As the coronavirus outbreak rapidly spread across the world and into the United States, several public-health experts both within and outside of the federal government sounded the alarm about the severity of the crisis on an email chain they called "Red Dawn."
The New York Times over the weekend published about 80 pages of emails it obtained. The correspondence included top officials in the Centers for Disease Control and Prevention and the departments of Homeland Security, Health and Human Services, and Veterans Affairs, as well as the former homeland security adviser Tom Bossert and top academics and infectious-diseases specialists.
In addition to the "Red Dawn" emails, The Times published a long investigative review of all the times President Donald Trump brushed aside warnings of the severity of the coronavirus crisis, failed to act, and was belabored by significant infighting and mixed messages over what action to take and when.
Meanwhile, independent and government health experts were sharing data, doing in-depth modeling and research on the virus, and expressing serious concerns about the government's lack of a clear, coordinated mitigation strategy.
On January 28, Dr. Carter Mecher, a senior Veterans Affairs medical adviser who was instrumental in crafting the George W. Bush administration's pandemic-preparedness plans, said the CDC and the World Health Organization were already "behind the curve."
"The chatter on the blogs is that WHO and CDC are behind the curve," he wrote. "I'm seeing comments from people asking why WHO and CDC seem to be downplaying this. I'm certainly no public health expert (just a dufus from the VA), but no matter how I look at this, it looks be bad. If we assume the same case ascertainment rate as the spring wave of 2009 H1N1, this looks nearly as transmissible as flu (but with a longer incubation period and greater Ro)."
He added: "Any way you cut it, this is going to be bad. You guys made fun of me screaming to close the schools. Now I'm screaming, close the colleges and universities."
Dr. James Lawler, an infectious-diseases specialist at the University of Nebraska and a former National Security Council official, jokingly compared the idea that the coronavirus was just like a bad flu to other historical understatements.
"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.'"
In another email that day, Col. Matthew Hepburn, the program manager for the Defense Advanced Research Projects Agency, said: "I am dealing with a very similar scenario, in terms of not trying to overreact and damage credibility. My argument is that we should treat this as the next pandemic for now, and we can always scale back if the outbreak dissipates, or is not as severe."
In a February 9 email, Eva Lee, an expert in infectious-disease modeling at Georgia Tech, suggested that the government "strategically roll out some of the social distancing recommendations," saying it could be part of public messaging.
"I think different communities have different willingness to start," Lee said. "It doesn't hurt them and provide them with a sense of comfort and awareness."
The experts then turned to the outbreak aboard the Diamond Princess cruise ship - which would eventually report 712 confirmed cases among its 2,666 passengers and 1,045 crew members - as a small case study of how fast the virus could spread and how much the US needed to enact mitigation strategies.
"Diamond Princess - as I said from the start - offers the biggest opportunity to study in multiple levels," Lee wrote on February 10, adding that she was afraid it had become a quarantine "nightmare" with "missing opportunities and missteps."
"The case count aboard that cruise ship is now up to 136," Mecher responded. "This is unbelievable."
He added: "Over a span of 21 days (from Jan 20-Feb 10), this outbreak has expanded to 136 confirmed cases. That is a prevalence of 3.7% over the span of 3 weeks. That is unbelievable. But go back and compare the dynamics of the nCov outbreak to the spring wave of H1N1, this outbreak is even faster.
"We are so far behind the curve," Mecher said, adding that he "would drop almost everything we are now doing and prepare for implementing" non-pharmaceutical interventions.
In an email on February 17, Mecher said that those interventions, like social distancing, "are going to be central to our response to this outbreak."
Lee responded the next day: "We predicted the Diamond Princess infection totality before they announced it. What it shows - is that intervention (NPI) must be done timely. A delayed intervention cannot reverse the course and can be catastrophic."
Lee said the cruise ship had "far more positive infected cases than they should have" if it had "intervened differently and swiftly."
"The health system burden cannot be overemphasized," Lee added.
Ten days later, Mecher said he was worried that the US was on track to turn out like Italy, which was hit particularly hard by the virus. He compared the situation to how differently St. Louis and Philadelphia implemented mitigation measures during the 1918 flu pandemic.
"We would estimate that the outbreak in Wuhan had about a 2 week head start on the rest of Hubei," he said, referring to the Chinese province the city is in. "So the measures China implemented to slow transmission happened about two later in the course of the outbreak in Wuhan compared to the rest of Hubei Province. That comparison looks a lot like Philadelphia and St. Louis.
"So we have a relatively narrow window and we are flying blind," Mecher added. "Looks like Italy missed it."
On March 1, Mecher raised concerns about preliminary research on asymptomatic carriers. "Should have pulled all the triggers for NPls by now - they are already later than they realize," he wrote. "I fear we are about to see a replay of Italy. Other cities need to learn from Seattle."
By that point, the experts were sounding the alarm that the US was falling dangerously behind the curve and running out of time to mitigate the virus' spread.
In a message on March 4, Mecher said that if policymakers "miss the window to act, they don't get a do-over."
"Can't take a Mulligan with NPIs. There is no reset button to play the game again. You only get one shot," he wrote, adding: "This is exactly what happened in 1918. A while back I shared some slides on the lessons learned from 1918. Unfortunately, we have to learn some lessons again and again."
Dr. Richard Hatchett, the CEO of the Coalition for Epidemic Preparedness, said he was frustrated that officials were not taking bold action.
"It is remarkable that leaders are reluctant to implement interventions that they will have to implement anyway when they lose control," he wrote on March 4. "Do they think the virus is magically going to behave differently when it gets to their community? Why can't they look at the successful examples and emulate these?"
A message on March 5 called the CDC's recommendations against closing schools as a preventive measure "very unfortunate."
Local officials too were frustrated and bewildered by the delays and lack of availability of coronavirus testing, something all the experts on the thread emphasized as crucial in tracing the origin of outbreaks within communities.
"Whatever is going on/went on between cdc and fda and the laboratory community that created this delay will be dissected by someone in the future, but it still is not fixed for us to be able to do what others countries have done or for me as a local public health official to get vital data on what is really going on," Dr. Eric McDonald, the medical director of epidemiology for San Diego County in California, wrote on March 7. "Frustrating doesn't capture it. You know what I am saying."
On March 11, Trump announced some coronavirus mitigation measures - but he did so in an Oval Office address in which he significantly misrepresented several key aspects of the White House's coronavirus response.
In his speech, Trump said the United States would take the drastic step of banning all travel from most of Europe for 30 days to limit the spread of the coronavirus from abroad.
Shortly after Trump's speech, however, the Department of Homeland Security issued major clarifications, saying that the travel ban would not apply to US citizens or permanent residents abroad and would include only 26 members of the Schengen Area travel agreement that covers most of mainland Europe but excludes the UK and Ireland.
In an email the next day, Bossert said: "Can anyone justify the European travel restriction, scientifically? Seriously, is there any benefit? I don't see it, but I'm hoping there is something I don't know."
Gerald W. Parker, an associate dean in the College of Veterinary Medicine and Biomedical Sciences at Texas A&M, replied: "I do not see it. No use now. I saw it for China. But not now. We should focus on targeted, layered community mitigation measures."
Lawler more bluntly responded: "F--- no. This is the absolute wrong move."
Hatchett agreed. "No justification that I can see, unless we want to put up similar geographic cordons in the US," he said. "There is plenty of disease already in the US to cause spread domestically."
"We are making every misstep leaders initially made in table-tops at the outset of pandemic planning in 2006," Lawler said on March 12. "We had systematically addressed all of these and had a plan that would work - and has worked in Hong Kong/Singapore.
"We have thrown 15 years of institutional learning out the window and are making decisions based on intuition. Pilots can tell you what happens when a crew makes decisions based on intuition rather than what their instruments are telling them. And we continue to push the stick forward."
Trump did not announce aggressive, nationwide social-distancing and stay-at-home guidelines until March 16.
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