WASHINGTON - President Donald Trump’s repeated assertions the United States is “rounding the turn” on the novel coronavirus have increasingly alarmed the government’s top health experts, who say the country is heading into a long and potentially deadly winter with an unprepared government unwilling to make tough choices.
"We're in for a whole lot of hurt. It's not a good situation," Anthony Fauci, the country's leading infectious-disease expert, said in a wide-ranging interview late Friday. "All the stars are aligned in the wrong place as you go into the fall and winter season, with people congregating at home indoors. You could not possibly be positioned more poorly."
Fauci, a leading member of the government's coronavirus response, said the United States needed to make an "abrupt change" in public health practices and behaviors. He said the country could surpass 100,000 new coronavirus cases a day and predicted rising deaths in the coming weeks. He spoke as the nation set a new daily record Friday with more than 98,000 cases. As hospitalizations increase, deaths are also ticking up, with more than 1,000 reported Wednesday and Thursday, bringing the total to more than 229,000 since the start of the pandemic, according to health data analyzed by The Washington Post.
Fauci's blunt warnings come as Trump has rallied in states and cities experiencing record surges in infections and hospitalizations in a last-ditch effort to convince voters he has successfully managed the pandemic. He has held maskless rallies with thousands of supporters, often in violation of local health mandates.
Even as new infections climb in 42 states, Trump has downplayed the virus or mocked those who take it seriously. "Covid-19, covid, covid, covid," he said during one event, lamenting that the news media gives it too much attention. In another rally, he baselessly said that U.S. doctors record more deaths from covid-19, the disease the coronavirus causes, than other nations because they get more money.
"I mean our doctors are very smart people. So what they do is they say, 'I'm sorry but everybody dies of covid,' " Trump said Friday at a rally in Waterford Township, Mich., without offering any evidence.
Fauci said former vice president Joe Biden's campaign "is taking it seriously from a public health perspective." Trump, Fauci said, is "looking at it from a different perspective." He said that perspective was "the economy and reopening the country."
Fauci, who once took a starring role in the response and briefed the president almost every day as director of the National Institute of Allergy and Infectious Diseases, described a disjointed response as cases surge. Several current and former senior administration officials said the White House is almost entirely focused on a vaccine, even though experts warn it is unlikely to be a silver bullet that ends the pandemic immediately since it will take months under the best of circumstances to inoculate tens of millions of people to achieve herd immunity.
Officials told governors on a call Friday that they hoped to begin distributing a vaccine by the end of the year, giving some specific guidance on how states would receive their first doses. Fauci focused on the rise in cases, according to people familiar with the call.
Fauci said the White House coronavirus task force meets less frequently and has far less influence as the president and his top advisers have focused on reopening the country. "Right now, the public health aspect of the task force has diminished greatly," he said.
Fauci said he and Deborah Birx, coronavirus task force coordinator, no longer have regular access to the president and he has not spoken to Trump since early October. "The last time I spoke to the president was not about any policy; it was when he was recovering in Walter Reed, he called me up," he said. Fauci said he phones into meetings of other staffers but largely avoids the West Wing because "of all the infections there."
He also lamented that Scott Atlas, a neuroradiologist and Trump's favored pandemic adviser, who advocates letting the virus spread among young healthy people and reopening the country without restrictions, is the only medical adviser the president regularly meets with.
"I have real problems with that guy," Fauci said of Atlas. "He's a smart guy who's talking about things that I believe he doesn't have any real insight or knowledge or experience in. He keeps talking about things that when you dissect it out and parse it out, it doesn't make any sense."
Fauci said he actually appreciated chief of staff Mark Meadows saying last weekend on CNN that the administration was not going to control the pandemic. "I tip my hat to him for admitting the strategy," he said. "He is straightforward in telling you what's on his mind. I commend him for that."
At one point during the interview, Fauci said he needed to be careful with his words because he would be blocked from doing appearances in the future.
Judd Deere, a White House spokesman, offered blistering criticism of Fauci for his comments in a statement to The Washington Post on Saturday. Deere said Fauci "knows the risks [from the coronavirus] today are dramatically lower than they were only a few months ago."
"It's unacceptable and breaking with all norms for Dr. Fauci, a senior member of the President's Coronavirus Task Force and someone who has praised President Trump's actions throughout this pandemic, to choose three days before an election to play politics," Deere said. "As a member of the Task Force, Dr. Fauci has a duty to express concerns or push for a change in strategy, but he's not done that, instead choosing to criticize the President in the media and make his political leanings known by praising the President's opponent - exactly what the American people have come to expect from The Swamp."
Deere added that president "always put the well-being of the American people first," citing his decision to cut off travel from China, his early shutdown of the country and his mobilization of the private sector to deliver critical supplies and develop treatments and vaccines.
Fauci's candid warnings about the threat of the virus have angered the president, who has mocked the scientist for his prognostications early in the outbreak - for instance, saying that masks were not necessary - and even for his baseball pitch. "People are tired of hearing Fauci and these idiots, all these idiots who got it wrong," Trump said during one rally in October.
Some White House advisers have been leery of a public fight with Fauci - knowing his popularity is higher than that of the president. But they've also grown frustrated by his media appearances and complain he is too focused on his personal reputation and is "not on the team," said one senior administration official who spoke on the condition of anonymity because he was not authorized to comment. The doctor has become loathed among many Trump supporters, and Fauci has told others that he has experienced a surge in harassment and threats.
White House spokespeople did not offer comments from either Atlas or Birx despite being asked several times.
Several senior administration officials and outside advisers described a White House overwhelmed by the pandemic, with a feeling of helplessness over the inability to curb its spread without also throttling the economy or damaging the president's reelection chances.
"People need to take a step back and be humble about this," said Joe Grogan, the former head of the domestic policy council under Trump. "Nobody, regardless of political party or ideology, should be getting arrogant about how they have this figured out."
However, the campaign trail message that life is returning to normal underscores how little the president and White House have focused on the pandemic beyond pushing for development and approvals of vaccines and treatments. With the clearance of a vaccine unlikely until year's end, that raises questions about what happens after Election Day, during what is projected to be the worst stretch yet of the pandemic. The Trump administration will be in charge of managing the pandemic no matter who wins until at least Jan. 20.
"We need to plan now for how we turn the corner in 2021, and one thing we should be doing is laying the foundation to get public schools reopened in the late winter or early spring," said Trump's former Food and Drug Administration commissioner Scott Gottlieb. "If we don't plan now, we'll lose the opportunity to prioritize opening what should be most important to us, just as we lost that chance in the fall because we didn't plan appropriately this summer."
Without the ear of the president or other top White House officials, Fauci and otherhealth experts believe the most effective thing they can do is get the public health message out through local and national television media interviews. Birx, the coronavirus coordinator, has traveled across the country in recent weeks delivering blunt advice to state and local leaders grappling with surges of infections, hospitalizations and deaths.
"The thing we can do is to try to get the message out," Fauci said.
Earlier in the pandemic, Fauci said he and Birx would agree on a message that Birx, who works out of the White House and once met with the president almost every day, would deliver to Trump.
"All of a sudden, they didn't like what the message was because it wasn't what they wanted to do anymore," he said. "They needed to have a medical message that was essentially consistent with what they were saying
"And one of the ways to say the outbreak is over is [to say] it's really irrelevant because it doesn't make any difference. All you need to do is prevent people from dying and protect people in places like the nursing homes," Fauci said. "And because of that, Debbie almost never ever sees the president anymore. The only medical person who sees the president on a regular basis is Scott Atlas. It's certainly not Debbie Birx."
Although Trump, Atlas and other top officials say their strategy is to "protect the vulnerable," health experts say the administration has not done enough to protect those in nursing homes. The administration has sent tests to nursing homes and other hard-hit communities, but not nearly the number that experts say are needed. Many nursing homes are also experiencing shortages of personal protective equipment, personnel and other critical supplies that the administration has not sufficiently addressed.
While Atlas has publicly rebutted assertions that he promotes a herd immunity strategy, he recently endorsed the Great Barrington Declaration - a document named after the town in Massachusetts where it was unveiled on Oct. 4 at a libertarian think tank - that calls for allowing the coronavirus to spread freely at "natural" rates among healthy young people, while keeping most aspects of the economy up and running.
"He insists he's not somebody who's pushing for herd immunity," Fauci said of Atlas. "He says, 'That's not what I mean.' [But] everything he says - when you put them together and stitch them together - everything is geared toward the concept of 'it doesn't make any difference if people get infected. It's a waste of time. Masks don't work. Who cares,' and the only thing you need to do is protect the vulnerable, like people in the nursing homes," Fauci said.
Fauci said that many people who catch the virus recover "virologically" but will have chronic health problems.
"The idea of this false narrative that if you don't die, everything is hunky dory is just not the case," he said. "But to say, 'Let people get infected, it doesn't matter, just make sure people don't die' - to me as a person who's been practicing medicine for 50 years, it doesn't make any sense at all."
A similar assessment was offered by Tom Bossert, the former homeland security adviser in the Trump administration. "It sounds alluring," Bossert said. "It sounds so seductive. It's not possible. Math makes it irresponsible to even try and say it."
Fauci and other top health experts applauded the substantial growth in expertise about how to treat covid-19 since last spring that has led to a dramatic reduction in death rates.
"Even though we're getting challenged with more cases," he said, "the medical system is much better prepared to take care of seriously ill people, so that's the reason why I think the surge of cases is going to be counterbalanced by better experience."
Nonetheless, he and others said they are worried about regions of the country that may be ill-prepared to deal with a winter surge of infections, including Midwestern and Western states because they have limited intensive care beds, as well as nurses who can treat growing numbers of covid-19 patients.
“It’s much more about some of the states like Utah, Nevada, South Dakota, North Dakota, where . . . they never had a pretty good reserve of intensive care beds and things like that. I hope they’ll be OK, but it’s still a risk that, as you get more surging, they’re going to run out of capacity,” Fauci said.