WASHINGTON - As the number of coronavirus cases ticked upward in mid-November - worse than the frightening days of spring and ahead of an expected surge after families congregated for Thanksgiving - four doctors on President Donald Trump’s task force decided to stage an intervention.
After their warnings had gone largely unheeded for months in the dormant West Wing, Deborah Birx, Anthony Fauci, Stephen Hahn and Robert Redfield together sounded new alarms, cautioning of a dark winter to come without dramatic action to slow community spread.
White House Chief of Staff Mark Meadows, among the many Trump aides who were infected with the virus this fall, was taken aback, according to three senior administration officials with knowledge of the discussions. He told the doctors he did not believe their troubling data assessment. And he accused them of outlining problems without prescribing solutions.
The doctors explained that the solutions were simple and had long been clear - among them, to leverage the power of the presidential bully pulpit to persuade all Americans to wear masks, especially the legions of Trump supporters refusing to do so, and to dramatically expand testing.
"It was something that we were almost repetitively saying whenever we would get into the Situation Room," said Fauci, who directs the National Institute of Allergy and Infectious Diseases. "Whenever we got the opportunity to say, 'This is really going to be a problem because the baseline of infections was really quite high to begin with, so you had a lot of community spread.' "
On Nov. 19, hours after the Centers for Disease Control and Prevention advised against Thanksgiving travel, Vice President Mike Pence, who chairs the coronavirus task force, agreed to hold a full news conference with some of the doctors - something they had not done since the summer. But much to the doctors' dismay, Pence did not forcefully implore people to wear masks, nor did the administration take meaningful action on testing.
As for the president, he did not appear at all.
Trump went days without mentioning the pandemic other than to celebrate progress on vaccines. The president by then had abdicated his responsibility to manage the public health crisis and instead used his megaphone almost exclusively to spread misinformation in a failed attempt to overturn the results of the election he lost to President-elect Joe Biden.
"I think he's just done with covid," said one of Trump's closest advisers who, like many others interviewed for this story, spoke on the condition of anonymity to candidly discuss internal deliberations and operations. "I think he put it on a timetable and he's done with covid. . . . It just exceeded the amount of time he gave it."
Now, a month later, the number of coronavirus cases in the United States is reaching records daily. The nation's death count is rising steadily as well, this past week surpassing 300,000 - a total that had seemed unfathomable earlier this year. The dark winter is here, hospitalizations risk breaching capacities, and health professionals predict it will get worse before it gets better.
The miraculous arrival of a coronavirus vaccine this past week marks the first glimmer of hope amid a pandemic that for 10 months has ravaged the country, decimated its economy and fundamentally altered social interactions.
Yet that triumph of scientific ingenuity and bureaucratic efficiency does not conceal the difficult truth, that the virus has caused proportionately more infections and deaths in the United States than in most other developed nations - a result, experts say, of a dysfunctional federal response led by a president perpetually in denial.
"We were always going to have spread in the fall and the winter, but it didn't have to be nearly this bad," said Scott Gottlieb, a former FDA commissioner in the Trump administration. "We could have done better galvanizing collective action, getting more adherence to masks. The idea that we had this national debate on the question of whether masks infringed on your liberty was deeply unfortunate. It put us in a bad position."
Maryland Gov. Larry Hogan, one of the few Republican elected officials who have criticized Trump's handling of the pandemic, said many in the administration are working hard to control the alarming November-to-December surge, but not the man at the top.
"My concern was, in the worst part of the battle, the general was missing in action," Hogan said of the recent surge.
The story of how America arrived at this final season of devastation, with the reported death toll some days surpassing 3,000 people - a new 9/11 day after day - is based on interviews over the past month with 48 senior administration officials, government health professionals, outside presidential advisers and other people briefed on the inner workings of the federal response.
The catastrophe began with Trump's initial refusal to take seriously the threat of a once-in-a-century pandemic. But, as officials detailed, it has been compounded over time by a host of damaging presidential traits - his skepticism of science, impatience with health restrictions, prioritization of personal politics over public safety, undisciplined communications, chaotic management style, indulgence of conspiracies, proclivity toward magical thinking, allowance of turf wars and flagrant disregard for the well-being of those around him.
"There isn't a single light-switch moment where the government has screwed up and we're going down the wrong path," said Kyle McGowan, who resigned in August as chief of staff at the CDC under Redfield, the center's director. "It was a series of multiple decisions that showed a lack of desire to listen to the actual scientists and also a lack of leadership in general, and that put us on this progression of where we're at today."
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Trump's defenders say the president and his administration deserve credit not only for Operation Warp Speed - the public-private initiative to develop, test and now distribute vaccines - but also for their work early on to address a shortage of ventilators, ease supply-chain delays for personal protective equipment and set guidelines for businesses and other gathering places to reopen after the March and April shutdowns.
They also point to Trump's decision in late January to restrict travel from China, where the virus originated. And they say they're not sure what Trump should have done differently.
"President Trump has led a historic, whole-of-America coronavirus response - resulting in 100,000 ventilators procured, an abundance of critical PPE sourced for our frontline heroes, the largest testing regime in the world, groundbreaking treatments, and a safe and effective vaccine in record time with another to be approved in the coming days," White House spokeswoman Sarah Matthews said in a statement. She went on to attribute the success of vaccines to Trump's "bold and innovative leadership."
Still, the administration's overall response is likely to be scrutinized for years to come as a case study in crisis mismanagement. At the heart of the problem, experts say, have been Trump's scrambled and faulty communications.
"Words matter a lot, and what we have here is a failure to communicate - and worse than that, the effective communication of policies, of myths, of confusion about masks, about hydroxychloroquine, about vaccines, about closures, about testing," said Tom Frieden, a former CDC director in the Obama administration. "It's stunning."
Trump's repeated downplaying of the virus, coupled with his equivocations about masks, created an opening for reckless behavior that contributed to a significant increase in infections and deaths, experts said.
"The central and most important thing we needed was national leadership from the president to be able to really lead with empathy," said Anita Cicero, deputy director of the Johns Hopkins Center for Health Security. "It seemed much more focused on the administration as the lead character, rather than communities in need."
A hallmark of the response has been the secrecy of some in the White House, including Meadows, whom other officials described as outright hostile in his denial of the virus and punitive toward colleagues who sought to follow public health guidelines or be transparent.
As the virus spread wildly among White House staff this fall, Meadows sought to conceal some cases from becoming public - including, at first, his own - and instructed at least one fellow adviser who sought to disclose an infection not to.
In addition, Meadows threatened to fire White House Medical Unit doctors, who fall below the chief of staff in the chain of command, if they helped release information about new infections, according to one official. Ben Williamson, an aide to Meadows, said it was "false" that the chief of staff ever threatened to terminate doctors.
Meadows argued internally, according to this official, that the White House was "under no obligation to tell the press or the public that Joe Schmo who works in the White House has tested positive."
Despite shunning recommended protocols internally, Trump aides speak with pride about the actions they took on the pandemic and are incredulous that their work has been so widely panned.
One senior administration official involved in the response said what was accomplished in less than a year - from producing and distributing protective gear to creating vaccines - is nothing short of remarkable. But, this official acknowledged, "The way it was messaged, unfortunately, was flawed."
A second senior administration official said, "I'm not clear on what Trump should have done different, but put me in the camp of, well, something, because it has not been a success."
Olivia Troye, a former Pence adviser and task force aide who resigned in the summer and campaigned against Trump's reelection, said the nation's trauma is a result of the president's mismanagement of the crisis early on, and is being prolonged by his disinterest in it now.
"I would love to say that I'm shocked, but I'm not," Troye said. "This is in keeping with everything he has been." She added: "People are still dying every day. There's thousands of cases every day and yet he won't do the right thing. . . . To see a sitting president directly refuse to help during a crisis is just flabbergasting to me."
Paul A. Offit, who is director of the Vaccine Education Center at Children's Hospital of Philadelphia, a professor of vaccinology at the University of Pennsylvania and a member of the FDA's vaccine advisory council, said of Trump: "He's a salesman, but this is something he can't sell. So he just gave up. He gave up on trying to sell people something that was unsellable."
On Friday morning, in a tableau orchestrated to provide hope to a beleaguered nation, Pence and second lady Karen Pence received the Pfizer vaccine - a needle in his left shoulder as they sat beneath a sign that read, "SAFE and EFFECTIVE," broadcast live on national television.
Trump was nowhere to be seen.
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Tucker Carlson arrived at Trump's private Mar-a-Lago Club the first Saturday in March, before cities started shutting down, on an urgent mission: to convey to the president the seriousness of the coronavirus threat.
Carlson's message was simple but pointed. He warned the president that the virus was real, that people he knew were going to get it, that the country might have already missed the point at which they could control it and, as he later told Vanity Fair, that "this could be really bad."
But Carlson and the president ultimately talked past one another, said a person familiar with the conversation. Carlson told Trump he could lose the election because of the virus, and Trump argued that the virus was less deadly than people were claiming.
The scene at Mar-a-Lago that weekend underscored the concerns. Far from taking any precautions, Trump that Saturday dined with Brazilian President Jair Bolsonaro and his delegation - several of whom later tested positive for the virus - while Donald Trump Jr.'s girlfriend, Kimberly Guilfoyle, threw herself a lavish 51st birthday party at the club. The next day, Trump hosted a fundraising brunch with about 900 attendees.
As the country began to shut down in March, Trump and his administration found themselves in the early throes of denial and dysfunction. Despite the warnings of Carlson and others, Trump continued to downplay the severity of the virus, and turf wars and unclear chains of command roiled the administration's fledgling response.
Public health advisers and other administration officials were left scrambling - scattershot, and with little clear direction - to recoup time squandered.
Jared Kushner, the president's son-in-law and senior adviser who had spent the early days of 2020 focused on other challenges in his overly large portfolio - including a Middle East peace plan and overseeing Trump's reelection campaign - turned his attention to the virus.
Kushner's allies and even some of his critics say he was effective in helping cut through bureaucracy - ensuring, for instance, that states eventually had as many ventilators as they needed. A text or call to Kushner could yield a clear response or directive in just minutes, said one senior administration official, and shortly after Pence was appointed head of the coronavirus task force his chief of staff, Marc Short, enlisted Kushner's help to streamline resources and speed up response times.
But the help Kushner provided was often ad hoc rather than part of a long-term strategy, according to people familiar with his role.
"It was entirely tactical troubleshooting and, to be fair, it was pretty successful, with the ventilators and this and that, but it was whack-a-mole," said an outside Republican in frequent touch with the White House.
Part of Kushner's coronavirus management approach was an ambitious effort to bring in a cadre of young consultants from the private sector as volunteers. The group was dismissively referred to as the "Slim Suit" crowd.
Kushner "is like, 'I'm going to bring in my data and we're going to MBA this to death and make it work,' " one senior administration official said.
But problems quickly emerged with Kushner's team of volunteers. The group was not issued government laptops or emails, forcing them to use their personal Gmail addresses - a practice that often hindered their efforts to procure personal protective equipment from companies that were understandably skeptical of inquiries coming from nongovernment email accounts. The volunteers in charge of PPE procurement also did not know the Food and Drug Administration requirements for importing the protective equipment, and found themselves spending unnecessary time Googling basic questions and calling the FDA for guidance.
Max Kennedy Jr., a senior associate at a private growth equity firm when he joined Kushner's effort as a volunteer, was so alarmed by what he witnessed that he initially filed an anonymous whistleblower report.
Among his complaints was a culture that prioritized tips and leads from VIPs, which consumed an inordinate amount of the volunteers' time and energy. Kennedy wrote in his report that Jeanine Pirro, a Trump booster who hosts a Fox News show, "repeatedly called and emailed until 100,000 masks were sent to a particular hospital she favored. No checks were completed to ensure that the hospital was in particular need of PPE."
Kennedy, a lifelong Democrat and a grandson of Robert F. Kennedy, later revealed his identity and, in an interview with The Washington Post, described a group of smart and earnest volunteers who were, at best, out of their depth and, at worst, asked to do things they felt uncomfortable doing.
Kennedy said that Brad Smith, the director of the Centers for Medicaid and Medicare Services and a friend of Kushner, asked him and another volunteer to make a coronavirus model for 2020 that specifically projected a low casualty count. When Kennedy noted that he had no training in epidemiology and had never modeled a virus before, he recalled, Smith told him that it was just like making a financial model. The other models made by the health experts, Smith explained, were "too catastrophic."
"'They think 250,000 people could die and I want this model to show that fewer than 100,000 people will die in the worst-case scenario,' " Kennedy said Smith told him. "He gave us the numbers he wanted it to say."
Kennedy and the other volunteer refused to make the model. But he said the incident left him discomfited.
"[Smith] said, 'Look around. Does it look like 250,000 people are going to die? I don't think so,' " Kennedy recounted. "And I remember thinking it was a weird thing to say because we were surrounded by military officers in the [Federal Emergency Management Agency] basement and it did look like a lot of people might die."
In an emailed statement, Smith denied asking Kennedy and a fellow volunteer to create a low fatality model.
"The only model I asked the team to build in the three weeks Max volunteered was a model to project PPE needs through July 2020," Smith said. "To calculate PPE needs, the model used hospitalizations and deaths as inputs. The mean version of the model assumed 169,000 deaths by July 2020 and the worst case version of the model assumed 312,000 deaths by July 2020. According to the CDC, there were approximately 160,000 deaths as of July 30, so the model's assumptions proved to be very accurate."
There were other problems too. Kushner's initiative to stand up drive-through testing sites nationwide at retail stores such as CVS, Target and Walgreens, for instance, may have been a good idea in theory but almost instantly raised concerns. Government officials asked Kushner and his team whether they had fully considered the logistical and supply issues behind setting up the sites - including swabs and reagents for tests, and protective equipment for the clinicians administering them.
Kushner's team responded that they had it covered, but it quickly became clear they did not. At a time when health-care workers were using garbage bags as gowns and reusing N95 masks because of severe shortages, roughly 30 percent of "key supplies," including masks, in the national stockpile of emergency medical equipment went toward Kushner's testing effort, according to an internal March planning document obtained by The Post and confirmed by one current and one former administration official.
Though Kushner had initially promised thousands of testing sites, only 78 materialized, the document said, and the national stockpile was used to supply more than half of those.
"The knock against Jared has always been that he's a dilettante who will dabble in this and dabble in that without doing the homework or really engaging in a long-term, sustained, committed way, but will be there to claim credit if things go well and disappear if things go poorly," a former senior administration official said. "And this is another example of that."
By the summer, Trump had grown angry with Kushner over problems with testing, said current and former administration officials - a rare conflict between the president and his son-in-law.
Matthews defended Kushner's testing initiative, saying there are now more than 6,000 retail testing sites and that the federal government has established more than 500 temporary surge testing sites in 17 states over the past 10 months.
At the beginning of the outbreak, the United States failed to deploy a coronavirus diagnostic test across the country so state and local officials could quickly detect and trace confirmed cases. And while the administration eventually scaled up testing considerably - more than 1.5 million tests a day are now being conducted - it still has not developed a national testing strategy. Even as more tests have become available, experts said, there have rarely been enough for the scale of the pandemic.
"Compared to other countries, the biggest mistake we made was in testing," said Katrina Armstrong, a physician and chief of Massachusetts General Hospital who has been treating coronavirus patients. "It's not even a hard test, and we whiffed it. There should be central leadership bringing everything together. For the clinical side, not having access to testing early on and through the summer was the biggest tragedy of what got us here."
The best chance to control an outbreak is at the very beginning. But U.S. officials squandered that opportunity in February for two key reasons. The first was the CDC's failure to deploy a working coronavirus test, and the second was the task force's almost singular focus on repatriating Americans from China and cruise ships, rather than on preparing the United States for an inevitable outbreak.
A review of task force agendas from that time demonstrates a disproportionate focus on cruise ships, masks and other bureaucratic and logistical issues, rather than on more practical public health steps such as testing, contact tracing and targeted efforts to prevent the virus's spread. That allowed the virus to spread undetected for all of February, several officials and experts said, as it seeded itself in New York, Washington state, California, New Orleans and other populous areas. And from then on, the country was perpetually behind the virus.
Kennedy said his experience volunteering in the White House left him disillusioned.
"I don't think this has to be a politicized crisis," Kennedy said. "This pandemic is incredibly tragic and, as someone who was in the room, it was very clear it wasn't taken seriously. It was well understood what measures could be taken to save lives, to reduce the severity of the pandemic, and the administration and Jared Kushner made an active choice not to pursue those actions."
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As the virus began to rage across the United States, some of the nation's health officials had a novel idea. Face coverings were emerging as one of the simplest tools available to control the contagion's spread. So Robert Kadlec, the assistant secretary for preparedness and response at the Department of Health and Human Services, called Jerry Cook, an executive at the cotton clothing giant Hanes, on March 13 to discuss producing enough masks to send to every American household, according to two senior administration officials.
Cook pulled together a number of underwear makers, including Fruit of the Loom, SanMar, Beverly Knits and Delta Apparel, to figure out how to redirect their manufacturing operations to manufacture 650 million three-ply cotton masks - enough to send a packet of five to each household. The masks would bear an HHS logo, contain a microbiocide that would kill the virus, and say: "Do your part, help stop the spread."
A command group at FEMA unanimously approved the plan, and the task force doctors did as well. Birx, the White House coronavirus response coordinator, saw the white prototypes and asked if they could be made in a neutral tone.
But when Kadlec's boss, HHS Secretary Alex Azar, began to pitch it at a White House task force meeting in March, there was sharp dissent. Several on the task force generally did not have much confidence in Kadlec, and a senior administration official said his plan was half-baked and that he was unable to answer basic questions, like how much the effort would cost or how they would deliver all the masks.
Short abruptly stopped the conversation and told Pence the idea wasn't ready and was being pulled off the agenda. Other officials complained that the masks looked like underwear, according to three current and former senior administration officials. Peter T. Gaynor, the FEMA administrator, compared them to jockstraps.
Then there was the issue of logistics. For months leading up to the pandemic, Trump had been attacking the U.S. Postal Service and airing grievances over its business relationship with Amazon. Some aides surmised that, for Trump, a private-public partnership involving the Postal Service as the distributor would be a nonstarter.
The mail-a-mask plan was killed. The Office of Management and Budget tried to cancel the contracts with the underwear makers, but the masks still were produced and distributed to health clinics, religious groups and states that requested them. Hanes did not respond to a request for comment.
Kadlec was so frustrated that he decided his time as preparedness and response chief was no longer best spent on preparing and responding, so he focused instead on vaccines and therapeutics.
Skepticism of masks became a hallmark of the Trump administration's pandemic response. On April 3, when the CDC recommended that all Americans wear masks, Trump announced that he would not do so because he could not envision himself sitting behind the Resolute Desk with his face covered as he greeted visiting dignitaries. The president stressed that mask-wearing was "voluntary," effectively permitting his legions of followers to disregard the CDC's recommendation.
In the months that followed, Trump was only seen wearing a mask on rare occasions, instead following the advice of Stephen Miller, Johnny McEntee, Derek Lyons and other trusted aides to think of masks as a cultural wedge issue.
Pence covered his face with somewhat more regularity than the president, but after forgoing a mask during an April 28 visit to the Mayo Clinic in Minnesota, he drew a public rebuke from the hospital's leaders. Short then yelled at a hospital official over it, a person with knowledge of the visit said.
"What the Trump administration has managed to do is they accomplished - remarkably - a very high-tech solution, which is developing a vaccine, but they completely failed at the low-tech solution, which is masking and social distancing, and they put people at risk," Offit said.
Trump did not imagine the coronavirus would consume the fourth year of his presidency. When he established a task force in January, he assumed it would not last long and that the crisis would subside relatively quickly, according to two officials with knowledge of the situation. These officials said the president selected Pence, the favorite of then-acting White House chief of staff Mick Mulvaney, for chair of the task force over Gottlieb and former New Jersey governor Chris Christie.
In retrospect, according to a senior administration official, Trump's biggest political miscalculation was basing the task force in the White House. "Once you put it in the Situation Room, the president owns every failure, leak, whatever, whereas this could have been an Azar, Redfield, Hahn problem," this official said.
In the early weeks, Pence was the frontman at daily coronavirus news conferences. He provided top-line updates, including case and death counts, before turning it over to Fauci, Birx and other health professionals. Short advised the vice president against detailing such dire statistics, but Pence insisted, believing he was obligated to share such facts with the public, according to another official with knowledge of these discussions.
Over time, however, Trump decided he wanted to be the face of the government's response, so he took over Pence's role at the briefings. A number of Republican senators privately counseled the president to let the doctors be out front, according to a senior Republican congressional official, but "Trump just couldn't let someone else get all that attention."
Trump's performances were riddled with misinformation, contradictions and indecorous boasts, while also predicting miracles and promoting cure-all therapeutics. Trump often said he was trying to be a "cheerleader" for the country, and a senior administration official explained that the president has said he drew lessons from Norman Vincent Peale's "The Power of Positive Thinking."
"What he's saying there is, 'I'm going to will the economy to success through mass psychology. We're going to tell the country things are going great and it's going to be a self-fulfilling prophecy,' " this official said of Trump.
But there were consequences for Trump's often too-rosy takes. Hogan - who as chairman of the National Governors Association helped lead regular meetings among governors and task force members, sometimes including Trump - said there was "a huge disconnect" between what was agreed to by Pence and members of the task force and what the president told the public.
"We would have a great meeting that might have lasted an hour or two with all the top folks focused on the virus, and then the president would have one of those rambling press conferences that went on maybe an hour too long and he said the opposite of what others in the administration told us that day," Hogan recalled.
The Maryland governor, one of the rare Republicans who seemed unafraid to challenge Trump, said he directly confronted the president in some of these sessions about what was not working.
"I pushed back very hard when there was no testing program and there was no availability of basic supplies, like swabs and tubes and testing agents and ventilators," Hogan said. "There were a few times the president bristled when I wasn't saying everything was great. . . . One time the president said on a call, 'You're not being very nice to me.' I said, 'No, Mr. President, I'm always nice. I'm just telling you what the governors see.' "
The White House also made governors' jobs more difficult by interfering at the CDC, which was forced to water down reopening guidelines for businesses, schools, restaurants and other facilities after a cadre of White House and administration officials weighed in with suggestions that were not based on science.
By late spring - after he infamously suggested people ingest bleach to cure themselves of the virus - Trump stopped appearing at coronavirus briefings. Meadows is among those credited with pulling the plug.
"He felt it was a loser message," said one senior administration official with knowledge of Meadows's thinking. "So why message on covid?"
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Scott Atlas found himself in Trump's orbit the way so many do: through the television screen.
A neuroradiologist with no infectious-disease or public health background, Atlas joined the coronavirus response team in August as a special government employee, after a few senior Trump advisers - Kushner, McEntee and Hope Hicks - were impressed by his appearances on cable news.
Atlas began working out of Kushner's office suite, and quickly scored a blue badge - the most coveted level of White House access - and a spot on the coronavirus task force. Though many were skeptical of him, the vice president's team felt that if Atlas was going to be part of virus response, then he needed to be a full-fledged member of the effort, said two people familiar with the decision.
Atlas pushed a controversial "herd immunity" strategy - of letting the virus spread freely among the young and healthy - and clashed with others on the task force, many of whom described him as combative and condescending. He lorded his seemingly unfettered access to the president over the group and, as one senior adviser said, "The science just got totally perverted with Scott in the room."
Atlas, who resigned Nov. 30, defended his advice to Trump as "based on the best available science and data at the time" and said he sought to reduce both the virus spread and what he called "structural harms." In a lengthy emailed statement, Atlas denied much of The Post's reporting about his work in the administration, including that he had described those with the coronavirus in derisive or demeaning terms.
"I am very disappointed to see more totally false statements and patently absurd lies about me," Atlas said. "Although I don't intend to weigh-in on every false and defamatory story or allow myself to be endlessly used as a political piñata, I firmly deny the false accusations that, as a special advisor to the President, I advocated for 'herd immunity' via letting the infection spread as a scientific approach to the pandemic. Nothing could be further from the truth."
Even those inclined to be sympathetic to Atlas's coronavirus theory - that the virus mainly affected the most vulnerable, who were the only ones who truly needed protection - found his personal manner off-putting, said one senior administration official. And privately, Atlas often the argued his case more crudely, bluntly saying coronavirus was a disease that only affected the overweight, the diabetic and the elderly, the other adviser said.
But Trump liked Atlas - and the shoddy science he was peddling seemingly bolstered the president's optimism. Atlas's appeal to Trump, this adviser explained, was that he "had a doctor title but a MAGA perspective," referring to Trump's "Make America Great Again" slogan.
Atlas's presence, however, frustrated much of the rest of the group, especially the public health experts who feared he was undermining their hard-fought efforts to keep the public safe.
"If you ever wanted to spread confusion and give license to the people in the cities and states who did not want to abide by any of the public health measures, you gave them license to do it," Fauci said. "They could say, 'Look, this guy who's a well-respected Stanford person who the president seems to like is saying this thing; why should we listen to Fauci?' I think he was disruptive to what Birx and I were trying to do."
The addition of Atlas to the coronavirus task force was just the latest iteration of the infighting that had plagued the virus response all along. He clashed with the other doctors, but especially with Birx.
One early dispute was over testing. At the time, the president was pushing to move away from the widespread testing recommended by health experts and toward more narrow surveillance testing in vulnerable communities. Atlas and Birx fought over the issue in the Oval Office, with Birx - who was backed up by Redfield - advising that widespread testing was the best way to catch new cases, a senior administration official said.
In August, the CDC put out revised testing guidelines that were more in line with Atlas's view than Birx's, only to walk them back after a public outcry.
During another task force meeting, Atlas argued that it would be reasonable to consider substantially fewer mitigation efforts, allowing people to become infected. Instead, Atlas said, officials should focus their efforts on protecting those in nursing homes. Birx retorted that the vulnerable were not only in nursing homes, prompting agreement by other doctors in the group.
"Dr. Scott Atlas has caused people to lose their lives because he stood at the White House podium and told people masks may not work and he told people we should get over it and build up herd immunity," said McGowan, the former CDC chief of staff. "He's telling the world lies from a bully pulpit, from a position of power, and I believe people died because of that."
Some of Trump's advisers tried to convey to the president how much his reelection might hinge on the pandemic. Being seen as a responsible, empathetic leader in a moment of crisis, they explained, would buoy his chances of victory.
For instance, internal campaign data from pollster Tony Fabrizio found that in July, just 40 percent of voters approved of Trump's handling of the virus and 58 percent disapproved, a deficit of 18 percentage points. Among independents, the gap grew to 30 percentage points, according to a senior campaign adviser.
According to an internal polling memo obtained by The Post, more than 70 percent of voters in target states supported "mandatory masks at least indoors when in public, and even a majority of Republicans support this."
Though Republicans were not keen on the idea of an executive order for mask-wearing, they were less opposed to an order that applied only indoors, the internal polling found. And, as one of the slides reviewed by The Post read, "Voters favor mask-wearing while keeping the economy open," and also favor Trump "issuing an executive order mandating the use of masks in public places."
Given those findings, Fabrizio, Kushner, then-campaign manager Brad Parscale and others urged Trump to model good behavior by wearing a mask, and to encourage his supporters to do so as well, several Trump advisers said. But the president was unreceptive, as was Meadows.
"He was of the opinion that it would hurt his base," the senior campaign adviser said. "He listened and it just didn't move him. The argument just didn't move him."
The president and some on his team were also increasingly frustrated with Fauci, who frequently appeared in the media offering what they viewed as an overly alarmist public health message. "Fauci was probably Joe Biden's most effective campaign surrogate on the trail in 2020," said Jason Miller, a senior campaign adviser.
Trump aides added that there also was little pushback to the idea of Trump resuming large rallies - without social distancing or mask requirements. The few advisers who did counsel caution were largely ignored, with allies arguing that rallies were key to the president's brand and that the raucous events also helped improve his mood.
"My attitude was, how are voters going to take us seriously that we're taking this seriously if we're doing things where the perception is we're putting people at risk?" the senior adviser said. "It surely undermines."
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As summer turned to fall, Birx - whose calming guidance and elegant scarves had inspired online memes - found herself silenced and increasingly minimized in the coronavirus response.
Atlas succeeded in sidelining her from Trump's immediate orbit. Her national television appearances all but vanished. She traveled to dozens of states and had unfiltered conversations with governors and local officials, but was denied the time she wanted with the president to keep him abreast of the facts. And her warnings fell on deaf ears inside the West Wing.
"She would circulate her daily report, and more often than not, there would be no responses from anyone on the email," a senior administration official recalled. "I remember there were times where she would flag something massive, like, we are within weeks of a massive remdesivir shortage, and no one would reply."
Birx met either in person or virtually with Fauci and other doctors on the task force at least once a week to discuss the science and support each other as they were being ignored at the White House. They plotted alternative ways to get their messages to the public, including through Birx's travels to states.
But Birx was undermined there, too. After she advised Florida's political leaders in August to close bars and restrict indoor dining, Atlas visited the state and contradicted her. Atlas told Republican Gov. Ron DeSantis and other local leaders to focus less on widespread testing and instead to direct their efforts to opening the economy back up and opening schools, according to two senior administration officials.
As it became clear the pandemic was worsening and the country was headed for a disastrous winter, Atlas dismissed Birx's projections in task force meetings and in private discussions with Trump and Pence. This pushed Birx to be more outspoken, especially in the reports she and her small team put together, some of which took on a grim tone, officials said.
"It was almost like she wanted to make sure she had a paper trail saying, 'I, too, think we're in trouble,' " another senior administration official said. "It was a combination of events that pushed her to change her tune and be much more realistic about the seriousness of what was going on."
The rise in cases and deaths in November coincided with a drop in visibility from Trump and Pence. Following the Nov. 3 election, the two went many days without public appearances. Whenever the president did speak or weigh in on Twitter, it was usually about his desire to overturn the election results, not about the worsening pandemic.
As for Pence, one consistent criticism was his reluctance to deliver tough news and dire coronavirus statistics to the president. As one former senior administration official put it, "He knows, like everybody else knows, that covid is the last thing Trump wants to hear about or see anybody making news about. If not touting Operation Warp Speed, it's the topic that shall not be spoken of." A senior administration official and Pence ally, however, said Pence always shared the daily reality with Trump but, as a perpetual optimist, often did so with a positive spin.
The president and vice president did make a couple of appearances to tout vaccine breakthroughs. But much to the frustration of health officials, they did little to leverage their influence with the 74 million Americans who had just voted for them to persuade people to make sacrifices to stop the spread.
"There are tens of millions of people who fundamentally don't have the same perception of reality when it comes to the virus," Frieden said. "There are always going to be people who are suspicious and paranoid and believe in UFOs or whatever, but because we're not on the same page on covid, it's very hard to get people to act together."
The week before Thanksgiving, health officials fanned out to plead with Americans not to travel over the holiday. Fauci practically begged people in an appearance on ABC's "Good Morning America" to stay home and not interact with people outside their immediate household.
But even America's most famous doctor, one with an approval rating well north of Trump's, was unconvincing to many. More than 3 million people were screened at U.S. airports in a three-day period just before Thanksgiving, according to the Transportation Security Administration. AAA projected that an additional 48 million people would travel by car around the holiday.
That nonchalance about spreading the virus carried this month into the White House, where Trump and first lady Melania Trump hosted a traditional series of elaborate holiday parties.
Night after night, the Trumps had party guests congregate inside the White House residence to mix, mingle and hear the president speak - each clinking of champagne flutes a potential superspreader moment.
"Here, you have Fauci and Birx saying: wear a mask, keep your distance, avoid congregate settings and indoor crowds, particularly indoors," a senior administration official said. "And then you have these events at the White House where nobody is wearing a mask, they're having an event inside and then coming outside, if there ever was a complete confusion of messages."
Pence and second lady Karen Pence also hosted holiday parties at the Naval Observatory, where pictures from one such event earlier this month showed hundreds of guests mingling mostly maskless underneath an enclosed tent. Even Pence himself, the head of the coronavirus task force, did not wear a mask.
Members of military bands, servers and others were forced to work and exposed for hours to guests who were not wearing masks, officials said.
At least one worker who got infected never heard from anyone in the White House about the illness. They were replaced for the next party.