More than six weeks into the Trump administration’s response effort — which began Jan. 29 with the announcement of a coronavirus task force and, two days later, the declaration of a public health emergency — ramped-up testing for the virus has only just begun, hospital systems say they don’t have enough beds and medical supplies to handle the onslaught of anticipated patients, and there is a shortage of respirators, ventilators and other protective equipment for nurses and doctors on the front lines.
President Donald Trump, meanwhile, only recently shifted his tone: On Sunday, he called the virus “something we have tremendous control of.” By Monday, he was urging people to stay home and beginning to hurl the full might of thefederal government at what he described as “an invisible enemy.” But with confirmed cases soaring past 7,000 and now reaching into 50 states, officials are warning privately that it may be as long as 18 months before the pandemic is brought to heel.
To biodefense experts, the Trump administration’s sluggish response revealed a dangerous failure of imagination throughout the system, and showed how unprepared the government still is to handle a catastrophic biological event.
“The sense is that we haven’t fully prepared” for that possibility, said a U.S. government official who was not authorized to speak on the record. “If we had an attack, and even if we had the treatment or the vaccine that everyone needed, we don’t have the capacity to get that to 330 million Americans if we were in a lockdown situation where trucks weren’t moving. So that’s one thing that we’ve looked at.”
Other basic logistical questions also have yet to be resolved, the official added. “Can we create a capacity? What does that look like? Do we set it up in gymnasiums? Who’s going to do it? How are the things going to get delivered if you have sort of a general breakdown in the system?”
Covid-19 was not manufactured, and the risk of it being weaponized is extremely low given its highly infectious nature that would likely backfire on any group trying to spread it, experts said.
But an administration official cautioned that the prospect of intentional exposure targeting U.S. government employees “is a concern,” and noted that the Defense Department “has imposed a lot of travel restrictions” despite a certain amount of exposure being “inevitable.”
The FBI, whose field offices are known to allow “walk-in” tipsters, is also taking extra precautions. “In support of our mission, we are enacting measures to protect the FBI workforce, including heightened hygiene practices, social distancing options, like telework and flexible work schedules where appropriate, and authorizing only essential operational travel until further notice,” a spokesperson said.
The scale of the outbreak is the closest thing the U.S. has seen to how a bioweapon—which may take the form of viruses, bacteria, toxins, fungi and rickettsiae—can shut down a society and severely strain resources, several sources said.
“We haven’t seen anything that appears to be this pathogenic and transmissible since maybe 1918 or 1957,” said the U.S. government official. And the response so far to coronavirus, the official added, “shows that we don’t have the systems in place to rapidly diagnose cases, or to scale up a mass response very quickly.”
“We are in the realm now where biological weapons are really becoming possible,” the official said. “People have talked about [gene editing in bioweapons] for 50 years. … It is not science fiction anymore. Literally in the last five years we’ve crossed that threshold.”
Asha George, the executive director of the Bipartisan Commission on Biodefense, echoed those concerns. “What we’re seeing are all the places where we are vulnerable,” she said. “You can see people not really having thought about what impact a biological event would have on the nation in any number of different sectors.”
With the 2009 H1N1 pandemic, she said, a national strategy for pandemic influenza was already in place, though Dr. Deborah Birx, the White House Coronavirus Task Force response coordinator, acknowledged in a news conference on Tuesday that “now we are seeing we have to revise” the flu pandemic preparedness plan.
And because the U.S. deals with seasonal influenza every year, manufacturers already knew how to produce the necessary vaccines. The Food and Drug Administration’s emergency use authorization protocol, which clears labs to produce tests in the event of an outbreak, has also gotten more complicated—while it was streamlined for Ebola, Zika, and H1N1, the FDA was slow to trigger the workaround for coronavirus testing.
“It feels like we have regressed considerably,” said Gerstein.
The Bipartisan Commission on Biodefense, established in 2014 and co-chaired by former Sen. Joe Lieberman and former Homeland Security Secretary Tom Ridge, warned in 2018 that “the United States is underprepared for biological threats” from both terrorists and “nature itself,” via emerging and reemerging infectious diseases like Covid-19.
“Despite significant progress on several fronts, the Nation is dangerously vulnerable to a biological event,” reads the organization’s bipartisan report. “The root cause of this continuing vulnerability is the lack of strong centralized leadership at the highest level of government.”
The threat of a large-scale biological catastrophe, particularly one that hits all at once instead of over a period of weeks or months, is particularly problematic because the U.S. health care system is still “the weakest link” in the nation’s ability to respond effectively to an outbreak, said Ali S. Khan, dean of the College of Public Health at the University of Nebraska Medical Center.
“Routinely, we are not even able to surge for a bad flu season,” said Khan, who served as the CDC’s director of public health preparedness and response and helped establish the CDC’s bioterrorism program. During the 2017-18 flu season, one of the deadliest in 40 years, with more than 61,000 flu-related deaths across the country, overwhelmed hospitals in some parts of the country pitched tents outside ERs and used ambulances as stand-ins for patient rooms.
The detection capabilities are behind, too: While DHS has a BioWatch program that gathers air samples in 30 U.S. cities to monitor the threat of bioterrorism, it’s nearly two decades old and takes from 11 to 13 hours to determine whether a biological agent has been deployed.
The emergence and spread of Covid-19 should have been easier to predict and prepare for than a bioterror attack would be—but it still caught the administration by surprise.
It’s not as though the emergence of a novel disease with a significant mortality rate is “brand new,” Khan said, pointing to the SARS outbreak roughly 17 years ago. “We knew this was a possibility, so there are so no excuses. We are eight weeks behind where we should have been in terms of our planning.”
One of the biggest issues with planning effectively is that “public health is largely invisible, underappreciated, and as a result underfunded,” Umair A. Shah, a top Texas health official, told the House Homeland Security Committee in October. “This ‘Invisibility Crisis’ problem has unfortunately led to funding cuts for public health and public health preparedness at every level of government.”
George emphasized that the issue doesn’t lie just with the executive branch — Congress, with the power of the purse, needs to be an active partner in developing an agenda, assigning responsibilities and allocating the appropriate funds, instead of just “spitting out emergency supplementals.”
The U.S. launched a national stockpile program 20 years ago as a way to prepare for biological, chemical or nuclear attacks on the homeland. Its goal was initially to prepare for an unusual threat and was very oriented toward specific biological agents, George said. It now houses the country’s largest supply of vaccines and medical supplies for use in a public health emergency, like an outbreak of smallpox and anthrax, or widespread radiation sickness.
The stockpile is a work in progress, however. While the CDC now says there is enough smallpox vaccine in the stockpile for every American, it initially housed only 15 million doses, 90,000 of which were available for immediate use. The renowned epidemiologist D.A. Henderson, who led preparedness for the Department of Health and Human Services after 9/11, wrote in 2009 that the CDC also hadn’t checked the vaccines’ potency in nearly eight years, instead of every three as is required. (An HHS spokesperson also said in a statement that the Strategic National Stockpile participates in the FDA/DOD Shelf-life Extension Program “to extend the life of some products beyond their original use-by dates.”)
As the COVID-19 outbreak has demonstrated, the possibilities for a catastrophic biological event go beyond what was initially envisioned — so there needs to be an attendant increase in what goes into the stockpile, George said. Supplies are running low, particularly when it comes to ventilators — a growing necessity as Covid-19, a respiratory virus, spreads. In a news briefing on Monday, HHS Secretary Alex Azar declined to reveal the exact number of ventilators in the stockpile, citing “national security concerns.” (Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, has said the number is around 12,700.)
George and Khan explained that the numbers are a matter of national security because they could reveal a vulnerability. The idea is to prevent adversaries from exploiting a shortage by launching a biological attack that would require people to use a resource, like ventilators, in numbers too large to accommodate. “We don’t want to give our adversaries a road map,” Khan said.
But it is generally well known that ventilators and essential medical supplies like needles, gauze and gloves are in short supply, George said, as are other kinds of medicines, like fever reducers, which are necessary in cases like this, where the best that can be done for now is supportive rather than preventive care. A deployable vaccine is still at least a year away, Fauci said last week.
“We are in the exponential phase right now,” said Gerstein. “It’s only going to get worse. We are nowhere near the end of our transmission.”
Jason Millman contributed to this report.