US caught Covid-19 unprepared – where did it go wrong?

On Jan 21, the day the first US case of coronavirus was reported, the secretary of the Department of Health and Human Services (HHS) appeared on Fox News to report the latest on the disease as it ravaged China. Alex Azar (above), a 52-year-old lawyer and former drug industry executive, assured Americans the US government was prepared.

“We developed a diagnostic test at the CDC, so we can confirm if somebody has this,” Azar said. “We will be spreading that diagnostic around the country so that we are able to do rapid testing on site.”

While coronavirus in Wuhan, China, was “potentially serious,” Azar assured viewers in America, it “was one for which we have a playbook.”

Azar’s initial comments misfired on two fronts. Like many US officials, from President Donald Trump on down, he underestimated the pandemic’s severity. He also overestimated his agency’s preparedness.

As is now widely known, two agencies Azar oversaw as HHS secretary, the Centers for Disease Control and Prevention and the Food and Drug Administration, wouldn’t come up with viable tests for five and half weeks, even as other countries and the World Health Organization (WHO) had already prepared their own.

Shortly after his televised comments, Azar tapped a trusted aide with minimal public health experience to lead the agency’s day-to-day response to Covid-19. The aide, Brian Harrison, had joined the department after running a dog-breeding business for six years. Five sources say some officials in the White House derisively called him “the dog breeder.”

Azar’s optimistic public pronouncement and choice of an inexperienced manager are emblematic of his agency’s oft-troubled response to the crisis. His HHS is a behemoth department, overseeing almost every federal public health agency in the country, with a US$1.3 trillion budget that exceeds the gross national product of most countries.

Azar and his top deputies oversaw health agencies that were slow to alert the public to the magnitude of the crisis, to produce a test to tell patients if they were sick, and to provide protective masks to hospitals even as physicians pleaded for them.

The first test created by the CDC, meant to be used by other labs, was plagued by a glitch that rendered it useless and wasn’t fixed for weeks. It wasn’t until March that tests by other labs went into production. The lack of tests “limited hospitals’ ability to monitor the health of patients and staff,” the HHS Inspector General said in a report this month. The equipment shortage “put staff and patients at risk.”

A promised virus surveillance programme failed to take root, despite assurances Azar gave to Congress. Rather than share information, three current and three former government officials told Reuters, Azar and top staff sidelined key agencies that could have played a higher-profile role in addressing the pandemic. “It was a mess,” said a White House official who worked with HHS.

Officials across the government, from President Trump on down, have been blasted for America’s halting response to the pandemic. Critics inside and outside the administration say a meaningful share of the responsibility lies with HHS and Trump appointee Azar.

“You have to blame the problem on the virus, but it’s Azar’s operation,” said Lynn Goldman, the dean of the public health school at George Washington University, who has served on advisory boards of the FDA and CDC. “And the buck stops there.”

HHS declined to make Azar available for an interview. Michael Caputo, the new chief HHS spokesman, declined to answer Reuters questions about Azar’s stewardship, saying in a statement: “We are communicating to the American public during a deadly pandemic.”

Dallas labradoodles

Azar is a Republican lawyer who once clerked for the late conservative Supreme Court Justice Antonin Scalia and counts current Supreme Court Justice Brett Kavanaugh as a friend. Under George W Bush, Azar worked for HHS as general counsel and deputy secretary.

During the Obama years, he cycled through the private sector as a pharmaceutical company lobbyist and executive for Eli Lilly. After Trump’s first HHS secretary was forced out in a travel corruption scandal, Azar stepped in, in January 2018.

Two years later, at the dawn of the coronavirus crisis, Azar appointed his most trusted aide and chief of staff, Harrison, as HHS’s main coordinator for the government’s response to the virus.

Harrison, 37, was an unusual choice, with no formal education in public health, management, or medicine and with only limited experience in the fields. In 2006, he joined HHS in a one-year stint as a “Confidential Assistant” to Azar, who was then deputy secretary. He also had posts working for Vice President Dick Cheney, the Department of Defense and a Washington public relations company.

Before joining the Trump Administration in January 2018, Harrison’s official HHS biography says, he “ran a small business in Texas.” The biography does not disclose the name or nature of that business, but his personal financial disclosure forms show that from 2012 until 2018 he ran a company called Dallas Labradoodles.

The company sells Australian Labradoodles, a breed that is a cross between a Labrador Retriever and a Poodle. He sold it in April 2018, his financial disclosure form said. HHS emailed Reuters that the sales price was US$225,000.

At HHS, Harrison was initially deputy chief of staff before being promoted, in the summer of 2019, to replace Azar’s first chief of staff, Peter Urbanowicz, an experienced hospital executive with decades of experience in public health.

This January, Harrison became a key manager of the HHS virus response. “Everyone had to report up through him,” said one HHS official.

One questionable decision, three sources say, came that month, after the White House announced it was convening a coronavirus task force. The HHS role was to muster resources from key public health agencies: the CDC, FDA, National Institutes of Health, Office of Global Affairs and the Assistant Secretary for Preparedness and Response.

Harrison decided, the sources say, to exclude FDA Commissioner Stephen Hahn from the task force. “He said he didn’t need to be included,” said one official with knowledge of the matter.

When task force members were announced Jan 29, neither Hahn nor the FDA were included. Hahn wasn’t put on the task force until Vice President Mike Pence took over in February. Two of Hahn’s high-profile counterparts were on it from the start: CDC director Robert Redfield and Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

The HHS denied it was Harrison’s decision to leave out Hahn and the FDA, but declined to say who made the call. The agency lauded Harrison’s work on the task force.

In a statement, Hahn said the FDA was focused on the coronavirus epidemic, “not on when we were added to the task force,” and that the agency was not “excluded.”

Fauci, who has become a public face of the Trump Administration’s Covid-19 effort, said he wasn’t sure including the FDA was necessary at the start. Initially, the Chinese government was saying the virus spread through animals, not human to human, he said. “You would include the FDA when you want to expedite drugs or devices,” Fauci said.

Others said the lack of a strong FDA role early on had direct consequences. Two sources familiar with events say the White House wasn’t getting information from the FDA about the state of the testing effort, a crucial element of the coronavirus response.

Reached by phone, Harrison declined to answer Reuters’ questions. In a later statement, he did not address questions about the task force but said he was proud of his work history. “Americans would be well served by having more government officials who have started and worked in small family businesses and fewer trying to use that experience to attack them and distort the record,” he wrote.

In a statement to Reuters, Azar said Harrison has been an asset. “From day one, Brian has demonstrated remarkable leadership and managerial talents,” Azar wrote.

Low risk?

In the pandemic’s early days, Azar offered words of both concern and assurance in public. On Jan 31, a day after the WHO declared Covid-19 a global health emergency, Azar declared it a public health emergency.

That same day, during the first Coronavirus Task Force briefing, Azar told the public: “I want to stress: The risk of infection for Americans remains low.”

The United States, he said, had taken adequate precautions. Travel restrictions and 14-day quarantines on Americans who had been to Wuhan, where the virus originated, were imposed. Americans returning from other parts of China had to self-quarantine.

The next week, on Feb 7, in another press conference, Azar repeated the message. “The immediate risk to the American public is low at this time,” he announced.

Behind the scenes, his aides say, Azar had alerted the White House in early January, and then later that month spoke directly to the president. It is unclear exactly what Azar told the president, because transcripts are not available.

“There’s a lot of CYA going on,” said one senior administration official, who said Azar never spelled out that stockpiles of protective equipment might be inadequate or the tests were not working. “We were told the test was ready. That turned out to be flat-out wrong.”

Trump denied Azar sent out alarms. “@SecAzar told me nothing until later,” he tweeted earlier this month.

Meanwhile, Azar continued to say “the immediate risk” to Americans was low and that travel restrictions had worked. “So I think so far, our measures have been quite effective,” he told NPR on Feb 14.

Others were raising alarms. “It’s not so much of a question of if this will happen any more, but rather more of a question of exactly when this will happen,” Dr Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, said at a Feb 25 news briefing.

More glitches

Responding to Congressional concerns, Azar said HHS had launched a coronavirus surveillance system in five cities. The plan was to test patients who showed up with flu symptoms, to see if they actually were infected with the novel coronavirus.

But the system was either delayed or not implemented in the cities and now is seen by epidemiologists as irrelevant given the massive community spread and continued inadequate testing.

By the end of February, Azar sought more money to attack the crisis as he testified before Congress. “This is an unprecedented potentially severe health challenge globally, and will require additional measures,” he said.

Still, he assured senators his agency was in control. “We have enacted the most aggressive containment measures in the history of our country,” he said.

He again provided words of calm, appearing on Fox News. “But thanks to President Trump’s historically aggressive containment efforts, we’ve actually contained the spread of this virus here in the United States at this point,” he said Feb 25. “I think part of the message to the American people is we all need to take a bit of deep breath here.”

“The government is working on this. You’ve got the right people on this.”

By the end of February, Azar and Harrison were no longer running the White House task force. That month, Vice President Pence took control. The FDA and Hahn are now actively involved. A Pence spokesperson said the issue of precluding the FDA from the task force “pre-dates the VP’s leadership” and declined further comment.

Azar seemed caught off guard by the change. “I’m still chairman of the task force,” he told the press after Pence took over.

Given Azar’s early struggles, the White House should have taken a stronger role over the task force from the outset, said Ashish Jha, director of Harvard University’s Global Health Institute. “It was very clear that Azar wasn’t able to marshal the forces across the government like he needed to,” he said.

Jeffrey Flier, a former Harvard Medical School dean, said the HHS role remains as vital as ever. As of Wednesday, over 47,000 Americans have died of Covid-19, and more than 830,000 have been infected.

“Clearly there was a need for better coordination of the FDA and CDC and other agencies,” he said. “HHS has to be operating effectively in a crisis like this.”

- Reuters

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