Azar dismissed the people holding signs. “These are professional protesters, paid by the vape industry, Mr. President,” he said. “I’m sure your polling data will tell you that you are winning on vaping.”
Trump had had enough.
“Okay,” Trump said. “Goodbye.”
The call was over.
Azar’s chief of staff, Brian Harrison, had been listening on another line. Once the president hung up and he and Azar were alone on the line, Harrison said, “You really shouldn’t speak to the president of the United States like that.”
Azar understood his point but disagreed, given the president’s modus operandi. Azar had long ago grown accustomed to gut punches from the president and he felt that Trump would respect him more if he punched back. Trump would call Azar unscheduled up to three times a day. Early in the morning or in the middle of the day or late at night, sometimes with a compliment but more often angry about something he saw on a cable news show. He would demand Azar fix it, whatever the problem might be.
That night, Azar had an opportunity to give Trump a freebie on his favorite medium: television. The secretary had a prescheduled interview that would air at 11:00 p.m. on the Fox News Channel with host Shannon Bream. The appearance came on National Religious Freedom Day. Religious freedom was not typically a front-and-center issue for a U.S. health secretary, but it was for many Trump voters, so Azar touted Trump’s commitment to protecting the freedom to pray in school.
“We have in President Trump the greatest protector of religious liberty who has ever sat in the Oval Office,” Azar told Bream and her Fox viewers.
* * *
—
By mid-January, as the CDC began implementing public health screenings at a handful of major international airports, coronavirus was already silently pouring into the United States, carried by unwitting travelers. It was too late to stop the contagion. On the morning of Saturday, January 18, Azar rose early with a nagging concern. While health agencies and the NSC had been rapidly preparing for a potential pandemic, he hadn’t had a deep conversation of any kind with Trump about the virus. He knew Trump was at Mar-a-Lago for the weekend, consumed with his impeachment trial. He figured it was doubtful the president knew much if anything about the virus. From his den at home in a Maryland suburb, Azar reached acting White House chief of staff Mick Mulvaney, who was golfing at Trump International Golf Club in West Palm Beach, near Mar-a-Lago.
“Mick, we’ve got this novel coronavirus,” Azar said. He described how it resembled its predecessors, SARS and MERS, and how this virus could quickly turn into a global threat. He explained the airport screenings and that the Chinese government had admitted to having forty-five cases, which almost certainly meant there were a lot more. Plus, there were reports the virus had already spilled into other Asian countries.
“I’m very nervous about the president and whether you guys have educated him about this,” Azar said.
Mulvaney said nothing about briefing Trump on the virus.
“Mick, I’ve gotta talk to the president,” Azar said. “I’ve got to fill him in on this if you guys haven’t already.”
Several hours passed. At about 6:00 p.m., at Mulvaney’s suggestion, Trump called Azar, who happened to be back in his den. The president immediately began laying into his health secretary on vaping.
“You should have left them alone!” Trump said of the e-cigarette industry.
Azar was burning out on the subject and cursed back.
“I won you the fucking election,” he said. “This is gold with suburban women, the people you most need.”
Trump didn’t engage on that point, and instead issued instructions.
“You need to come up with a plan to quickly get those flavors back on the market,” he said.
Azar sighed, thinking how he could move the conversation to the virus, but the president started peppering Azar about something else.
“How’s our health-care plan?” Trump said. “Where’s the new plan to replace Obamacare? How about our lawsuit? Where the fuck are we, Alex?”
After Azar answered, Trump said he had to get going.
“No, no, Mr. President,” Azar said hurriedly. He explained that he wanted to talk about the coronavirus that so far had sickened dozens of people that they knew of in Wuhan, and that the symptoms mimicked a lethal pneumonia and looked a lot like SARS.
“What’s a coronavirus?” Trump asked.
“It can be really dangerous,” Azar said. “This could kill a lot of people. It’s already in China.”
Azar gave the president a quick lesson on the SARS outbreak nearly two decades earlier and said this new virus could be just as bad and required vigilance.
“We’re working to try to catch cases as people come into the country, but it’s a really big deal,” Azar said. “It is a potentially very serious health situation.”
Trump didn’t ask any questions. He sounded peeved, said he needed to get off the phone, and hung up. The president had a party to get to, the Palm Beach Policemen’s and Firemen’s Ball, hosted at Mar-a-Lago. He put on his tuxedo, shook hands in the ballroom, and gave a special toast.
Two
Totally Under Control
On January 21, 2020, President Trump jetted off to the snow-capped Swiss Alps, where he addressed the World Economic Forum the next day. This was a pilgrimage to the Mecca of moneyed global elites—the kind of people Trump had long resented for looking down on him and not taking him seriously—to rub it in their faces that his “America First” agenda was bearing fruit. The unemployment rate had fallen, the stock markets were up, and Trump had a new trade deal with China to boot.
Never mind that the coronavirus was fast spreading, or that China was still refusing to allow a team of U.S. scientists into Wuhan for an inspection, or that Matt Pottinger and Trump’s top doctors feared China once again was trying to cover up an internal problem. Trump wished to project optimism. The last thing he wanted was to alarm Americans, which could depress the economy and sink his reelection chances.
White House aides booked an interview for Trump in Davos with CNBC’s Joe Kernen, hoping to give the president a forum to tout the economy. But the Squawk Box cohost asked about the virus, which was still only garnering modest mentions in national news. Kernen referenced the Washington State man having recently been declared the first confirmed U.S. case.
“Are there worries about a pandemic at this point?” Kernen asked.
“No, not at all,” Trump said. “We have it totally under control. It’s one person coming in from China, and we have it under control. It’s going to be just fine.”
When Kernen asked whether he trusted China was sharing everything the U.S. government needed, Trump said he had no worries there either.
“I do. I do,” he said. “I have a great relationship with President Xi. We just signed probably the biggest deal ever made. It certainly has the potential to be the biggest deal ever made. And it was a very interesting period of time, but we got it done, and no, I do. I think the relationship is very, very good.”
Public health officials were aghast. The president had said the novel coronavirus was “under control” when they were learning new and worrisome things about it practically by the hour. What’s more, the phrase “under control” was a defined, scientific phrase meaning that the number of infections had been steadily reducing, essentially that the threat was petering out. The coronavirus was absolutely, definitively not under control.
Francis Collins was also in Davos that day for meetings with other leading global infectious disease experts about the coronavirus. The NIH director represented the U.S. delegation in a meeting with Dr. Tedros Adhanom Ghebreyesus, the director general of the World Health Organization, during which he sought to persuade the global institution to declare an international public health emergency. He was directly undercut by his boss, Trump. For C
ollins and his colleagues at the NIH, this was the beginning of the dramatic divergence between the scientific consensus and the president’s public statements.
Alex Azar was shopping at a music store in Washington’s Tenleytown neighborhood when he connected by phone with Robert O’Brien, who was flying back to Washington from Davos. Azar stepped outside into the cold for privacy to share his exasperation with the national security adviser.
“The president was pretty dismissive with me, Robert,” Azar said. “I can take that. But it’s really important that the president not be dismissive like he was on TV. This is a big deal. This is a really big problem.”
Azar had hoped O’Brien would say something like “Yeah, we’re on it,” or “You’re right. I’ll tell him.” As they spoke, Azar paced back and forth on the sidewalk, holding his phone to his ear with one hand and gesticulating with the other, scowling. Azar wasn’t upset with O’Brien but with the situation. He didn’t feel the White House leadership was treating this threat seriously.
* * *
—
Trump arrived back in Washington to face turf battles, which were flaring up in the West Wing and among the agencies. Distrust between the president’s political appointees and career health officials and other professionals was deepening. This was the consequence of him having spent three years molding the government in his own image. The White House had largely abandoned the pretense of following a methodical policy process to make decisions or crafting long-term strategic plans. The driving imperative for those at the top was to survive the daily news cycle by diagnosing every problem as a public relations crisis. Senior officials were on edge about their employment. This weakened the chain of command and risked paralyzing the administration at the very moment the machinery of government needed to be running at maximum tilt. Mick Mulvaney, who had been acting White House chief of staff for thirteen months, still had not shaken the “acting” from his title, which was interpreted fairly or not as an indicator the president lacked confidence in him.
Azar, having angered Trump over e-cigarettes and delays in health-care reforms Trump had promised on the campaign trail, had alienated a slew of administration colleagues before the coronavirus hit and was seen as vulnerable. A lawyer who had recently run pharmaceutical giant Eli Lilly’s U.S. division, he was a longtime Republican with the résumé to match. He’d worked as a law clerk to Justice Antonin Scalia, on the Whitewater investigation embroiling the Clintons, and in the George W. Bush administration as both a deputy and general counsel for the Department of Health and Human Services. As a big pharma executive, he had been a demanding taskmaster and was used to calling the shots. But now in government, his subordinates bristled at times at his C-suite manner. He rubbed the president the wrong way, too, with his detailed, laborious recitations on everything from legal precedent to vaccine clinical trials.
Azar had a long-simmering rivalry with Joe Grogan, director of the White House’s Domestic Policy Council, dating from their disagreements over prescription drug pricing and other health-care policies. One of their colleagues described it as “a big dick-swinging contest” between them. Azar also had a feud going with Seema Verma, the Centers for Medicare & Medicaid Services director, who reported to him, that grew so acrimonious and personally nasty that, by the end of 2019, it had required interventions from senior White House aides Kellyanne Conway, Chris Liddell, Mulvaney, and ultimately Trump himself. It was in this poisonous, disloyal atmosphere that the White House tried to mount a coronavirus response.
While Trump and his entourage were in Davos, Grogan became increasingly worried by media reports about the coronavirus, as well as conversations he was having with Scott Gottlieb, a friend who had recently departed as Food and Drug Administration commissioner. The two men spoke early in the morning on January 19 and Gottlieb was stressed about the emerging threat. Until this point, the government response was largely being handled by Azar and the CDC and other agencies that reported to him, with relatively little White House involvement outside of the National Security Council. But after talking to Gottlieb, Grogan thought to himself, Oh, fuck. I’m going to have to deal with this.
On Monday, January 20, Grogan came to work and scheduled a series of meetings on the coronavirus to get himself and his team up to speed. The NSC had been having its own coronavirus meetings for at least a week, which meant health agency officials now had to brief dueling groups of White House aides.
During one of Grogan’s first coronavirus meetings in the Roosevelt Room, aides discussed the CDC’s recent discovery of the thirty-five-year-old man who had traveled home to Washington State from Wuhan, the first known case of the coronavirus in the United States. Hogan Gidley, the principal deputy press secretary, cornered Grogan with an urgent concern.
“This is gonna leak,” Gidley said, worried about how news of a U.S. case might impact the president. Gidley wanted to make sure the White House got in front of the story so people wouldn’t panic.
“I don’t know what to tell you,” Grogan replied. “We’ve got a goddamn U.S. case. It is going to get out.”
The CDC publicly announced the case a day later, on January 21.
Azar was furious that Grogan was convening his own coronavirus meetings. In his January 22 call to O’Brien, he unloaded on what he called the “mayhem” of the government response. He said experts at the CDC and FDA, whose leaders reported to Azar, risked burnout if they had to keep briefing multiple groups of White House officials. O’Brien told Azar that he would task his deputy, Pottinger, to run coronavirus meetings so there would not be repetition, even though Mulvaney had already blessed Grogan’s lead role.
On January 23, the day after the return of the Davos delegation, Mulvaney convened a meeting of White House aides in his office to get a handle on the coronavirus. Pottinger and Grogan were there, as well as Conway, legislative affairs director Eric Ueland, press secretary Stephanie Grisham, Gidley, and Keith Kellogg. There was growing apprehension about the political consequences of the virus. Video footage out of China was frightening—trucks rolling through the streets of cities spraying fog, people wearing smocks and other protective gear around their bodies, deaths piling up. Imagine how voters might react if these images played out in America, too?
“This could cost us the election,” Grogan said. “Look, guys, one of the criticisms we’re getting on the left on Twitter is that we eviscerated the NSC because [former national security adviser John] Bolton shut down the global health security directorate, and that is true.”
“Okay, Grogan, what do you want to do?” Mulvaney asked.
“We need to bring a czar in, like Ron Klain was for Ebola,” Grogan said, referring to the Obama administration’s handling of the Ebola outbreak in 2014 and 2015. “We need somebody who can do media and project, ‘We’re in charge of it.’ It doesn’t need to be a doctor. It needs to be somebody who has good communication skills and good political instincts.”
The group discussed an array of people who could be the face of the administration’s response but found fault with all of them. Some thought Anthony Fauci, though a leading expert on infectious diseases, would look too old on television; Azar sounded too condescending; Robert Redfield came off as too much of a professor and lacked political chops. They considered the merits of luring Gottlieb back into the administration.
But the idea of a coronavirus czar was tabled. And Mulvaney started to chair meetings on the crisis, a feeble attempt to unite the overlapping internal efforts.
* * *
—
On January 24, Azar met with Trump and updated the president on his department’s coronavirus work.
“How’s China doing?” Trump asked.
“They are being relatively transparent compared to SARS,” Azar said. “But it’s China, so you never know what you don’t know.”
Azar continued: “They’ve got to let the CDC in and they’ve got to give
us samples. Under WHO regulations, they are in violation because they haven’t done that.”
The president appeared to hear only the first—and most optimistic—thing his health secretary had said.
“You know, I’m going to send out a tweet praising them,” Trump said out of nowhere. “Praising China.”
Azar was speechless. Trump had been on a pro-China roll for weeks, so excited before and after signing the trade deal on January 15, which he felt was a huge plum for his reelection campaign. He made clear he didn’t want to insult Chinese president Xi Jinping.
Trump then yelled out for Dan Scavino, who sat in a small, windowless cubbyhole of an office just outside the Oval Office. Scavino was the director of social media, which meant he was one of the only people with access to Trump’s vaunted Twitter account and often pecked out messages the boss dictated.
Azar’s shoulders tightened. He knew what Trump was about to do—dictate a tweet about China to Scavino—and wanted desperately to stop him.
“Mr. President, that is a big give to Xi,” Azar said hurriedly. “You should not do that lightly. His response is not going well. You endorsing him will shore up his power structure. This is not something you should do lightly.” He stressed that they didn’t know whether China was being transparent.
But Trump waved his hand and said he would praise China anyhow. He signaled he was done with Azar’s briefing, and kept barking out for Scavino, who soon appeared at the door. Azar couldn’t change Trump’s mind, not at this pace. So he left the Oval and headed toward O’Brien’s corner office. He found the national security adviser inside.
Azar told O’Brien about Trump’s tweet plan and then blurted out, “You’ve got to tell the president he can’t praise Xi. I can’t get him to stop. He can’t send this tweet. I can’t convince him. And I can’t take the phone out of his hands.”
I Alone Can Fix It: Donald J. Trump's Catastrophic Final Year Page 4