azar stressed that the Department of Health and Human Services and the White House National Security Council were doing everything they could to prevent the virus from spreading in the United States. He ticked off what the Centers for Disease Control and Prevention and other agencies had already done: they were screening travelers, working to bring home Americans from China. But the virus was presenting an enormous challenge.

Trump paused. “Well, how’s China being?” he had asked Azar. “Are they cooperating?”

The answer was more complicated than what Trump wanted to hear. Yes, Azar explained, China was cooperating somewhat. It was doing more than it had done during the SARS outbreak in 2003, when it had concealed virtually all information about the outbreak for months. But that was a low bar. The Chinese still wouldn’t let the CDC enter Wuhan to understand the outbreak. They weren’t sharing samples of the virus with the United States that would allow scientists to study it and accelerate the development of diagnostics and treatments. Without the CDC on the ground, the US government had little visibility into what was actually happening and what the risks were. They couldn’t understand how it was spreading and how aggressive it was. All they had were half-truths from the Chinese government, which was already silencing Chinese doctors and citizens who were trying to speak out.

Trump thought out loud, “I’m going to put out a tweet praising Xi.”

“For the love of God, don’t do that,” Azar responded immediately.

The United States needed to squeeze China for more cooperation. If President Xi Jinping thought Trump was happy with the way things were going, China would clam up, feeling it had fulfilled its obligations with the tiny bits of information it had put out. The proposed tweet would be a huge gift that Xi didn’t deserve and that would only further empower the Chinese president.

But Trump wanted to butter Xi up. The two countries had signed a trade deal just nine days earlier, and Trump saw the economic pact as critical to his reelection. He thought China was going to purchase tens of billions of dollars’ worth of soybeans and corn, which would help him lock up political support in midwestern states.

Brushing aside Azar’s protests, Trump summoned his social media guru, Dan Scavino, to begin drafting the tweet. When Scavino entered the Oval Office, Azar took the opportunity to duck out. And run.

When O’Brien heard what was happening, he dropped what he was doing and rushed into the Oval Office. Azar stopped for a moment. Who else could he get to intervene? Mike Pompeo!

Secretary of State Pompeo was also in the West Wing that day, and Azar rushed to find him to deliver the same message. But by the time he made it back to the Oval Office, it was too late; the tweet had been sent.

“China has been working very hard to contain the Coronavirus,” Trump wrote. “The United States greatly appreciates their efforts and transparency. It will all work out well. In particular, on behalf of the American people, I want to thank President Xi.”

Twenty-one days earlier, on January 3, Azar had first heard about the virus when CDC director Robert Redfield had recounted a disturbing phone call he had just had with his Chinese counterpart, the director-general of the Chinese Center for Disease Control and Prevention, George Gao.

Redfield and other top CDC leaders had known that something was amiss on December 31, when they had read a report in a medical journal about twenty-seven cases of an unidentified pneumonia outbreak linked to a wet market in Wuhan, China. The CDC had a team on the ground in Beijing, and Redfield was trying to send twenty or thirty more people into the country to investigate what was going on. Shortly after reading the report, he had spoken with Gao, whom he knew well. Both men were virologists, and they held each other in high regard.

During the January 3 call, Gao assured Redfield that the Chinese had the outbreak under control. Chinese health officials didn’t believe that there had been any human-to-human transmission. The virus, they believed, would burn itself out. When Redfield asked who was officially being classified as sick from the virus, Gao replied that the government was looking for people with unidentified pneumonia who had visited the wet market. Redfield pressed him: What about people with unidentified pneumonia who hadn’t visited the market? Gao had said he would look into it.

When the two spoke a couple days later, Gao’s story changed slightly; he told Redfield that there were clusters of infection within families. Redfield pushed Gao again; he simply didn’t believe that there had been no human-to-human transmission. What was the likelihood of an entire family visiting the same food market and all of its members catching the same virus from animals? It didn’t make sense. They had to be spreading it to one another. Gao would have to expand the case definition, Redfield urged, and look for people with unspecified pneumonia, people who hadn’t visited the wet market.

A few days later, when the two spoke again, a distraught Gao broke down on the phone. “We’re in trouble,” he told Redfield, his voice cracking. He had initially been confident that there had been no transmission in the hospital and that the disease would not be very contagious. But he now knew that was wrong; the virus was on the move.

Redfield needed to get a CDC team on the ground to assess the situation and provide assistance. He wrote a formal letter on January 6, after one of his earlier conversations with Gao, expecting an invitation. But even as China was dealing with the virus, it was reluctant to allow entry to foreigners. Beijing ignored the CDC request, as well as subsequent requests from both the United States and the World Health Organization. The Chinese government did not have a reputation for transparency or collaboration when it came to infectious disease outbreaks that originated there, and this was no exception.

Instead, as the outbreak grew, US officials received only spotty and selective information out of China. There were reports of the country quickly building giant hospitals and workers on airplanes in full hazmat suits screening passengers, even as the government insisted that human-to-human transmission was not happening.

Back in Washington, a small group began working on how to address the outbreak. Azar had instructed his chief of staff, Brian Harrison, to inform the National Security Council after the January 3 call between Redfield and Gao. There was little recourse possible for the limited information the administration was getting out of China. The United States couldn’t exactly invade the country. So Azar and Matt Pottinger, the deputy national security advisor, began convening daily meetings with their teams to share what little they knew and to discuss steps to prevent the virus from spreading in the United States.

At first Azar felt that the small group was handling the situation well. On January 17, the CDC activated its emergency response center and began screening travelers from Wuhan. It activated the entire agency on January 19. During past crises, such initial steps might have proven sufficient.

Perhaps no one in the Trump administration had more enemies than Alex Azar. He had served in the George W. Bush administration as general counsel, and then deputy secretary, of Health and Human Services, and his past experience dealing with health outbreaks gave him some authority in this moment. But his personality (his few allies would call it confidence and competence; his many critics called it unchecked arrogance) was a major problem. And during those days in January, he was clinging to political life support. The president was still livid that Azar had convinced him to propose banning most flavored e-cigarettes a few months earlier, an idea that Trump’s conservative base had revolted against. Ever since that blowup, Azar had done his best to claw back into Trump’s good graces, trying to wrap both arms around whatever the White House was working on. But by the time the coronavirus hit, Azar, who seemed to be perpetually on the brink of being fired, had a major credibility deficit within the administration.

In addition to the e-cigarette fiasco, Azar’s bitter rivalries consumed an inordinate amount of time and energy. His ongoing feud with Centers for Medicare & Medicaid Services administrator Seema Verma, one of his subordinates, was proving a particular headache for the White House. Someone had leaked damaging reports to the media about Verma’s alleged use of taxpayer money to pay outside contractors with the purpose of boosting CMS and its work. White House officials were convinced that the leaks had come from Azar’s team, and Verma’s own staffers had concluded that only HHS possessed some of the emails leaked to reporters. Having that petty stuff come out in the media was embarrassing. Azar had been especially angry at Verma for opposing one of his signature drug pricing policies in 2019. The White House had hoped to present a unified health care plan to voters but instead had a health policy team whose members were constantly at one another’s throats.

In November 2019, Verma told Trump that she and her staff felt bullied by Azar and that his behavior was interfering with the president’s health agenda. Things got to the point that President Trump, Vice President Mike Pence, and acting Chief of Staff Mick Mulvaney all had to intervene. In an attempt to broker some sort of truce, Pence told the two, “we all just have to make it for eleven months together.”

Being HHS secretary was Azar’s dream job, and he fought like hell to keep it. Some associates observed that he was enamored with the perks that came with being a cabinet official: the White House events, the security detail and limousine service, the regular access to the president. He knew that his survival in the job depended on his relationship with Trump, and he was willing to go to extensive lengths to butter the president up and keep him happy, even when his demands were unreasonable—which they often were. Still, Azar frequently served as a punching bag for Trump, being yelled at over bad health care polling numbers and Trump’s perception that the health agencies weren’t moving fast enough to implement various policies. Azar took it and his subordinates in turn often felt bullied by him in his desperate attempts to deliver for the president.

With Trump not taking him seriously, Azar felt compelled to play the game and used his Twitter account to promote Trump-related propaganda. On January 13, Azar’s account posted a flattering article about the president’s daughter Ivanka. Three days later, he posted a picture of himself on Twitter smiling alongside a Fox News host touting “Religious Freedom Day.” Azar still hadn’t spoken publicly about the virus. He might have been panicking about the virus in internal meetings, but he was shilling for Trump on Twitter. And people were noticing.

On January 18, Scott Gottlieb, a former FDA commissioner under Trump, texted Joe Grogan, the director of the White House Domestic Policy Council. Grogan was another of Azar’s bitter rivals. Grogan’s portfolio covered all domestic policy, but his background was in health policy and he had known Redfield for years. Grogan and Azar had been having ugly knock-down, drag-out fights for months over drug-pricing policy and Grogan knew how to trigger Azar’s temper and make him look foolish inside the White House. Some officials thought he was secretly gunning for Azar’s job.

Gottlieb had left the administration almost ten months earlier, but he was one of the few former officials who had left on their own terms and maintained the respect of the president and most of the top advisers.

Alarmed at the spread of the novel coronavirus, Gottlieb texted Grogan that dreary, freezing, snowy January day. The CDC, FDA, National Institutes of Health, and Centers for Medicare & Medicaid Services all fell under HHS’s control. Grogan might want to make sure that Azar was coordinating a response across the entire agency, Gottlieb said.

“Between us, while Azar is spending time buffing his image on Twitter, you might check in and make sure he’s coordinating his response to Wuhan,” Gottlieb texted.

“You mean the Chinese virus deal?” Grogan wrote back.

“Yes. Redfield I’m sure is focused but you want to make sure Azar is coordinating across HHS. . . . Redfield is smart and good but not an aggressive leader. I’m not saying it will spiral worse but it could,” Gottlieb texted. “I can’t talk to HHS so I talk to you. Airport screening is of questionable value. More in the vein of seeming like something that stops importation spread.”

“Constantly astounded by how little Azar knows about what’s going on in HHS,” Grogan responded. “That’s a good flag, thanks.”

“Reason to believe it’s a limited outbreak related to a zoonotic source,” Gottlieb texted. “Not trying to be alarmist, but if we’re wrong, the downside is bad.” He added that Grogan should ask HHS for a briefing, which Grogan did later that day.

At that point, Azar was working primarily with the White House National Security Council on the White House’s response, but now Grogan was poking around. That meant trouble for the HHS secretary. The following week, there were three different sets of meetings one day on the coronavirus. Everyone just kept bouncing from meeting to meeting without doing much of anything concrete. And with Grogan now in the picture, there was a good chance that Azar would be elbowed out. He needed to assert his authority and demonstrate he had matters under control. That meant briefing the president, who happened to be in an extremely foul mood.

The House of Representatives had impeached Trump the previous month for trying to coerce Ukraine into digging up dirt on Joe Biden’s family. The Republican-controlled Senate was preparing to conduct its trial, which everyone anticipated would result in an acquittal. But becoming just the third president in US history to be impeached was still a slap in the face. Aides knew that the best way to cheer up Trump was to get him out of Washington and send him to one of his private clubs, where he would be surrounded by his most fawning admirers. And that was where he was, at his Palm Beach resort, Mar-a-Lago, when Azar tracked him down that mid-January afternoon by calling through the White House switchboard.

The HHS secretary could barely get a word in before Trump started shouting. He was still angry at Azar about the e-cigarette debacle and said it would cost him his reelection. Then Trump asked where the health care plan was to replace Obamacare when the Supreme Court struck it down. Azar, a lawyer by training, had long said that Trump’s legal strategy didn’t stand a chance. He told Trump, as he had on several occasions, that he would lose the Supreme Court case 9-0, so there wouldn’t be an opportunity for a replacement plan.

Trump then tried to end the conversation, but Azar cut in. “Mr. President, I’ve got to tell you something,” he said. “There’s this new virus out of China that could be extremely dangerous. It could be the kind of thing we have been preparing for and worried about.” He told Trump that the CDC had begun screening travelers coming into the United States from China, but it might need to do more.

“Yeah, okay,” Trump said. And he abruptly ended the call.

Azar left the call feeling defeated. He just didn’t know how to break through to the president and massage his ego the way other more skilled aides and confidan...