by Sanjay Gupta
We go through each day having millions of microexperiences, and the vast majority of them are completely expected, habituated, and contextualized. When we are surprised, we automatically put that surprise inside a box that we can understand and explain. It is human nature to look for the familiar and discard the inconsistencies. When something highly unusual or unprecedented happens in our lives, the mind is very good at eliminating those incidents. Forgetting them. Pretending they never existed. If it doesn’t make sense or creates too much conflict in our own brains, it doesn’t fit the narrative our minds have created to guide our lives.
When this novel coronavirus emerged, many scientists, public health officials, and doctors—myself included—immediately looked to other deadly coronaviruses, such as SARS and MERS, for clues to predict how this one would behave. It was almost a reflex. Coronavirus from China? That belongs in the SARS box. Or: A burgeoning pandemic? The last pandemic I covered was H1N1 or swine flu in 2009. I will put this novel virus in that box. But it was nothing like either of them, and the truth is that there was no standardized box in which to place COVID. I remember putting my head down deep into this, taking in all the information I could: reading research papers and unpublished preproofs; conducting Zoom calls with sources in China, South Korea, and Japan; talking to experts like Tony Fauci and global health expert Peter Daszak, whose research has been key to understanding the impact of emerging diseases.28 And I remember that everyone had a theory about some aspect of this novel coronavirus. Even my mother had a theory.
In the earliest days, we thought human-to-human transmissibility was unlikely, that masks weren’t particularly helpful, that people couldn’t spread it asymptomatically or through the air. Maybe we just hoped these things would be true—magical thinking to try and convince ourselves the pandemic wasn’t the black swan event we had been fearing for a hundred years. But we were wrong. In fact, our existing fund of knowledge turned out to be a major obstacle in our thinking—it got in our way. Just consider that. If you are dealing with something truly novel, it makes sense to bring in people from completely different walks of life because they don’t immediately fall into the trap of trying to incorrectly place that novel thing into a familiar box. But we didn’t do that, and instead kept looking for our comfortable boxes. It was a humbling experience for everyone, even for people like Tony Fauci, who got agitated when I reminded him that he had said, “In the history of respiratory viruses, there’s never been one that has spread so efficiently asymptomatically.”
When the kids got sent home from school in early March and most businesses shut their doors, people assumed the lockdown would be a few weeks, maybe a month. Easter was declared the goal for gaining our freedom and normalcy again. It was a complete fantasy in retrospect, but the alternative—the reality of a virus engulfing the globe and robbing our way of life—was not digestible. President Trump told me in late February that he didn’t want to panic the American public and that “we’re ready for it,” which was another manifestation of ignoring a catastrophe despite clues falling from the sky. Again, I know being honest and direct and telling people the truth is sometimes hard.
Over the past few decades, I have learned that presenting a plan alongside the problem doesn’t soften the blow of terrible news, but it can help mitigate the panic. People will feel less helpless and instead be driven to take action and do something. A report by Columbia University stated that had we taken action and carried out control measures like physical distancing and mask wearing just one to two weeks earlier, a substantial number of cases and deaths—more than half—could have been averted.29 From Dr. Birx’s perspective, after our initial surge in the spring, which killed about 100,000 Americans, “All of the rest of them, in my mind,” she told me, “could have been mitigated or decreased substantially if we took the lessons we had learned from that moment and ensured we utilized them city by city and county by county, state by state.”30
February 2020 has been named The Lost Month.31 It was a crucial time, but we as a nation were not in step with the science. We may not have been masked yet, but we were blindfolded by a lack of imagination. Interestingly, when the 9/11 Commission presented its conclusions on how the attacks could have been prevented, four kinds of failures were revealed: policy, capabilities, management, and imagination.32 These failures spectacularly repeated themselves in the pandemic. Just as we could not, prior to 9/11, ever imagine airplanes weaponized like that to mass-murder thousands of people, we could not imagine an invisible virus tramping across our turf where we have some of the best doctors and scientists in the world. When we were told on February 2 that the risk of widespread infection across America was “low,” we had only about a dozen confirmed cases; within six weeks, there were nearly 3,500 confirmed. Like an echo from 9/11’s failures, we similarly lapsed in policies, capabilities, and management when COVID crashed into our lives. An honest assessment of the problem and plan also sets people’s expectations, which is critically important.
If I had known in January 2020 that for the next eighteen months, we’d be living in COVID lockdown life, it would have been a very difficult fact to accept, but in at least one way, it would have been easier: There would be a timetable about how things should progress—and a tangible end. The human mind prefers the certainty and finality of a countdown to zero, as opposed to the inherent ambiguity of counting up for what feels like forever. We’re not nearly as good at counting up as we are at counting down.33 However painful and long, when we count down, we still have the anticipation of an end date.
Daring to Use the P Word
On March 9, 2020, I published a column on CNN’s website declaring the fomenting crisis a pandemic and used that weighty term on television for the first time.34 The reaction was swift. Some accused me of hyping the story, and serious threats directed at me were reported to CNN security and the local police. Our family never experienced danger, but every night, I quietly padded around the house after the girls were asleep to triple-check that all the doors were locked. I was glad to have dogs I knew could alert us if necessary.
Calling it a pandemic was not a decision I took lightly and it was not intended to spark fear. At the time there were more than 100,000 cases and over 3,000 deaths attributed to this new virus globally, and the numbers were climbing. The virus had found a foothold on every continent except Antarctica. Contrary to what you might think, the specific criteria for a pandemic are not universally defined, but there are three general indicators: (1) a virus that can cause illness or death, (2) sustained person-to-person transmission of that virus, and (3) evidence of spread throughout the world. The CDC says a pandemic is “an epidemic that has spread over several countries or continents, usually affecting a large number of people,” while an epidemic is “an increase, often sudden, in the number of cases of a disease above what is normally expected in that population.”35 By the time CNN called it, some had already raised the alarm, including the director of the CDC’s National Center for Immunization and Respiratory Diseases, Dr. Nancy Messonnier, who used the P word in a late February press conference.36
On February 25, as she and her team at the CDC began preparing, Messonnier went further: “It’s not so much a question of if this will happen anymore but rather more a question of exactly when this will happen and how many people in this country will have severe illness.” She went on to say, “I understand this whole situation may seem overwhelming and that disruption to everyday life may be severe. But these are things that people need to start thinking about now. I had a conversation with my family over breakfast this morning and I told my children that while I didn’t think that they were at risk right now, we as a family need to be preparing for significant disruption of our lives.… I also want to acknowledge the importance of uncertainty. During an outbreak with a new virus, there is a lot of uncertainty.”37
Those comments didn’t make the Trump administration happy. From their perspective, the virus was “contained” in the United Stat
es and “very well under control.”38 Two days after Messonnier’s remarks, the White House appointed Birx to the position of coronavirus response coordinator, and she became the only person on the task force to work from an office in the White House. After Dr. Messonnier’s bold and honest statements, she no longer appeared at public briefings of the White House coronavirus task force.
The shift in thinking among public health officials was a turning point for me in my mind. I had a bad feeling about what we were in for—a move from the idea that we could get our arms around this (containment) to barely keeping up and just trying to slow it down (mitigation). I also had a hunch that almost no American was psychically prepared to absorb the new reality. In my “pandemic” article for CNN.com, I said things no one wanted to hear:39
Now is the time to prepare for what may be ahead. That could mean quarantines, closed schools and cancelled events in your town. It might mean strain at work or taking a break from hobbies that usually bring you joy. It might mean putting off a family vacation or catching up over the phone instead of getting together.
Humanity has overcome pandemics before. In this globally connected world, we may be asked to add more social distance between each other, but that doesn’t mean we can’t still collectively come together as a nation and as a world. This is a crisis we can overcome if we can work together.
My words were jarring for people. Many understood the gravity of the situation and started to take action. Others would go on to declare COVID a “hoax,” perhaps trying to call my bluff. Whatever the reason, it was difficult to watch a country like the United States fail to execute the most basic public health strategies.
We were better at getting the big things right. We made remarkable progress in scientific and medical arenas, developing protocols and therapeutics for people who got sick. Most notable of all, we managed to develop several vaccines at historic speed. Vaccines are one of the greatest technological innovations in human history, and once again, as with smallpox, polio, and dozens of other vaccines, they would eventually rescue us, but they can never work as quickly as changes in human behavior.
Public health experts had given us the warnings and the tools, however basic, throughout this pandemic: physically distance, wear a face mask, wash our hands often. Other countries, such as South Korea, where the first patient was diagnosed the same day the first US patient was diagnosed, leaned into those basic public health measures and have done exponentially better. Their death count has been in the low thousands. Ours: in the hundreds of thousands—more than half a million.
So if I had to answer the question about primary cause of death here, I’d call it multisystem organ failure, ranging from our poor health to our inflated sense of readiness. The real tragedy, however, is that this was so preventable. Not only has this pandemic long been expected, but the exact manner in which it played out was predicted as well. Yet, we still failed to believe it or act on the information we had available until it was too late. When the coronavirus task force did another tabletop exercise in the underbelly of the West Wing’s Situation Room on February 21, 2020, as the pandemonium of the scourge was taking deep root, the conclusion was obvious as Dr. Fauci recalls from the crucible of this war: “We’re in for a disaster.”
I. Although the flu pandemic of 1918 is often called the Spanish flu, it did not originate in Spain. Unlike other countries that participated in World War I, Spain remained neutral and its media could report news of the flu more freely. So, when nations undergoing a wartime media blackout read in-depth accounts from Spanish news sources, especially after Spain’s King Alfonso XIII came down with the illness, people assumed that Spain was the pandemic’s ground zero. But that was likely not the case. Scientists are still unsure of its birthplace, with Britain, France, and China all candidates. It may have even originated in the United States, where the first known case was reported at a military base in Kansas on March 11, 1918.
II. The Bills of Mortality in the collection that Defoe used for his book were dated from December 27, 1664, through December 19, 1665. Serial entrepreneur and inventor Jay Walker owns a leather-bound and vellum-paged volume of the original bills in his private Library of the History of Human Imagination in Connecticut.
CHAPTER 2 Multisystem Organ Failure
A month before the tabletop exercise that capped The Lost Month of February, Dr. Carter Mecher, a senior medical adviser at the Department of Veterans Affairs for the Office of Public Health, had typed an email to a small, elite group of public health experts warning them that the WHO and CDC “were behind the curve” in responding to the novel coronavirus and swift action was needed to stop it. The recipients, all of whom held high-ranking positions in the government or at universities, belonged to a group jokingly nicknamed Red Dawn, a nod to the 1984 movie that pitted actors Patrick Swayze and Charlie Sheen against a foreign enemy invasion. The “Red Dawn Breaking Bad” email thread was hosted by Dr. Duane Caneva, chief medical officer at the Department of Homeland Security.I Caneva wrote that the chain was started “to provide thoughts, concerns, raise issues, share information across various colleagues responding to COVID-19.”1
Mecher’s email that night on January 28 was stark: “This is really unbelievable.… Any way you cut it, this is going to be bad.… The projected size of the outbreak already seems hard to believe.” Mecher had analyzed early data from China and concluded that the virus was as transmissible as the flu, but with a greater ability to replicate and a case fatality rate far worse. “You guys made fun of me, screaming to close the schools,” Mecher wrote. “Now I’m screaming, ‘Close the colleges and universities.’ ”
Dr. James Lawler, an infectious disease doctor at the University of Nebraska who served in the White House under President George W. Bush and as an adviser to President Barack Obama, was also a regular participant in the email chain. He too predicted the gravity of the situation and followed with his own not-so-subtle bomb on the Red Dawn chain a few hours after Mecher:
From: James V. Lawler
Sent: Tuesday, January 28, 2020 8:56 PM
Great Understatements in History:
Napoleon’s retreat from Moscow—“just a little stroll gone bad”
Pompeii—“a bit of a dust storm”
Hiroshima—“a bad summer heat wave”
AND
Wuhan—“just a bad flu season”
This was the same day national security adviser Robert O’Brien warned President Trump that this would be “the roughest thing” he’d face.2 Matthew Pottinger, the deputy national security adviser, agreed and shared his own dire warnings with the president after reaching personal contacts in China. Pottinger would know: He had worked as a journalist in Hong Kong first for Reuters and then the Wall Street Journal during the SARS epidemic, later becoming a Marine Corps intelligence officer. During his years in China, he’d collected a handful of trusted friends he could rely on at this pressing time. He was the White House’s foremost China expert and was attuned to the Communist regime’s dishonest behavior and lapses in biolab safety.
According to Pottinger, the Chinese government was not telling the truth and had handed over the crisis to its military—not their own CDC with which the US CDC worked.3 Once the Chinese CDC was cut out of the emergency, the Chinese military went about trying to cover up and contain the crisis. It also meant that our CDC director, Bob Redfield, who had been in regular contact with his counterpart, Dr. George Gao, the Chinese virologist and immunologist who led China’s version of the CDC, was also out of the loop. According to Redfield, the Chinese government was lying not only to the world, but to its own doctors and public health authorities.
Deception Out of China
When I sat down with Redfield in 2021 to get his perspective on the previous year, it was a snowy February day. He had recently left his post at the CDC and was back in Baltimore sorting through boxes from the move and piecing his life together again as a private citizen. Redfield told me they’d put in several reque
sts to be allowed into China, including President Trump appealing directly to President Xi Jinping. All were denied. One of Redfield’s biggest regrets was not successfully gaining entry to China in those early days. He couldn’t get his CDC people deployed from Beijing to Wuhan to start a formal investigation. Instead, all he could do was have regular discussions with his friend Gao. Their private conversations, likely recorded by the Chinese military, revolved around the truth about this new pneumonia and how it spread. For example, when Redfield noticed that the first twenty-seven individuals in China diagnosed with COVID were comprised of three distinct clusters, he knew that meant these people were infecting each other as opposed to all contracting it independently from another location or walking through the same market. This was a clear sign of human-to-human transmission. On a call in the first week of January, Redfield remembers pointing out the obvious: “George, you don’t really believe that mother and father and daughter all got it from an animal at the same time, do ya?”
Inexplicably, George’s reply was along the lines of: “Bob, there’s just no evidence of human-to-human transmission.”4
Redfield challenged his friend of twenty-odd years, describing cases that had nothing to do with the wet market. The Chinese government and military had long been controlling the narrative and keeping the focus on the wet market, unbeknownst to him. Gao did not even know that there had been an outbreak of respiratory illness in the Wuhan Institute of Virology (WIV) back in the fall of 2019 (the antibody testing of those lab workers did not reveal coronavirus exposure, but those lab results were not independently confirmed). Three researchers from the lab got sick enough to seek hospital care.5 This was weeks before Beijing later said its first confirmed case was a man who fell ill on December 8.6 Had Redfield been able to better assist his friend with twenty or thirty people on the ground in those first few weeks in January, he thinks the pandemic’s plotline would have changed.