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People queue to enter a tent erected to test for the coronavirus disease (COVID-19) at the Brooklyn Hospital Center in Brooklyn, New York City, on March 19, 2020. Image Credit: Reuters

Washington: The outbreak of the respiratory virus began in China and was quickly spread around the world by air travellers, who ran high fevers. In the United States, it was first detected in Chicago, and 47 days later the World Health Organisation declared a pandemic. By then it was too late: 110 million Americans were expected to become ill, leading to 7.7 million hospitalised and 586,000 dead.

That scenario, code-named “Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration’s Department of Health and Human Services in a series of exercises that ran from last January to August.

The simulation’s sobering results - contained in a draft report dated October 2019 that has not previously been reported - drove home just how underfunded, underprepared and uncoordinated the federal government would be for a life-or-death battle with a virus for which no treatment existed.

Many of the potentially deadly consequences of a failure to address the shortcomings are now playing out in all-too-real fashion across the country. And it was hardly the first warning for the nation’s leaders. Three times over the past four years the US government, across two administrations, had grappled in depth with what a pandemic would look like, identifying likely shortcomings and in some cases recommending specific action.

Report on lessons learnt

In 2016 the Obama administration produced a comprehensive report on the lessons learned by the government from battling Ebola. In January 2017 outgoing Obama administration officials ran an extensive exercise on responding to a pandemic for incoming senior officials of the Trump administration.

The full story of the Trump administration’s response to the coronavirus is still playing out. Government officials, health professionals, journalists and historians will spend years looking back on the muddled messages and missed opportunities of the past three months, as President Donald Trump moved from dismissing the coronavirus as a few cases that would soon be “under control” to his revisionist announcement Monday that he had known all along that a pandemic was on the way.

Any suggestion that President Trump did not take the threat of COVID-19 seriously is false

- Judd Deere, a White House spokesman

The White House defended its record, saying it responded to the 2019 exercise with an executive order to improve the availability and quality of flu vaccines, and that it moved early this year to increase funding for the Health and Human Service Department’s programme that focuses on global pandemic threats.

“Any suggestion that President Trump did not take the threat of COVID-19 seriously is false,” said Judd Deere, a White House spokesman.

But officials have declined to say why the administration was so slow to roll out broad testing, or move faster, as the simulations all indicated it should, to urge social distancing and school closings.

Asked at his news briefing Thursday about the government’s preparedness, Trump responded, “Nobody knew there would be a pandemic or epidemic of this proportion. Nobody has ever seen anything like this before.”

Knowledge about risks

The work done over the past five years, however, demonstrates that the government had considerable knowledge about the risks of a pandemic and accurately predicted the very types of problems Trump is now scrambling belatedly to address.

“Crimson Contagion,” the exercise conducted last year in Washington and 12 states including New York and Illinois, showed that federal agencies under Trump continued the Obama-era effort to think ahead about a pandemic.

But the planning and thinking happened many layers down in the bureaucracy. The knowledge and sense of urgency about the peril appear never to have gotten sufficient attention at the highest level of the executive branch or from Congress, leaving the nation with funding shortfalls, equipment shortages and disorganization within and among various branches and levels of government.

Gaps in response

As early as the George W. Bush administration, homeland security and health officials focused on big gaps in the US response to a biological attacks and the growing risk of pandemics. The first test came in April 2009, just a few months after the start of President Barack Obama’s first term. A 10-year-old California girl was diagnosed with a contagious disease that would be called swine flu or H1N1, the first flu pandemic in more than 40 years.

The Centers for Disease Control and Prevention estimates that ultimately there were about 60.8 million cases in the US, along with 274,304 hospitalisations and 12,469 deaths associated with H1N1.

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A person wearing gloves and a protective mask records a video for Instagram on a swing set near the Santa Monica Pier, temporarily closed due to the coronavirus, in Santa Monica, California, U.S., on Thursday, March 19, 2020. California Governor Gavin Newsom ordered that all of the state's 40 million residents go into home isolation starting Thursday evening, marking the most stringent US effort yet to stymie the spread of the novel coronavirus. Image Credit: Bloomberg

The virus turned out to be less deadly than first expected. But it was a warning shot that officials in the Obama administration said they took seriously, kicking off a planning effort that escalated in early 2014, with the outbreak of Ebola in West Africa and ensuing fear that it could spread to the US.

Ebola was less contagious than the flu, but far more deadly. It killed 11,000 people in Africa. But it could have been far worse. The US sent nearly 3,000 troops to Africa to help keep the disease from spreading. While the containment effort was considered a success, inside the White House, officials sensed that the US had gotten lucky - and that the response had revealed gaps in preparedness.

Christopher Kirchhoff, a national security aide who moved from the Pentagon to the White House to deal with the Ebola crisis, was given the job of putting together a “lessons learned” report, with input from across the government.

The weaknesses Kirchhoff identified were early warning signals of what has unfolded in the past three months.

While the US rapidly developed a way to screen air passengers coming into the US - borrowing from intelligence tools developed after 9/11 to track possible terrorists - Kirchhoff found deficiencies in even measuring how fast the virus was spreading.

Ebola Task Force

On the plus side, the Obama White House had created an Ebola Task Force, run by Ron Klain, Vice-President Joe Biden’s former chief of staff, before a single case emerged in the US Congress allocated $5.4 billion in emergency funding to pay for Ebola treatment and prevention efforts in the US and West Africa.

The money helped fund a little-known agency inside the Health and Human Services Department in charge of preparing for future contagious disease outbreaks, the same office that in 2019 ran the Crimson Contagion exercise and other similar events in the years since.

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What is striking in reading Kirchhoff’s account today, however, is how few of the major faults he found in the American response resulted in action - even though the report was filled with department-by-department recommendations.

But one big change did come out of the study: The creation of a dedicated office at the National Security Council to coordinate responses and raise the alarm early.

“What I learned most is that we had to stand up a global biosecurity and health directorate, and get it enshrined for the next administration,” said Lisa Monaco, Obama’s homeland security adviser.

Trial run

After Trump’s election, Monaco arranged an extensive exercise for high-level incoming officials - including Rex Tillerson, the nominee for secretary of state; John Kelly, designated to become homeland security secretary, and Rick Perry, who would become energy secretary - gaming out the response to a deadly flu outbreak.

She asked Tom Bossert, who was preparing to come in as Trump’s homeland security adviser, to run the event alongside her.

“We modelled a new strain of flu in the exercise precisely because it’s so communicable,” Monaco said. “There is no vaccine, and you would get issues like nursing homes being particularly vulnerable, shortages of ventilators.”

Monaco was impressed by how seriously Bossert, her successor, appeared to take the threat, as did many of the 30 or so Trump team members who participated in the exercise, details of which were reported by Politico.

But by the time the current crisis hit, almost all the leaders at the table - Tillerson, Kelly and Perry among them - had been fired or moved on.