with Alexandra Ellerbeck

The year 2020 will be remembered as the year of the coronavirus.

But before the Trump White House struggled to respond to the once-in-a-lifetime pandemic, there was a long history of U.S. presidents trying to prepare the nation for just such an event.

For years, epidemiologists warned a pandemic flu was inevitable. And to varying degrees, the Clinton, Bush and Obama administrations recognized the threat even as other priorities competed for their attention. While their efforts were at times lukewarm, they left the Trump administration with plans to respond to such a crisis plans Trump mostly ignored as he politicized the pandemic.

My colleagues documented this history in a feature-length, three-part documentary, exploring 30 years of White House warnings, preparations and, at times, failures. 

The projected, entitled “America’s pandemic: After decades of warnings, a failed response,” features interviews with former Clinton, Bush, Obama and Trump administration officials. Here are four key takeaways:

President Clinton was the first president to treat public health as a national security issue.

There weren’t any major pandemics during Clinton’s presidency; instead, new concerns around biological weapons drove much of the efforts in the 1990s.

It was a novel that first sparked Clinton’s interest in preparing for a biochemical attack. He read “The Cobra Event,” which is about a biologically engineered virus that caused a huge global pandemic. Clinton also paid close attention to a real-life defector from Russia who described a program focused on biological weapons to potentially attack the U.S. 

Together, those two influences motivated Clinton to create the Strategic National Stockpile in 1999, recognizing that large-scale health crises would require a coordinated response. The stockpile was to act as a repository for vaccines, protective equipment and anti-viral agents ready to be sent to any part of the country within 12 hours.

Presidents Bill Clinton and George W. Bush never faced a pandemic, but each took steps to prepare. (The Washington Post)
The White House has taken an on-again, off-again approach to pandemic preparedness.

For example: The National Security Council’s office on global health has been created and disbanded three separate times.

Donna Shalala, who served as Clinton’s health secretary, sent a health policy expert to the White House National Security Council in 1998. It was the first time someone at the NSC was there specifically to focus on health-related threats.

But three years later, the incoming Bush administration abolished this new Health and Security Office only to reopen it after the attacks on the World Trade Center and the anthrax attacks in fall 2001. Tom Ridge, the president’s homeland security director, called back Kenneth Barnard to resume his prior role as head of the office, given the revived concerns about biosecurity.

President Obama followed a similar pattern. He shuttered the office after his election, but after the 2014 Ebola epidemic he established a Directorate for Global Health Security and Biodefense at the NSC to fill the role.

“This is a systemic problem. It’s bipartisan. It goes administration to administration,” Bernard says in the documentary.

Then, when John Bolton became Trump’s third national security adviser, he moved to simplify an organizational chart he felt had become too bloated and disorganized. He cut staff and tried to streamline the various offices, in the process folding Obama’s global health directorate into a new one that focused on counterproliferation and biodefense.

While Trump officials have said the decision was to streamline operations, former Obama officials including Obama’s Ebola “czar” Ron Klain criticized the move, saying it likely make it harder to coordinate the coronavirus response.

President Barack Obama put pandemic preparedness to the side upon taking office. But the 2009 outbreak of H1N1 made health security an urgent priority. (The Washington Post)
Presidents Clinton, Bush and Obama each had moments of awakening about the threat of a major pandemic.

For Bush and Obama, these moments came after they dealt with smaller-scale pandemics.

During the SARS outbreak in 2002, Bush health secretary Tommy Thompson expanded the national stockpile from eight sites to 12 sites. But upon leaving the administration, Thompson warned that the threat of a pandemic flu still worried him.

“The big one is the pandemic flu,” Thompson said at the time. “This is a really huge bomb that could adversely affect the health care of the world.”

Mike Leavitt was serving as Bush’s health secretary a few years later, when the avian flu spread around the world. At the time, Bush had read “The Great Influenza,” a history of the 1918 flu by John M. Barry (read our review of the book here) and Leavitt recounted that he was asked to read it and consider what additional steps the U.S. should be taking.

Bush understood that a major pandemic is a 100-year problem, according to his former adviser Frances Townsend.

“It may not, likely wont happen on our watch, but that doesnt mean we dont have a responsibility to have a national strategy that the next team or the team after that can pick up off the shelf,” Townsend said.

President Trump downplayed the coronavirus as it ravaged the United States, disregarding the advice of experts and politicizing a health crisis. (The Washington Post)
There were warning signs of a future pandemic.

President Trump has repeatedly claimed that covid-19 came out of nowhere. But officials tasked with responding to past outbreaks had warned for years of this very type of aggressive flu pandemic.

Obama was focused on the recession, not preparing for a pandemic, when he took office in 2009. But his former advisers describe him as closely involved in the U.S. response to the H1N1 virus, the “swine” flu that killed more than 10,000 Americans later that year.

“I think what H1N1 showed us was that, sooner or later, a very lethal pandemic flu or virus or flu-like outbreak was going to come to America and we had to get ready for it,” Klain said.

As Ebola spread in West Africa in 2014, Obama moved swiftly, appointing Klain as his Ebola “czar.” Despite the lethality of the disease, there were just 11 confirmed cases and two deaths from Ebola in the U.S.

Before Obama left office, his administration drew up a 70-page preparedness playbook the next administration could draw upon. But Trump didn’t follow it, much to Obama’s chagrin.

“We literally left them a pandemic playbook,” Obama said last week. “They probably used it to prop up a wobbly table somewhere.”

Ahh, oof and ouch

AHH: The Senate confirmed Amy Coney Barrett to the Supreme Court

The 52-48 vote for Barrett was the culmination of weeks of political fighting, as Democrats charged Republicans with hypocrisy for holding a confirmation vote just a week before the election even though GOP leaders had blocked Obama’s nominee in 2016, The Post’s Seung Min Kim reports.

“Barrett will solidify a 6-3 conservative majority on the court and will be in position to immediately hear contentious cases on elections and health care. A centerpiece of the Democrats’ strategy against Barrett was the pending case on the fate of the Affordable Care Act, set for oral arguments at the Supreme Court on Nov. 10,” Seung Min writes. “The Trump administration and Republican attorneys general argue that the entire 2010 health care law and its protections for millions of Americans with preexisting medical conditions should be invalidated.”

Democrats have painted Barrett’s confirmation as the death knell for the increasingly popular health-care law, focusing on a law review article in which Barrett critiqued Chief Justice John G. Roberts Jr.’s legal reasoning in his case upholding the Obamacare mandate. But at a mock court hearing at William & Mary Law School in September, Barrett voted to keep the Affordable Care Act, albeit without the individual mandate. 

Barrett also has a long personal history of opposing abortion. Experts on both sides of the abortion debate expect that she may take steps to narrow Roe v. Wade.

Vice President Pence was not present at the confirmation vote, after Democrats urged him to stay away from the Capitol amid an outbreak of covid-19 among his staff. While Pence declined to come to the confirmation vote, he has rejected calls to quarantine, visiting Minneapolis on Monday to campaign for Trump.

OOF: The coronavirus is spreading to the last untouched pockets of America.

“Months after it raced in successive waves along the nation’s coasts and through the Sun Belt, it is reaching deep into its final frontier — the most sparsely populated states and counties, where distance from others has long been part of the appeal and this year had appeared to be a buffer against a deadly communicable disease,” The Post’s Karin Brulliard writes.

Hospitalization rates are straining rural health care in Montana, where active cases have doubled since the beginning of the month. Meanwhile, the National Guard has been deployed to Wyoming to help with contact tracing. Even rural villages in Alaska are seeing unprecedented increases.

Some of these areas dodged the early waves of infection, giving them time to stock up on protective equipment and testing supplies.

“But with that delay came another risk, others say. As the virus rolls through regions that for months felt relatively sheltered from the disease but not the broader effects of shutdowns and shortages, there is concern that weariness will stymie efforts to stunt the spread,” Brulliard reports.

Coronavirus cases are surging across the United States, with new infections nationwide surpassing 80,000 for the first time ever on Friday. Around 40,000 Americans are hospitalized, straining local health systems and renewing talks about rationing care.

OUCH: HHS staffers are resigning in the midst of the pandemic.

“At least 27 political appointees have exited the embattled Health and Human Services department since the start of the Covid-19 crisis in February, according to a POLITICO review, and senior leaders are bracing for dozens more officials to depart swiftly if President Donald Trump loses re-election,” Politico’s Dan Diamond reports.

An uptick in departures among political staff is common in the lead up to an election, but the people who have left the agency in recent months have been unusually prominent, including the Centers for Disease Controls chief of staff and the Food and Drug Administrations top policy official. Staffers are vying for jobs across Washington, and more may leave if Trump loses.

“Such a wave of departures would leave only a shell staff shepherding the department through a uniquely challenging winter of coronavirus outbreaks and drug and vaccine authorizations until Inauguration Day on Jan. 20,” Dan writes.

Many officials report low morale at HHS and its agencies, the result of overwork in the midst of the pandemic, internal feuds over policymaking, and negative headlines about the administration’s mistakes. Some officials say that the media pressure has morphed mistakes into major scandals, citing an episode in which the CDC uploaded draft guidelines on coronavirus transmission to its website and then quickly rescinded them. The move led to accusations of political interference, but agency insiders say it was simply an accident.

“Ive personally seen people working on their resumes inside the office,” one senior official told Politico. “Its no secret.”

Four current and two former CDC staffers told NBC News that months of mixed messages, political pressure and public gaffes about covid-19 have turned morale at the agency “toxic.”

"The house is not only on fire," said a veteran CDC staffer. "We're standing in ashes."

In the White House

Mark Meadows declared the administration is no longer going to try to control the spread of the virus.

Speaking on the Sunday shows, the White House chief of staff said instead it will focus on vaccines and therapeutics. Meadows also helped tamp down news last week of a coronavirus outbreak among Vice President Pence’s staff, The Post’s Josh Dawsey reports.

Those incidents were the latest in what some critics say are a series of mistakes from the top political aide.

“[W]ith Trump trailing Democratic challenger Joe Biden and the coronavirus pandemic surging again, Meadows’s uneven handling of the pandemic response and other West Wing crises has dismayed many staffers and campaign officials, who say he has largely proved to be an ineffective chief of staff, instead serving more as a political adviser and confidant,” Dawsey writes.

Reporting based on interviews with 18 White House officials, Trump advisers, Capitol Hill aides and others found that there was broad frustration with Meadows over the White House’s handling of the coronavirus, mixed messages around stimulus negotiations, and communication breakdowns during Trump’s recent hospitalization with covid-19. 

“Meadows has encouraged large campaign events and has not forced staff to follow all CDC guidelines, leaving some allies, such as Scott Gottlieb, the former FDA commissioner, saying that the chief of staff should have done more to protect the president,” Dawsey writes.

Coronavirus latest

  • Amid a third wave, hospitals have been holding off as long as possible on halting procedures like hip and knee replacements and colonoscopies. Earlier in the pandemic, hospitals postponed care to make room for coronavirus patients, the Wall Street Journal’s Melanie Evans reports.
  • A judge in El Paso County has ordered a 10 p.m. to 5 a.m. curfew as coronavirus cases overwhelm hospitals. Law enforcement officials will also enforce mask mandates and other public health guidelines, KVIA ABC-7 reports.
  • HHS is on track to deliver 125 million masks to schools around the country by Nov. 30. The masks, which come in both adult and child sizes, are targeted at schools serving low-income students, Bloomberg Law reports.

Health injustice

U.S. jails are outsourcing medical care, with deadly consequences.

“A Reuters review of deaths in more than 500 jails found that, from 2016 to 2018, those relying on one of the five leading jail healthcare contractors had higher death rates than facilities where medical services are run by government agencies. The analysis assessed deaths from illness and medical conditions, suicide, and the acute effects of drugs and alcohol,” Reuters’s Jason Szep, Ned Parker, Linda So, Peter Eisler, Grant Smith report.

Reuters collected data from 523 jails and found that, while death rates between jails using publicly managed health care versus those using private contractors were similar from 2010 to 2015, the death rates diverged between 2016 and 2018. Between 2016 and 2018, death rates were 18 percent to 58 percent higher among jails receiving care from private contractors, depending on the company.

“The Reuters review is the most definitive examination to date revealing the risks that have emerged as hundreds of jails have embraced the multi-billion dollar correctional healthcare industry and its promises of quality care and controlled costs. It is part of a larger Reuters examination finding that two-thirds of dead inmates, including Loflin, never got their day in court for the alleged offenses on which they were held,” Szep, Parker, So, Eisler and Smith write.

Around 62 percent of jails receive medical care from private contractors. The Reuters reporters profiled one such jail in Savannah, Ga. Chatham County Detention Center had a contract with Corizon Health Inc. for the jail’s health care services. The reporters found numerous instances of deaths that health care staff considered preventable, as well as reports of missing prescription drugs and weeks passing with no doctor on site.

As a Black man, George Floyd had elevated health risks.

Black men have higher rates of hypertension, obesity and heart disease; theyre twice as likely as White men to die of a cocaine overdose, twice as likely to be killed by police and, in Floyd’s age group, 10 times as likely to die of a homicide, The Posts Robert Samuels reports.

Studies have also suggested African Americans tend to have elevated levels of cortisol, which typically rises as a response to stress. “While those rises can be helpful in limited spurts providing focus to pull an all-nighter or increasing heart rates to accomplish a strenuous physical challenge they also strain the immune system. That’s why students get sick after finals week or athletes can get so sore after big games,” Robert writes.

Sugar rush