"I am a Covid ICU nurse in NYC & yesterday I couldn’t fix my patient."

This is one of the most remarkable Facebook entries of the COVID-19 pandemic.
No intro needed. She speaks for many.
I see her post has also been published via Medium.

I read this on Facebook. It was written by Julianne Nicole an ICU nurse in the center of the crisis in NYC. I want her message to get as much exposure as possible. It is so heart wrenching and so well written. It is long, but you will be changed if you read it all.

I am a Covid ICU nurse in New York City, and yesterday, like many other days lately, I couldn’t fix my patient. Sure, that happens all the time in the ICU. It definitely wasn’t the first time. It certainly won’t be the last. What makes this patient noteworthy? A few things, actually. He was infected with Covid 19, and he will lose his battle with Covid 19. He is only 23 years old.

I was destroyed by his clinical course in a way that has only happened a few times in my nursing career. It wasn’t his presentation. I’ve seen that before. It wasn’t his complications. I’ve seen that too.

It was the grief. It was his parents. The grief I witnessed yesterday, was grief that I haven’t allowed myself to recognize since this runaway train got rolling here in early March. I could sense it. It was lingering in the periphery of my mind, but yesterday something in me gave way, and that grief rushed in.

I think I was struck by a lot of emotions and realities yesterday. Emotions that have been brewing for weeks, and realities that I have been stifling because I had to in order to do my job effectively. My therapist tells me weekly via facetime that it’s impossible to process trauma when the trauma is still occurring. It just keeps building.

I get home from work, take my trusty companion Apollo immediately out to pee, he’s been home for 14 hours at a time. I have to keep my dog walker safe. No one can come into my apartment.

I’ve already been very sick from my work exposure, and I’m heavily exposed every day that I work since I returned after being 72 hours afebrile, the new standard for healthcare workers. That was after a week of running a fever of 104 even with Tylenol around the clock, but thankfully without respiratory symptoms. I was lucky.

Like every other healthcare worker on the planet right now, I strip inside the door, throw all the scrubs in the wash, bleach wipe all of my every day carry supplies, shoes and work bag stay at the bottom of the stairs.

You see, there’s a descending level of Covid contamination as you ascend the stairs just inside my apartment door. Work bag and shoes stay at the bottom. Dog walking shoes next step up, then dog leash, then running shoes.

I dodge my excited and doofy German shepherd, who is bringing me every toy he has to play with, and I go and scald myself for 20 minutes in a hot shower. Washing off the germs, metaphorically washing off the weight of the day.

We play fetch after the shower. Once he’s tired, I lay on the floor with him, holding him tight, until I’m ready to get up and eat, but sometimes I just go straight to bed.

Quite honestly, I’m so tired of the death. With three days off from what has been two months of literal hell on earth as a Covid ICU nurse in NYC, I’m having an evening glass of wine, and munching on the twizzlers my dear aunt sent me from Upstate NY, while my dog is bouncing off the walls because I still don’t have the energy to run every day with him.

Is it the residual effects of the virus? Is it just general exhaustion from working three days in a row? Regardless, the thoughts are finally bleeding out of my mind and into a medium that I’m not sure could possibly convey the reality of this experience.

There’s been a significant change in how we approach the critically ill covid-infected patients on a number of different levels over the last two months. We’re learning about the virus. We’re following trends and patterns. We are researching as we are treating.

The reality is, the people who get sick later in this pandemic will have a better chance for survival. Yet, every day working feels like Groundhog Day. All of the patients have developed the same issues. This 23-year-old kid walked around for a week silently hypoxic and silently dying. By the time he got to us, it was already far too late.

First pneumonia, then Acute Respiratory Distress Syndrome (ARDS), essentially lung failure. Then kidney failure from global hypoxia and the medications we were giving in the beginning, desperately trying to find something that works. Then learning that it doesn’t work, it’s doing more harm than good in the critical care Covid population.

Dialysis for the kidneys. They are so sick that your normal three-times weekly dialysis schedule is too harsh on their body. They’re too unstable. So, we, the ICU nurses, run the dialysis slowly and continuously.

They are all obstructing their bowels from the ever-changing array of medications, as we ran out of some medications completely during our surge. We had to substitute alternatives, narcotics, sedatives, and paralytics, medications we’re heavily sedating and treating their pain with, in an effort to help them tolerate barbaric ventilator settings.

Barbaric ventilator settings while lying them on their bellies because their lungs are so damaged that we have to flip them onto their bellies in an effort to perfuse the functioning lung tissue and ventilate the damaged lung tissue.

Lungs that are perfused with blood that doesn’t even have adequate oxygen carrying capacity because of how this virus attacks.

Blood that clots. And bleeds. And clots. And bleeds. Everything in their bodies is deranged. Treat the clots with continuous anticoagulation. Stop the anticoagulation when they bleed.

GI bleeds, brain bleeds, pulmonary emboli, strokes. The brain bleeds will likely die. The GI bleeds get blood transfusions and interventions.

Restart the anticoagulation when they clot their continuous or intermittent dialysis filters, rendering them unusable, because we’re trying not to let them die slowly from renal failure. We are constantly making impossible treatment decisions in the critical care pandemic population.

A lot of people have asked me what it’s like here. I truly don’t have adequate descriptors in my vocabulary, try as I might, so I’ll defer to the metaphor of fire.

We are attempting to put out one fire, while three more are cropping up. Then we find out a week or two later that we unknowingly threw gasoline on one fire, because there’s still so much we don’t know about this virus.

Then suddenly there’s no water to fight the fire with. We’re running around holding ice cubes in an effort to put out an inferno. Oh yeah, and the entire time you’ve been in this burning building, you barely have what you need to protect yourself.

The protection you’re using, the guidelines governing that protection, evolved with the surge. One-time use N95? That’s the prior standard, and after what we’ve been through, that’s honestly hysterical. As we were surging here, the CDC revised their guidelines, because the PPE shortage was so critical.

Use anything, they said. Use whatever you have for as long as you can, and improvise what you don’t have.

As we’re discussing medication and viral research, starting clinical trials, talking treatment options in morning rounds for your patient with the team of doctors and clinical pharmacists, suddenly, surprise! Your patient developed a mucous plug in his breathing tube.

Yes, that vital, precious tube that’s connected to the ventilator that’s breathing for them. It’s completely plugged. Blocked. No oxygen or carbon dioxide in or out. It’s a critical emergency.

Even with nebulizer treatments, once we finally had the closed-delivery systems we needed to administer these medications and keep ourselves safe, they’re still plugging. We cannot even routinely suction unless we absolutely have to because suctioning steals all of the positive pressure that’s keeping them alive from the ventilator circuit. One routine suction pass down the breathing tube could kill someone, or leave their body and vital organs hypoxic for hours after.

Well, now they’re plugged. We are then faced with a choice. Both choices place the respiratory therapists, nurses, and doctors at extremely high risk for aerosolized exposure.

We could exchange the breathing tube, but that could take too long, the patient may die in the 2-3 minutes we need to assemble the supplies and manpower needed, and it’s one of the highest-risk procedures for our providers that we could possibly carry out.

Or we could use the clamps that have been the best addition to my every day carry nursing arsenal. You yell for help, you’re alone in the room. Your friends and coworkers, respiratory therapists, doctors, are all rushing to get their PPE on and get into the room to help.

You move around the room cluttered with machines and life sustaining therapies to set up what you need to stave off death. You move deliberately, and you move FAST. The patient is decompensating in the now-familiar and coordinated effort to intervene.

Attach the ambu bag to wall oxygen. Turn it all the way up. Where’s the PEEP valve? God, someone go grab me the PEEP valve off the ambu bag in room 11 next door. We ran out of those a month ago, too. It’s all covid anyway, all of it is covid. Risk cross-contamination or risk imminent death for your patient, risk extreme viral load exposure for you and your coworkers, and most certain death for your patient if you intervene without a PEEP valve.

You clamp the breathing tube, tight. The respiratory therapist shuts off the ventilator, because that side of the circuit can aerosolize and spray virus too if you leave it blasting air after you disconnect. Open the circuit. Respiratory therapy attaches the ambu bag. You unclamp. Bag, bag, bag. Clear the plug. The patient’s oxygen saturation is 23%. Their heart rate is slowing. Their blood pressure is tanking. Max all your drips, then watch and wait while this patient takes 3 hours to recover to a measly oxygen saturation of 82%, the best you’ll get from them all shift. These patients have no pulmonary reserve.

All of our choices to intervene in this situation risk our own health and safety. In the beginning we were more cautious with ourselves. We don’t want to get sick. We don’t want to be a patient in our own ICU. We’ve cared for our own staff in our ICUs. We don’t want to die. Now? I’ve already been sick. I am so, so tired of the constant death that is the ICU, that personally, I will do anything as long as I have my weeks old N95 and face shield on, just to keep someone alive.

I’ve realized that for many of these patients in the ICU, it won’t matter what I do. It won’t matter how hard I work, though I’ll still work like a crazy person all day, aggressively advocate for my patients in the same way.

My coworkers will go without meals, even though they’re being donated and delivered by people who love and support you. Generous people are helping to keep local restaurants afloat. We can always take the meal home for dinner, or I can devour a slice of pizza as I walk out to my truck parked on the pier, a walk I look forward to every day, because it gives me about eight minutes of silence. To process. To reflect.

I’ll chug a Gatorade when I start feeling lightheaded and I’m seeing stars, immediately after I just pushed an amp of bicarb on a patient and I know I have at least five minutes of a stable blood pressure to step out of the unit, take off my mask and actually breathe.

Every dedicated staff member is working tirelessly to help. The now-closed dental clinic staff has been trained to work in the respiratory lab to run our arterial blood gases, so that the absolutely incredible respiratory therapists who we so desperately need can take care of the patients with us.

Nurses in procedural areas that were closed have been repurposed to work as runners. To run for supplies while the primary nurse is in an isolation room trying to stabilize a patient without the supplies they need, runners to run for blood transfusions.

Physical therapists, occupational therapists, speech and language pathologists being repurposed to be part of the proning teams that helps the nurses turn patients onto their backs and bellies amidst a tangled web of critical lines and tubes, where one small error could mean death for the patient, and exposure for all staff.

Anesthesiologists and residents are managing airways and lines when carrying out these massive patient position changes. Surgical residents are all over the hospital just to put in the critical invasive lines we need in all of our patients.

The travel nurses who rushed into this burning building to help us are easing a healthcare system. The first travel nurse I met came all the way from Texas. Others terminated their steady employment to enlist with a travel agency to help us. Every day there are more travelers arriving.

A nurse from LA came to me after she found out I was part of the home staff, in my home unit, where this all first started in my hospital what feels like a lifetime ago, and said, “I came here for you. For all of the nurses. Because I couldn’t imagine working the way you guys were working for how long you were working like that”. During our surge and peak in the ICU, we were 1:3 ratios with three patients who normally would be a 1:1 assignment. And they were all trying to die at the same time. We were having to choose which patients we were rushing to because we couldn’t help them all at the same time.

The overhead pages for emergencies throughout the hospital rang out and echoed endlessly. Every minute, another rapid response call. Another anesthesia page for an intubation. Another cardiopulmonary arrest. A hospital bursting at the seams with death. Refrigerated trailers being filled.

First it was our normal white body bags. Then orange disaster bags. Then blue tarp bags. We ran out of those too. Now, black bags.

The heartbreakingly unique part of this pandemic, is that these patients are so alone. We are here, but they are suffering alone, with no familiar face or voice. They are dying alone, surrounded by strangers crying into their own masks, trying not to let our precious N95 get wet, trying not to touch our faces with contaminated hands.

Their families are home, waiting for the phone call with their daily update. Some of their loved ones are also sick and quarantined at home.

Can you even IMAGINE? Your husband or wife, mother or father. Sibling. Your child. You drop your loved one off at the emergency department entrance, and you never, ever see them alive again.

Families are home, getting phone calls every day that they’re getting worse. Or maybe they’re getting better. Unfortunately, the ICU in what has quickly become the global epicenter for this pandemic is not a happy place. We are mostly purgatory where I work, so this snapshot may be more morbid than most.

These people are saying goodbye to their loved ones, while they’re still walking and talking, and then maybe a week or two later, they’re just gone. It’s like they disappeared into thin air.

That level of grief is absolutely astounding to me, and that’s coming from a person who knows grief. I was there at the bedside, I held my young husband’s hand when I watched his heart stop beating. I was there. That grief changes you immeasurably.

But this grief? This pandemic grief? It’s inconceivable. These families will suffer horribly, every day for the rest of their lives. They might not even be able to bury their loved one. God, if they can’t afford a funeral with an economic shut-down, their loved one will be buried in a mass grave on Hart Island with thousands of others like them. What grave will they have to visit on birthdays and holidays?

Yesterday, I was preparing for a bedside endoscopy procedure to secure a catastrophic GI bleed in this 23-year-old patient.

It was a bleed that required a massive transfusion protocol where the blood bank releases coolers of uncrossmatched O negative blood in an emergency, an overhead page that, ironically, I heard as I was getting into the elevator to head to the fourth floor for my shift yesterday morning; a massive transfusion protocol that I found out I would own as a primary nurse, as I desperately squeezed liters of IV fluids into this patient until we got the cooler full of blood products, and then pumped this patient full of units of blood until we could intervene with endoscopy.

Before the procedure, I stopped everything I was doing that wasn’t life-sustaining. I stopped gathering supplies to start and assist with the procedure.

I told the doctors that I would not do a required “time-out” procedure until I got my phone out, and I facetimed this kid’s mom because I didn’t think he would survive the bedside procedure.

She cried. She wailed. She begged her son to open his eyes, to breathe. She begged me to help her. Ayudame. Ayudame. She begged me to help him. She sang to him. She told him he was strong. She told him how much she loved him. I listened to her heart breaking in real time while she talked to her son, while she saw his swollen face, her baby boy, dying before her eyes through a phone.

Later in the day, after the procedure, his mom and dad came to the hospital. He survived the securement of the bleed, but he was still getting worse no matter what we did. He’s going to die. And against policy, we fought to get them up to see their son.

We found them masks and gowns that we’re still rationing in the hospital, and we let his parents see him, hold him. We let them be with their son.

Like every other nurse would do in the ICU here, I bounced around the room, moving mom from one side of the bed to the other and back again, so I could do what I needed to do, setting up my continuous dialysis machine, with the ONE filter that supply sent up for my use to initiate dialysis therapy. This spaceship-like machine, finicky as all hell, and I had one shot to prime this machine successfully to start dialysis therapy to try to slowly correct the metabolic acidosis that was just ONE of the problems that was killing him as his systolic blood pressure lingered in the 70s, despite maxing all of my blood pressure mediations.

Continuous dialysis started. You press start and hold your breath. You’re not removing any fluid, just filtering the blood, but even the tiniest of fluid shifts in this patient could kill him. But you have no choice.

His vital signs started to look concerning. I could feel the dread in the pit of my stomach, this was going south very quickly. Another nurse and the patient’s father had to physically drag this mother out of the room so we could fill the room with the brains and eyes and hands that would keep this boy alive for another hour.

She wailed in the hallway. Nurses in the next unit down the hall heard her cries through two sets of closed fire doors. We worked furiously to stabilize him for the next four hours.

Twenty minutes before the end of my shift last night, I sat with the attending physician and the parents in a quiet and deserted family waiting room outside the unit. I told his mother that no matter what I do, I cannot fix this. I have maximized everything I have, every tool and medicine at my disposal to save her son. I can’t save her son.

The doctor explained that no matter what we do, his body is failing him. No matter what we do, her son will die. They realized that no matter how hard they pray, no matter how much they want to tear down walls, no matter how many times his mother begs and pleads, “take me instead, I would rather die myself than lose my son”, we cannot save him.

We stayed while she screamed. We stayed until she finally let go of her vice grip on my hands, her body trembling uncontrollably, as she dissolved into her grief, in the arms of her husband.

This is ONE patient. One patient, in one ICU, in one hospital, in one city, in one country, on a planet being ravaged by a virus.

This is the tiniest, devastating snapshot of one patient and one family and their unimaginable grief. Yet, the weight is enormous.

The world should feel that weight too. Because this grief, this heartbreak is everywhere in many forms. Every person on this planet is grieving the loss of something.

Whether that’s freedom or autonomy sacrificed for the greater good. Whether that’s a paycheck or a business, or their livelihood, or maybe they’re grieving the loss of a loved one while still fighting to earn a paycheck, or waiting for government financial relief that they don’t know for certain will come. Maybe they’re a high school senior who will never get to have the graduation they dreamed of. Maybe they’re a college senior, who won’t get to have their senior game they so looked forward to. Maybe they’re afraid that the government is encroaching on their constitutional rights. Maybe it’s their first pregnancy, and it’s nothing like they imagined because of the terrifying world surrounding them.

Or maybe they lost a loved one, maybe someone they love is sick, and they can’t go see them, because there are no visitors allowed and they’re an essential worker. Maybe all they can see of someone they love is a random facetime call in the middle of the day from an area code and a number they don’t know.

Everyone is grieving. We’ve heard plenty of the public’s grief.

I don’t blame anyone for how they’re coping with that grief, even if it frustrates the ever-living hell out of me as I drown in death every day at work. It’s all valid. Everyone’s grief is different, but it doesn’t change the discomfort, the despair on various levels. We are at the bottom of Maslow’s hierarchy of needs. Basic survival, physiological and safety needs. I’ve been here before. I know this feeling. How we survive is how we survive.

Now that I’ve had the time to reflect and write, now that I’ve let the walls down in my mind to let the grief flood in, now that I’ve seen this grief for what feels like the thousandth time since the first week of March as a nurse in a Covid ICU in New York City, it’s time you heard our side. This is devastating. This is our reality. This is our grief.

Healthcare in America -- NY Times Link

It's not my habit to copy copyrighted content except for a few quotes. But in this case I'm taking the entire column hoping not to get in trouble because the message and content are vitally important. This by Michael Schwirtz (Photographs by Kirsten Luce) dated April 26, 2020, is a snapshot of healthcare all over America.
Urban tracts are in large cities with the same inequities cited here, as well as rural areas where hospitals are vanishing altogether. New York Times is a source the president calls "fake news".

One rich NY hospital got Warren Buffett’s help. This one got duct tape

It has been hours since the 71-year-old man in Room 3 of the intensive care unit succumbed to Covid-19, the disease caused by the coronavirus. His body has been cleaned, packed in an orange bag and covered in a white sheet, but the overextended transport team from the morgue has yet to arrive.

The nurses on duty have too many other worries. University Hospital of Brooklyn, in the heart of the city hit hardest by a world-altering pandemic, can seem like it is falling apart. The roof leaks. The corroded pipes burst with alarming frequency. On one of the intensive care units, plastic tarps and duct tape serve as flimsy barriers separating patients. Nurses record vital signs with pen and paper, rather than computer systems.

A patient in Room 2 is losing blood pressure and needs an ultrasound. A therapist is working to calm a woman in Room 4 who is intubated and semiconscious and who tried to rip out her breathing tube when her arm restraints were unfastened.

Genevieve Watson-Grey, the head nurse on duty, says she relies on faith and prayer to fill the gap between need and reality. “Knowing there is a higher force above,” she says, gives her hope.
Every hospital in New York has struggled to cope with the pandemic, but the outbreak has laid bare the deep disparities in the city’s health care system. The virus is killing black and Latino New Yorkers at about twice the rate of white residents, and hospitals serving the sickest patients often work with the fewest resources.

Wealthy private hospitals, primarily in Manhattan, have been able to marshal reserves of cash and political clout to increase patient capacity quickly, ramp up testing and acquire protective gear. At the height of the surge, the Mount Sinai health system was able to enlist private planes from Warren E. Buffett’s company to fly in coveted N95 masks from China.

University Hospital, which is publicly funded and part of SUNY Downstate Health Sciences University, has tried to raise money for protective gear through a GoFundMe page started by a resident physician.

Most of the hospital’s patients are poor and people of color, and it gets more than 80 percent of its revenue from government programs like Medicare and Medicaid.

Dr. Robert Foronjy, the hospital’s chief of pulmonary and critical care medicine, oversees the unit with the plastic tarps and duct tape. He said that he did not believe that any patients were lost because of inadequate resources. But the “aged and crumbling” facilities, he said, had made the job of caring for such patients much harder.

“Why shouldn’t an African-American have facilities that are at the same level of other patient populations?” he said.

When George James, a 60-year-old former public housing superintendent arrived at University Hospital in March to have an infection unrelated to the coronavirus treated, he did not have Covid-19 symptoms. Within days, though, he tested positive for the disease. As he gasped for breath one night in his hospital bed, he panicked when he was unable to call a nurse.

“I didn’t go to sleep the whole night because I was scared,” he said. “I couldn’t breathe.”
Instead of a modern call button or intercom system, all he had was a silver bell, the kind used in hotels decades ago to summon the concierge.

‘We need a new hospital’

It was late February and Dr. Wayne J. Riley, president of SUNY Downstate Health Sciences University, was at a conference in Atlanta when his phone began to ping with ominous messages. It was becoming clearer that the novel coronavirus, which had ravaged parts of China and Italy, had begun to spread rapidly in the United States.

“I said, ‘My gosh, if this thing really does take root in the United States then, here in Brooklyn, we’re going to have a problem,’” he recalled.

Not only did Dr. Riley worry about the resources that would be needed to provide care during a pandemic, he feared that the hospital’s patients would be particularly susceptible to the disease.

The central Brooklyn neighborhoods where most of University Hospital’s patients live, East Flatbush and Prospect Lefferts Gardens, have higher-than-average concentrations of chronic diseases like diabetes, hypertension and obesity, which preliminary studies have shown make Covid-19 most deadly.

The hospital opened in 1963 and it was meant to accommodate about 60,000 visits a year. Despite having almost no physical improvements, it now handles about 200,000 visits annually. The bunkerlike concrete building is crumbling from within. Earlier this year, a leaky roof forced a temporary evacuation of premature babies from a neonatal intensive care unit.

“It is too, too old compared to other hospitals across the water,” Dr. Riley said. “We need a new hospital to be prepared for the next pandemic and to better serve our community.”

Signs inside the hospital are written in English, Spanish and Creole, a reflection of the large number of immigrants in the area, particularly from the West Indies.

Many of the patients work but are poor or receive government assistance. Many are uninsured and use the hospital for emergencies and primary care. They come from a men’s shelter up the street or from a nearby home for domestic violence survivors to fill prescriptions or to have their diabetes checked.

“The day-to-day stress on these communities is just incredible, and that is driving these conditions,” said Dr. Moro Salifu, the chairman of the hospital’s department of medicine.

The hospital has been in financial disarray for years. A 2013 audit by the state comptroller’s office found that it was on a path toward insolvency. It was bleeding millions of dollars every week, the audit found, and only infusions of state money were keeping it afloat. It has also been poorly managed. Subsequent audits found that hospital leaders had used government money on a lavish birthday celebration in Bermuda for a consultant who was paid tens of millions of dollars, but who did very little to improve the hospital’s finances.

Dr. Riley, who became president in 2017, after the Bermuda birthday celebration, insisted that the limited resources had not affected the quality of care. The hospital, though, has at times been accused of violating safety standards.

Last July, the hospital suspended its transplant program after a review uncovered high mortality rates and serious safety concerns. Two doctors, the surgery department’s former chairman and another surgeon, filed wrongful termination lawsuits, accusing hospital officials of firing them as retaliation for their complaints about lax safety standards. The program has since been reactivated.

Even so, the hospital is vital to the community. Together with its affiliated teaching university, it is Brooklyn’s fourth-largest employer. The university, which is part of the State University of New York system, is the largest medical college in New York City, and it produces a large percentage of the doctors working here.

When the pandemic first hit the city, Andrew M. Cuomo, New York’s governor, ordered the hospital to take only patients who had the virus. The decision rankled medical workers and others, who complained about having to shoulder the heavy burden with limited resources.

“We’re now in a situation where an under-resourced hospital is being asked to manage the epicenter of the crisis,” said Zellnor Myrie, a Democratic state senator whose district includes University Hospital. “The dollars that we failed to invest years ago are affecting life-and-death decisions now.”

‘This is someone’s mother’

The first patient with Covid-19 at University Hospital, a 74-year-old woman on dialysis with hypertension and diabetes, was identified on March 12.

“I got the first call at 5:51 p.m. that we had our first case,” said Dr. Salifu, the department of medicine chairman. “I remember exactly where I was on 9/11, and I knew exactly where I was when I got this call.”

Within days, the cramped emergency room, which looks much the same as it did when the hospital first opened, was inundated. At times, more than 100 coughing, feverish patients were packed into hallways and side rooms, or clustered around the nursing station, spewing virus into the air.

The hospital came close to running out of ventilators. Julie Eason, the director of respiratory therapy, said she had to “get a little bit creative” as she tried to ration resources while keeping up with all of the Code 99s, the term used when a patient needs to be intubated.

“It was just endless,” she said. “Code 99s would come in three, four different rooms all within a few minutes of each other, all day long.”

Medical workers began to get sick, and several nurses ended up intubated in the hospital’s I.C.U.

“We were stewing in it,” an emergency room doctor, Lorenzo Paladino, said.

Doctors and nurses complained that the conditions put them at greater risk than colleagues at other hospitals.

Dr. Foronjy, the I.C.U. physician, said he knew a doctor at a well-funded Manhattan hospital who walked around without a mask, assured that the sealed-off negative-pressure rooms there would protect him from the virus-infected patients inside.
Not so at University Hospital.
“Having to work with such an antiquated infrastructure is incredibly stressful,” Dr. Foronjy said. “You have to worry more about your own safety.”

The city and state health departments have not released data on mortality rates by hospital, but given the high instance of pre-existing conditions among patients at University Hospital, doctors there estimated that its mortality rates must be among the highest in the city.

As the death toll began to mount, the bodies overwhelmed the hospital’s small, 10-person morgue. Then they filled not one, but two refrigerated tractor-trailers parked outside.

The hospital’s mortician, Michael McGillicuddy, had to hire six additional staff members to help manage the morgue. Recently, a steady stream of black hearses has arrived at the hospital each day to pick up bodies, but new ones soon replace those that are taken away.

“I’m doing it with dignity, trying not to pile the bodies up,” Mr. McGillicuddy said. “This is someone’s mother or grandmother.”

‘We don’t have a lot of money’

Although the rate of new infections is dropping in New York, the intensive care units at University Hospital are full. Nearly 50 patients remain in serious condition, attached to ventilators. Some have been hospitalized for weeks, their limbs nestled in yellow foam cushions to prevent bed sores. (Reporters with The New York Times spent two days at the hospital but did not have access to patient information because of privacy regulations.)

Nurses on the units said they were overworked and understaffed. In normal times, their jobs are so demanding that they are required to care for no more than two patients at once. Now, they are tending to three or four at a time, increasing the risk of mistakes.

Ventilators, which take over for virus-battered lungs and have been crucial in the pandemic, require constant calibration to keep patients’ oxygen levels just right. Nurses must monitor endotracheal tubes, which can get clogged and block airways. In Covid-19 patients, the heart or the kidneys can fail without warning.

A lack of protective gear remains a problem. Much of what the nurses are wearing is mismatched, donated from friends and neighbors or brought from home. One nurse complained that she had bought her mask herself and had been wearing the same bootees on her feet for the past three days.

“As you know, we are a state facility. We don’t have a lot of money,” said Rose Green, a nurse who was helping to staff the unit on her day off.

The hospital has begun to celebrate some successes. Recently, a nurse and a nursing assistant were taken off ventilators. On April 16, the hospital posted a video on Twitter of another nurse who had been intubated after coming down with Covid-19. She was being wheeled out of the emergency room to applause from colleagues.

On a recent day, a man in his 50s who had just come off a ventilator was sitting up in his room drinking a bottle of juice.

A nurse passed by and waved excitedly.

Learning About Bigotry at an Early Age

This is an excerpt from shaggy-dog reflections I scribbled in 2008 in the aftermath of the market crash of 2008.

Early exposures to antisemitism and other forms of bigotry were part of my growing up. Although I was not Jewish, I had many friends who were, and a few time I went to Friday night services at the synagogue just to see for myself how they worshiped. I was much impressed that following the service there was always a sumptuous reception in the social hall below the sanctuary spread with treats I had seen only a few fancy occasions in my own limited experience. Later, when I felt that my Southern Baptist peers were not on the side of the angels at the start of the civil rights movement I found a college home at Hillel, the Jewish students organization, as the only non-Jew in their midst. it was there that I learned to enjoy lox, bagels, cream cheese and danish, and later, potato latkes and applesauce.

In 1959 when I was fourteen, two local controversies were raging in Columbus, Georgia that got my attention. One was a very acrimonious debate about whether the local water supply should be treated with fluoride because it was found that in parts of the country where fluoride occurred naturally in the local water there was a marked decrease in the incidence of tooth decay. Something about fluoride seems to protect against cavities, hence those references on toothpaste labels. The other debate had to do with whether or not the city and county governments should be combined into a single administrative entity for the sake of consistency and economy. I think it was called "consolidated government."

I was not aware of politics at the time, so I had no way of knowing that Columbus, Georgia was (and probably still is) what we would call an extremely conservative place. There are a lot of reasons for this which others can explain, but at the start of the Sixties there was already an active local chapter of the John Birch Society, a group I didn't have any knowledge of, except that they seemed to be four-square opposed to both water fluoridation and consolidated government.

Naive me, both proposals seemed to be eminently sensible and practical and I didn't see any problem with either. But this was the time when "Impeach Earl Warren" signs were all over the Southern countryside, George Wallace was soon to be standing in an Alabama schoolhouse door just a few miles away on the basis of "states rights," and there was a widespread and credible threat that Communists were just waiting to get control of everything we held dear.

It was in this milieu that none other that Robert Welch, founder of the John Birch Society, came to Columbus a couple years later to speak to local supporters at the old Royal Theater. There was no charge for admission, and it was at that time that I, along with two other high school students, sat politely through the man's speech and then passed out leaflets to people as they left warning them that the John Birch Society was not what they thought it was. It was a simple, four-page typed flyer run off on a church mimeograph machine, that said, in part...

• Just how so many Americans have been tricked into such Communist ruses as democracy, foreign aid, UNICEF, the United Nations, NATO, and national defense defies reason.
• We, the Teen-Age Democratic Club are not indifferent to the John Birch Society; We are willing to take a positive stand.
• We fear the Birch as a demagogic (gaining political influence through social discontent) and fantastic (a program of strong centralization, severe nationalism, and suppression of opposition) group. In this opinion, we accept the following wild-eyed "commie" supporters: "Time" and "Life" magazines, and the Los Angeles Times; The New York Times, J.Edgar Hoover, and Attorney General Robert Kennedy.

A local flap ensued during which a local columnist suggested that the three of us had been manipulated by some unknown but sinister outside agitator. Who knows? I didn't write the leaflet and the guy who brought it was a preacher's kid who had used the copying machine at a local Methodist church to execute his subversive plan. But that's not the point. The point is that I agreed with what it said and I was willing, even at that young age, to take a stand for what I thought.

A story of Islamic origin about Satan

I note this link for future reference because it includes an
interesting parallel with the New Testament story. I recall
my folklore professor's definition of myth as the highest
form of truth in any society. 

This glimpse of Islamic scripture-story tradition parallels the New Testament account of the temptation of Christ following a forty-day fast in the wilderness.

This is from Pier 22, a reprint from October 1, 2018. This is a browser translation.

How did Satan drive historical events?

The youth of the Quraysh tribes gather in front of the house of the Prophet Muhammad, declaring their swords in preparation for his departure in order to kill him with the blow of one man and scattering his blood between the tribes and making it difficult to take revenge on the children of Hashem. A brilliant idea came upon the masters of Makkah after the complexity of Muhammad and his companions had become difficult for them. They left the heart of their people with them with his new claim, this problem seemed unresolved to them, until the Faraj came to them "from another world" and inspired them to gather a fighter from every tribe who would kill him together, thus his blood would be in the neck of all the Quraysh tribes, and the people of Hashem would not have to fight them all. This is how they get rid of it without entering a bloody war. The minds of the symposium's elders did not succeed in introducing such a brilliant idea, but it required that the devil himself relinquish his historical role in waswaas and embodied among them as a Najdi sheikh who put forth his idea and then dissolved in the clouds. It is true that the idea did not succeed, and the Messenger escaped from it after Ali bin Abi Talib slept in his place, but it established in the books of narrations a new role for the devil and his war against the Prophet and his call, does not depend on the moral role of suggesting evil in the souls and does not track the weaknesses of the believers to spoil their blacks, but it is linked to an action. My physical body had an effect on the course of events. Perhaps the aforementioned incident is the most famous, but dozens of other lights, shrouded in the books of narrations, have made Satan a major driver of its events.

Among the famous story before the mission, the one that tells the role of the Prophet in distancing his people from fighting those who choose the place of the Black Stone after they rebuilt the sanctuary, after his mind guided him to a solution that satisfies everyone by placing the stone over his garment to carry him all and share this honor. Some narrators add that Satan embodied them in the form of an old Najdi, who shouted to them with his loudest voice: “May you please place this pillar - which is your honor - a young orphan without your teeth”, so he almost signed them again and fought, but they settled for what happened. Hussein Al-Hajj says in his book “Myth when Arabs are in ignorance.” They knew the devil in ignorance and mentioned it and described it in their poems. They talked about it as a horn of a bull, which made them imagine the bull if the cows advanced in drinking water as a demon because of its horns, and they believed that the Earth’s rotation was caused by Its reliance on the head of the bull, and as it moved from century to century, its movement changed, as they attributed to it the revelation of their poets and named each of them a devil that means guiding them with the wonderful words. "Arab myths before Islam". The Arabs did not delude the jinn as horrific beings that violate all the covenants of other nations, but are satisfied with their likeness in the image of animals, and to drop their Bedouin lives in their poetic simulations, without trying to invent whole myths, and they attribute every action they did not find to explain the ability of a paradise. Or a demon.

During his interpretation of the 48th verse of Surat Al-Anfal, “As Satan decorated them with their deeds and said,“ Today you do not win from people, and I am a neighbor to you. ”When the two categories appeared, we set back on his heels and said,“ I am innocent of you. I see what you don’t see. I fear God and God is very punished. ”Al-Tabari narrates from Ibn Abbas. According to the narration, the devil appeared on the day of the location of the full moon embodied and was followed by a soldier of his devil followers, and he was carrying his flag, and that he was embodied in the form of one of the nobles of Bani Kenana, which is Suraqah bin Malik bin Jaasham, and he aligned with the company of the polytheists intending to fight with them, saying to them, "I am your neighbor." But, as soon as he saw Gabriel until he became a mastermind, and when they denounced it, I did it, and he answered them, "I see what you do not see" and completed his withdrawal, and the Meccans suffered a resounding defeat. This was met with a muffled objection to "tuck" Satan did in an authentic hadith that talks about a battle that took place during Ramadan, especially as it contradicts another valid hadith that the devils are handcuffed, unable to move throughout the holy month, which required a response from the elders, saying that it may be the restriction on the right of the apostate only, and that that fighter in Badr has It is of a lower rank than to be restricted, or that the act of chaining is a protection and protection for Muslims and not for other infidels who are allowed to go to demons throughout the month of Ramadan and others. In the battle of Uhud, and while the Muslims were on the verge of defeat, after “some of them settled Satan with some of what they gained” (Al-Imran: 115) and enticed them to leave their places to reap the spoils, the polytheists managed to surround them, and even surrounded a number of them with the Messenger and nearly killed him and severely wounded him. A loud cry shouted, "Muhammad was killed .. Muhammad was killed", and it was known historically as "The cry of Satan". She resonated not only with the battlefield but reached the city, and none of the immigrant women and supporters left but left her house, as she appalled the souls of the fighting Muslims, and some historians attributed it to the devil as an intervention from him in favor of the polytheists, and to ensure the ultimate defeat of the army of the Prophet. Ibn Abbas tells of this cry, saying, "He did not doubt that he was right, and we still do not suspect that he was killed, until the Messenger of God, peace and blessings of God be upon him, rose between the two happiness. We know him by his reward if he walks, and he said: We rejoiced even as he did not suffer." It is also narrated that he included the Prophet’s journey on the night of Al-Israa, he saw “something recessive from the path” he tried to invite him to stop his career, but the Messenger did not answer him and Gabriel asked him: What is this? He did not respond to him except with "a secret ... a secret", and at the end of the road he made clear to him that the caller was the devil, and that he wished the messenger would be answered even once, because if it happened, the journey would have spoiled and the Muslims would follow. What is that? He did not respond to him except with "a secret... a secret", and at the end of the road he made clear to him that the caller was the devil, and that he wished the messenger would be answered even once, because if it happened, the journey would have spoiled and the Muslims would follow. What is that? He did not respond to him except with "a secret... a secret", and at the end of the road he made clear to him that the person calling the devil, and that he was wishing to answer the Messenger even once, because if it had happened, the journey would have spoiled and the Muslims would follow.

Abu Hurairah preaches and steals the "sweetness" of Hallaj

Abu Hurairah narrates that the Messenger entrusted him to save food, and one day he found a thief trying to take from him and he caught him and threatened him to raise his command to the Prophet, so he complained to him about his poverty and that his children almost died from hunger, dispersed him and left him, but this matter was repeated twice after, and in the third he got lost Abu Huraira decided that he would never leave him, so the thief told him that he would tell him words that would never help him to let him go, so he agreed, and the man advised him saying: If you come to your bed, read the verse of the Holy, because you will still be with you from God Almighty, a keeper, and Satan will not bring you close until you become. When Abu Huraira recounted this position to the Prophet, he commented: "Believe you and he is a liar, that is a demon." Ibn Al-Imad Al-Hanbali tells in his book “Nuggets of Gold” that the great Sheikh Abdul Qadir Al-Jilani went out on a journey and spent days finding no water and intensified his thirst, and the devil wanted to deceive him and he remained a cloud and sent dew on him, then he appeared to him in the midst of a halo of light and called him "O Abdul Qadir I am your Lord and I have forbidden you And the Sheikh answered him: I seek refuge in God from the accursed Satan, I have a damn thing, God would not have forbidden anything in the words of His Messenger and make it permissible for my guardians. The light turned dark and fled. In the context of Ibn Taymiyyah’s keenness to confirm the heresy of Al-Hallaj, he asserted that he “sometimes possesses demons and demons, who were with him (some of his followers) on the mountain of Abu Qubais, so they asked him for sweetness. Sweetness in Yemen, a demon carried by that spot, "justifying" his "miscreants" with which people were fascinated, analyzing the permissibility of his blood. 

Calls to idols and separates churches

The 23rd verse of Noah surmises that the beginning of the worship of Noah's people to idols came from their glorification of good men who appeared in them: “friendliness”, “sawa”, “sickness”, “impeding” and “eagle”, but Satan embodied them in the form of a human being He advised them to set up milestones reminiscent of the succeeding generations after them, and mites them to make them a mediator between them and God, before he persuaded them to worship the statues without God. With this, polytheism became evident in the people of Noah gradually by the action of Satan. In the Qur’anic verse, “They said: Do not give up your gods, nor do you give a friend, not a day, nor a relief, a handicap, and an eagle.” The Buddhist religion considers Satan "Mara" responsible for strenuous attempts to banish the Buddha through enlightenment, taking advantage of the latter's puzzlement in his journey to reach the truth, and during seven weeks of violent conflict with the priest and distracting him with sensual pleasure under a tree later known as " The Greek, whom they considered responsible for igniting wars and spreading diseases and other human and natural disasters. In the year 1535 AD, the great rift occurred between the Orthodox and Protestant churches, and they accused each other of submitting to Satan, and drawings from that period depicted the Devil spewing his lust in the head of a cleric. The Greek, whom they considered responsible for igniting wars and spreading diseases and other human and natural disasters. And in 1535 AD, the great rift occurred between the Orthodox and Protestant churches, and they accused each other of submitting to Satan, and drawings of the depiction of Satan spreading his lair in the head of a cleric. In the book of Tobiah (Good God) from the Bible, there is the “Ashmaday” of Satan, the king of the jinn and the goblins, who wears Sarah the daughter of Roel and slays those who marry her on the wedding night before entering into it until he killed 7 men, and is described as the most evil of the demons. In the end, Toubia marries her, whose guardian angel Azariah advises him to stay 3 days after marrying her, free to pray, then he burns the liver of the whale and defeats Satan, justifying what happened to the previous husbands that they got married, so God exiled their hearts and devoted their lusts as animals, so Satan had authority over them (Book of Toubia, chapter 1) VI), then the Tobia expels Satan with smoke and escapes to Egypt, where Raphael receives him and ties him up to suffocate him (Book of Tobiah, Chapter VIII). It also tells the Gospels of Matthew, Mark, and Luke. The facts of an interview that took place between Christ and Satan, who took advantage of his passage for a period of weakness after fasting for 40 consecutive days, and asked him several deceptive questions related to man's bodily needs such as hunger, safety and strength, but Christ succeeded in responding to him. Christian historians considered that this event was a repetition of the original sin site, during which Satan succeeded in getting man out of the Garden of Eden, but Christ failed its occurrence again and triumphed for humanity in a barren wilderness.

Gov. Cuomo Comments on Character

Life Dances Inside a Circle Made By Living, They Say

This Note is stolen from The Group News Blog, a site I discovered when I first began blogging years ago. The site has since been abandoned but is still accessible at this time. Unfortunately it takes my browser an eternity to discover it navigating through the interwebs so I made this copy for easier access and a backup in case the original disappears as often happens with the web. This As I write, the COVID-19 pandemic is in the the opening weeks and months of testing, social distancing and lock-down. So this story comes with special meaning.

"Yexaaiidela, go deyah, tc'iindii."

That is a repetitive line in many of the old Apache prayers. For most of my life I figured it was one of those nice sounding, but essentially meaningless things that they put into prayers. Like the poetic devices Homer would use. It was never simply "Hector" or "Achilles," it would be "Hector of the shining helm" and "Achilles, the swiftfooted mankiller." The device allowed the person reciting the poem to conjure up the next line or scene. It buys time for somebody in performance.

This image appears at the original site. 

I presume the words are Apache for the title of the post.

My daughter has begun her internship. Despite the grueling march of 72 hour shifts, the endless parade of mind numbing sameness that gets punctuated by something wild and critical, she is loving it.
Her only complaint is that the King of the Docs took a look at her name tag with the Apache name Ga'age Biitsahkesh, tried a couple of times to pronounce it and has dubbed her "Gidget." To her dismay the name has stuck. To the other interns, the residents, and the attendings, she is now "Dr. Gidget." I suggested that she start dubbing her colleagues "Moondoggy" and "Ratfink" which provided a tired chuckle but little consolation.

To tell you the rest of the story, I have to tell you this one.

The winter of 1958 on the White Mountain Apache Reservation was hard. Unusually heavy snowfalls, very low temperatures and a sudden freeze all contributed to the dangerous misery there. The Bureau of Indian Affairs was not responding to the pleading of the people for help and aid. They ignored the missionaries who were trying to keep our tiny school going. It was a Mormon year that time. One of the "teachers" was from a Mormon Ward in Mesa.

Their Bishop, his family has asked that I not name him, because they are old school Mormons who believe that doing good, and caring for your fellow human beings is something that should be expected, it is not something to be celebrated, so I'll just call him The Bishop, hearing of the plight on the rez, opened his Bishop's stores. This is something that the Mormons take very seriously. They encourage their members to keep a year's supply of canned and preserved foods, and each Ward's Bishop has control of an even larger storage.
The Bishop opened his stores. He directed the members of his Ward to gather at the storehouse, bringing their trucks and vans. They loaded them down with food, blankets, and warm clothes. They drove 350 miles from Mesa to the rez. They began to distribute those badly needed items. They did this without preaching or doing anything but try to find out where what the greatest needs were. When they had finished, they drove back to their home, loaded up again, and drove back.

Countless times during that bitter winter, they would load up their vehicles and drive the long bad roads to us. The Bishop contacted other Bishops and the Church President and even the Prophet in Salt Lake City. The efforts of those people saved our people. Washington would have let us starve. The government was still crying poor from fighting WWII and Korea. All of our cries for help fell on ears that were turned deaf by lack of funds and the ability to do anything.

The Mormons, but especially the Bishop refused to let that happen. I have my own differences with the LDS church. Even as offshoot sects of Christianity go, they have some really bizarre ass tenets of faith. I dislike the theocracy they have forged in Utah, I object to their meddling in politics.

With all of that though, I must say, the majority of Mormons that I have met were plain old good human beings. They are capable of great compassion, and limitless generosity. They spent an entire winter driving up to our rez to share their bounty and their food with us for the simple reason that we were hungry and they knew it.

Another program that the Mormons had was the "Indian Placement" program. They would take promising kids off of the reservations and house them with Mormon families so that we could attend high schools that had little luxuries, like teachers, and books.

The Bishop, when my cousin, the brilliant attorney, and I were at high school age, made it possible for us to enroll in placement. He went so far as to pull strings which made it possible for us to attend the same high school and be housed in the same neighborhood. He was kind enough to look the other way when my cousin and I would openly defy one of their most sacred rules by speaking to each other in Apache. We lied a little bit, we told him that he had been given an Apache name by the people and that the name was "Inago'it Ditah Tazhii." We told him that the name meant "Give Away Food Eagle," it really meant "Generous Turkey." White people like Indian names that say Eagle. It makes them feel all special and stuff.

No matter what measure of disapproval or even anger I might work up for the Mormons, I know that I owe them, and especially The Bishop, a debt that can never be truly reconciled. I owe not only the measure of the help they gave me and my people. I owe them my life. I owe them for allowing me to get a decent education, which they did after they made sure I didn't starve to death.

I will oppose them when they meddle in politics, but I will never do so without curbing any anger. I owe them that.

So, here we are with Dr. Gidget in one of her 72 hour runs. She goes in to see a patient, it's a 70ish year old man. She recognises the name, and the city he's from. She asks him straight out if he is any relation to The Bishop. The old man tells her "That was my father."

Dr. Gidget says "Your father saved my father's life."

They spent a long time talking about old times. The old man, as a boy, had made that long trip up to the rez many times. He says that he remembers our family from those trips and from when my cousin and I were living with members of his Ward while we went to high school.

My cousin and I sent flowers to his room the very next day. Our card wished him a full and a speedy recovery.

The life that I have lived has been danced truly within a circle made by living that life. Most of the cycles and spirals don't have such a tidy arc. There's a lot more jazz than Bach in my soundtrack.

Even with the reputation that the Apache have as fierce warriors from a ferocious warrior's culture, something that most folks don't know is that to go to war, with neighboring tribes, with other Apache, with anybody, the warrior's first had to get the approval of a council of grandmothers. The grandmothers try, in their council, to consider the impact of present decisions down through five to seven generations.

The rough, tough, badass of the world Apache warriors, wouldn't go to war unless their grammies said it was OK. It worked well for us.

I'm not sure what the meanings of all this are, maybe you can offer some meanings in the comments. I know that I am trying to take more care in the things I do today.

Yexaaiidela, go deyah, tc'iindii.
(having been prepared, he walks, they say)

Washington Post Op-ed, April 4, 2020

Some of us have a difficult time reading web content with full cognition because it is often infested with advertisements, videos, suggested hyperlinks and sidebar distractions. 

I copied just the content of this important piece in order to make it more readable to myself and others, hoping not to have violated any copyright laws.

Text to an epic Washington Post op-ed April 4, 2020.

By the time Donald Trump proclaimed himself a wartime president — and the coronavirus the enemy — the United States was already on course to see more of its people die than in the wars of Korea, Vietnam, Afghanistan and Iraq combined.

The country has adopted an array of wartime measures never employed collectively in U.S. history — banning incoming travelers from two continents, bringing commerce to a near-halt, enlisting industry to make emergency medical gear, and confining 230 million Americans to their homes in a desperate bid to survive an attack by an unseen adversary.

Despite these and other extreme steps, the United States will likely go down as the country that was supposedly best prepared to fight a pandemic but ended up catastrophically overmatched by the novel coronavirus, sustaining heavier casualties than any other nation.

It did not have to happen this way. Though not perfectly prepared, the United States had more expertise, resources, plans and epidemiological experience than dozens of countries that ultimately fared far better in fending off the virus.

The failure has echoes of the period leading up to 9/11: Warnings were sounded, including at the highest levels of government, but the president was deaf to them until the enemy had already struck.

The Trump administration received its first formal notification of the outbreak of the coronavirus in China on Jan. 3. Within days, U.S. spy agencies were signaling the seriousness of the threat to Trump by including a warning about the coronavirus — the first of many — in the President’s Daily Brief.

And yet, it took 70 days from that initial notification for Trump to treat the coronavirus not as a distant threat or harmless flu strain well under control, but as a lethal force that had outflanked America’s defenses and was poised to kill tens of thousands of citizens. That more-than-two-month stretch now stands as critical time that was squandered.

Trump’s baseless assertions in those weeks, including his claim that it would all just “miraculously” go away, sowed significant public confusion and contradicted the urgent messages of public health experts.

“While the media would rather speculate about outrageous claims of palace intrigue, President Trump and this Administration remain completely focused on the health and safety of the American people with around the clock work to slow the spread of the virus, expand testing, and expedite vaccine development," said Judd Deere, a spokesman for the president. "Because of the President’s leadership we will emerge from this challenge healthy, stronger, and with a prosperous and growing economy.”

The president’s behavior and combative statements were merely a visible layer on top of deeper levels of dysfunction.

The most consequential failure involved a breakdown in efforts to develop a diagnostic test that could be mass produced and distributed across the United States, enabling agencies to map early outbreaks of the disease, and impose quarantine measures to contain them. At one point, a Food and Drug Administration official tore into lab officials at the Centers for Disease Control and Prevention, telling them their lapses in protocol, including concerns that the lab did not meet the criteria for sterile conditions, were so serious that the FDA would “shut you down” if the CDC were a commercial, rather than government, entity.

Other failures cascaded through the system. The administration often seemed weeks behind the curve in reacting to the viral spread, closing doors that were already contaminated. Protracted arguments between the White House and public health agencies over funding, combined with a meager existing stockpile of emergency supplies, left vast stretches of the country’s health-care system without protective gear until the outbreak had become a pandemic. Infighting, turf wars and abrupt leadership changes hobbled the work of the coronavirus task force.

It may never be known how many thousands of deaths, or millions of infections, might have been prevented with a response that was more coherent, urgent and effective. But even now, there are many indications that the administration’s handling of the crisis had potentially devastating consequences.

Even the president’s base has begun to confront this reality. In mid-March, as Trump was rebranding himself a wartime president and belatedly urging the public to help slow the spread of the virus, Republican leaders were poring over grim polling data that suggested Trump was lulling his followers into a false sense of security in the face of a lethal threat.

The poll showed that far more Republicans than Democrats were being influenced by Trump’s dismissive depictions of the virus and the comparably scornful coverage on Fox News and other conservative networks. As a result, Republicans were in distressingly large numbers refusing to change travel plans, follow “social distancing” guidelines, stock up on supplies or otherwise take the coronavirus threat seriously.

“Denial is not likely to be a successful strategy for survival,” GOP pollster Neil Newhouse concluded in a document that was shared with GOP leaders on Capitol Hill and discussed widely at the White House. Trump’s most ardent supporters, it said, were “putting themselves and their loved ones in danger.”

Trump’s message was changing as the report swept through the GOP’s senior ranks. In recent days, Trump has bristled at reminders that he had once claimed the caseload would soon be “down to zero.”

More than 7,000 people have died of the coronavirus in the United States so far, with about 240,000 cases reported. But Trump has acknowledged that new models suggest that the eventual national death toll could be between 100,000 and 240,000.

Beyond the suffering in store for thousands of victims and their families, the outcome has altered the international standing of the United States, damaging and diminishing its reputation as a global leader in times of extraordinary adversity.

“This has been a real blow to the sense that America was competent,” said Gregory F. Treverton, a former chairman of the National Intelligence Council, the government’s senior-most provider of intelligence analysis. He stepped down from the NIC in January 2017 and now teaches at the University of Southern California. “That was part of our global role. Traditional friends and allies looked to us because they thought we could be competently called upon to work with them in a crisis. This has been the opposite of that.”

This article, which retraces the failures over the first 70 days of the coronavirus crisis, is based on 47 interviews with administration officials, public health experts, intelligence officers and others involved in fighting the pandemic. Many spoke on the condition of anonymity to discuss sensitive information and decisions.

Scanning the horizon

Public health authorities are part of a special breed of public servant — along with counterterrorism officials, military planners, aviation authorities and others — whose careers are consumed with contemplating worst-case scenarios.

The arsenal they wield against viral invaders is powerful, capable of smothering a new pathogen while scrambling for a cure, but easily overwhelmed if not mobilized in time. As a result, officials at the Department of Health and Human Services, the CDC and other agencies spend their days scanning the horizon for emerging dangers.

The CDC learned of a cluster of cases in China on Dec. 31 and began developing reports for HHS on Jan. 1. But the most unambiguous warning that U.S. officials received about the coronavirus came Jan. 3, when Robert Redfield, the CDC director, received a call from a counterpart in China. The official told Redfield that a mysterious respiratory illness was spreading in Wuhan, a congested commercial city of 11 million people in the communist country’s interior.

Redfield quickly relayed the disturbing news to Alex Azar, the secretary of HHS, the agency that oversees the CDC and other public health entities. Azar, in turn, ensured that the White House was notified, instructing his chief of staff to share the Chinese report with the National Security Council.

From that moment, the administration and the virus were locked in a race against a ticking clock, a competition for the upper hand between pathogen and prevention that would dictate the scale of the outbreak when it reached American shores, and determine how many would get sick or die.

The initial response was promising, but officials also immediately encountered obstacles.

On Jan. 6, Redfield sent a letter to the Chinese offering to send help, including a team of CDC scientists. China rebuffed the offer for weeks, turning away assistance and depriving U.S. authorities of an early chance to get a sample of the virus, critical for developing diagnostic tests and any potential vaccine.

China impeded the U.S. response in other ways, including by withholding accurate information about the outbreak. Beijing had a long track record of downplaying illnesses that emerged within its borders, an impulse that U.S. officials attribute to a desire by the country’s leaders to avoid embarrassment and accountability with China’s 1.3 billion people and other countries that find themselves in the pathogen’s path.

China stuck to this costly script in the case of the coronavirus, reporting Jan. 14 that it had seen “no clear evidence of human-to-human transmission.” U.S. officials treated the claim with skepticism that intensified when the first case surfaced outside China with a reported infection in Thailand.

A week earlier, senior officials at HHS had begun convening an intra-agency task force including Redfield, Azar and Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. The following week, there were also scattered meetings at the White House with officials from the National Security Council and State Department, focused mainly on when and whether to bring back government employees in China.

U.S. officials began taking preliminary steps to counter a potential outbreak. By mid-January, Robert Kadlec, an Air Force officer and physician who serves as assistant secretary for preparedness and response at HHS, had instructed subordinates to draw up contingency plans for enforcing the Defense Production Act, a measure that enables the government to compel private companies to produce equipment or devices critical to the country’s security. Aides were bitterly divided over whether to implement the act, and nothing happened for many weeks.

On Jan. 14, Kadlec scribbled a single word in a notebook he carries: “Coronavirus!!!”

Despite the flurry of activity at lower levels of his administration, Trump was not substantially briefed by health officials about the coronavirus until Jan.18, when, while spending the weekend at Mar-a-Lago, he took a call from Azar.

Even before the heath secretary could get a word in about the virus, Trump cut him off and began criticizing Azar for his handling of an aborted federal ban on vaping products, a matter that vexed the president.

At the time, Trump was in the throes of an impeachment battle over his alleged attempt to coerce political favors from the leader of Ukraine. Acquittal seemed certain by the GOP-controlled Senate, but Trump was preoccupied with the trial, calling lawmakers late at night to rant, and making lists of perceived enemies he would seek to punish when the case against him concluded.

In hindsight, officials said, Azar could have been more forceful in urging Trump to turn at least some of his attention to a threat that would soon pose an even graver test to his presidency, a crisis that would cost American lives and consume the final year of Trump’s first term.

But the secretary, who had a strained relationship with Trump and many others in the administration, assured the president that those responsible were working on and monitoring the issue. Azar told several associates that the president believed he was “alarmist” and Azar struggled to get Trump’s attention to focus on the issue, even asking one confidant for advice.

Within days, there were new causes for alarm.

On Jan. 21, a Seattle man who had recently traveled to Wuhan tested positive for the coronavirus, becoming the first known infection on U.S. soil. Then, two days later, Chinese authorities took the drastic step of shutting down Wuhan, turning the teeming metropolis into a ghost city of empty highways and shuttered skyscrapers, with millions of people marooned in their homes.

“That was like, whoa,” said a senior U.S. official involved in White House meetings on the crisis. “That was when the Richter scale hit 8.”

It was also when U.S. officials began to confront the failings of their own efforts to respond.

Azar, who had served in senior positions at HHS through crises including the 9/11 terrorist attacks and the outbreak of bird flu in 2005, was intimately familiar with the playbook for crisis management.

He instructed subordinates to move rapidly to establish a nationwide surveillance system to track the spread of the coronavirus — a stepped-up version of what the CDC does every year to monitor new strains of the ordinary flu.

But doing so would require assets that would elude U.S. officials for months — a diagnostic test that could accurately identify those infected with the new virus and be produced on a mass scale for rapid deployment across the United States, and money to implement the system.

Azar’s team also hit another obstacle. The Chinese were still refusing to share the viral samples they had collected and were using to develop their own tests. In frustration, U.S. officials looked for other possible routes.

A biocontainment lab at the University of Texas medical branch in Galveston had a research partnership with the Wuhan Institute of Virology.

Kadlec, who knew the Galveston lab director, hoped scientists could arrange a transaction on their own without government interference. At first, the lab in Wuhan agreed, but officials in Beijing intervened Jan. 24 and blocked any lab-to-lab transfer.

There is no indication that officials sought to escalate the matter or enlist Trump to intervene. In fact, Trump has consistently praised Chinese President Xi Jinping despite warnings from U.S. intelligence and health officials that Beijing was concealing the true scale of the outbreak and impeding cooperation on key fronts.

The CDC had issued its first public alert about the coronavirus Jan. 8, and by the 17th was monitoring major airports in Los Angeles, San Francisco and New York, where large numbers of passengers arrived each day from China.

In other ways, though, the situation was already spinning out of control, with multiplying cases in Seattle, intransigence by the Chinese, mounting questions from the public, and nothing in place to stop infected travelers from arriving from abroad.

Trump was out of the country for this critical stretch, taking part in the annual global economic forum in Davos, Switzerland. He was accompanied by a contingent of top officials including national security adviser Robert O’Brien, who took a trans-Atlantic call from an anxious Azar.

Azar told O’Brien that it was “mayhem” at the White House, with HHS officials being pressed to provide nearly identical briefings to three audiences on the same day.

Azar urged O’Brien to have the NSC assert control over a matter with potential implications for air travel, immigration authorities, the State Department and the Pentagon. O’Brien seemed to grasp the urgency, and put his deputy, Matthew Pottinger, who had worked in China as a journalist for the Wall Street Journal, in charge of coordinating the still-nascent U.S. response.

But the rising anxiety within the administration appeared not to register with the president. On Jan. 22, Trump received his first question about the coronavirus in an interview on CNBC while in Davos. Asked whether he was worried about a potential pandemic, Trump said, “No. Not at all. And we have it totally under control. It’s one person coming in from China. . . . It’s going to be just fine.”

Spreading uncontrollably
The move by the NSC to seize control of the response marked an opportunity to reorient U.S. strategy around containing the virus where possible and procuring resources that hospitals would need in any U.S. outbreak, including such basic equipment as protective masks and ventilators.

But instead of mobilizing for what was coming, U.S. officials seemed more preoccupied with logistical problems, including how to evacuate Americans from China.

In Washington, then-acting chief of staff Mick Mulvaney and Pottinger began convening meetings at the White House with senior officials from HHS, the CDC and the State Department.

The group, which included Azar, Pottinger and Fauci, as well as nine others across the administration, formed the core of what would become the administration’s coronavirus task force. But it primarily focused on efforts to keep infected people in China from traveling to the United States even while evacuating thousands of U.S. citizens. The meetings did not seriously focus on testing or supplies, which have since become the administration’s most challenging problems.

The task force was formally announced on Jan. 29.

“The genesis of this group was around border control and repatriation,” said a senior official involved in the meetings. “It wasn’t a comprehensive, whole-of-government group to run everything.”

The State Department agenda dominated those early discussions, according to participants. Officials began making plans to charter aircraft to evacuate 6,000 Americans stranded in Wuhan. They also debated language for travel advisories that State could issue to discourage other travel in and out of China.

On Jan. 29, Mulvaney chaired a meeting in the White House Situation Room in which officials debated moving travel restrictions to “Level 4,” meaning a “do not travel” advisory from the State Department. Then, the next day, China took the draconian step of locking down the entire Hubei province, which encompasses Wuhan.

That move by Beijing finally prompted a commensurate action by the Trump administration. On Jan. 31, Azar announced restrictions barring any non-U.S. citizen who had been in China during the preceding two weeks from entering the United States.

Trump has, with some justification, pointed to the China-related restriction as evidence that he had responded aggressively and early to the outbreak. It was among the few intervention options throughout the crisis that played to the instincts of the president, who often seems fixated on erecting borders and keeping foreigners out of the country.

But by that point, 300,000 people had come into the United States from China over the previous month. There were only 7,818 confirmed cases around the world at the end of January, according to figures released by the World Health Organization — but it is now clear that the virus was spreading uncontrollably.

Pottinger was by then pushing for another travel ban, this time restricting the flow of travelers from Italy and other nations in the European Union that were rapidly emerging as major new nodes of the outbreak. Pottinger’s proposal was endorsed by key health-care officials, including Fauci, who argued that it was critical to close off any path the virus might take into the country.

This time, the plan met with resistance from Treasury Secretary Steven Mnuchin and others who worried about the impact on the U.S. economy. It was an early sign of tension in an area that would split the administration, pitting those who prioritized public health against those determined to avoid any disruption in an election year to the run of expansion and employment growth.

Those backing the economy prevailed with the president. And it was more than a month before the administration issued a belated and confusing ban on flights into the United States from Europe. Hundreds of thousands of people crossed the Atlantic during that interval.

A wall of resistance

While fights over air travel played out in the White House, public health officials began to panic over a startling shortage of critical medical equipment including protective masks for doctors and nurses, as well as a rapidly shrinking pool of money needed to pay for such things.

By early February, the administration was quickly draining a $105 million congressional fund to respond to infectious disease outbreaks. The coronavirus threat to the United States still seemed distant if not entirely hypothetical to much of the public. But to health officials charged with stockpiling supplies for worst-case-scenarios, disaster appeared increasingly inevitable.

A national stockpile of N95 protective masks, gowns, gloves and other supplies was already woefully inadequate after years of underfunding. The prospects for replenishing that store were suddenly threatened by the unfolding crisis in China, which disrupted offshore supply chains.

Much of the manufacturing of such equipment had long since migrated to China, where factories were now shuttered because workers were on order to stay in their households. At the same time, China was buying up masks and other gear to gird for its own coronavirus outbreak, driving up costs and monopolizing supplies.

In late January and early February, leaders at HHS sent two letters to the White House Office of Management and Budget asking to use its transfer authority to shift $136 million of department funds into pools that could be tapped for combating the coronavirus. Azar and his aides also began raising the need for a multibillion-dollar supplemental budget request to send to Congress.

Yet White House budget hawks argued that appropriating too much money at once when there were only a few U.S. cases would be viewed as alarmist.

Joe Grogan, head of the Domestic Policy Council, clashed with health officials over preparedness. He mistrusted how the money would be used and questioned how health officials had used previous preparedness funds.

Azar then spoke to Russell Vought, the acting director of the White House Office of Management and Budget, during Trump’s State of the Union speech on Feb. 4. Vought seemed amenable, and told Azar to submit a proposal.

Azar did so the next day, drafting a supplemental request for more than $4 billion, a sum that OMB officials and others at the White House greeted as an outrage. Azar arrived at the White House that day for a tense meeting in the Situation Room that erupted in a shouting match, according to three people familiar with the incident.

A deputy in the budget office accused Azar of preemptively lobbying Congress for a gigantic sum that White House officials had no interest in granting. Azar bristled at the criticism and defended the need for an emergency infusion. But his standing with White House officials, already shaky before the coronavirus crisis began, was damaged further.

White House officials relented to a degree weeks later as the feared coronavirus surge in the United States began to materialize. The OMB team whittled Azar’s demands down to $2.5 billion, money that would be available only in the current fiscal year. Congress ignored that figure, approving an $8 billion supplemental bill that Trump signed into law March 6.

But again, delays proved costly. The disputes meant that the United States missed a narrow window to stockpile ventilators, masks and other protective gear before the administration was bidding against many other desperate nations, and state officials fed up with federal failures began scouring for supplies themselves.

In late March, the administration ordered 10,000 ventilators — far short of what public health officials and governors said was needed. And many will not arrive until the summer or fall, when models expect the pandemic to be receding.

“It’s actually kind of a joke,” said one administration official involved in deliberations about the belated purchase.

Inconclusive tests

Although viruses travel unseen, public health officials have developed elaborate ways of mapping and tracking their movements. Stemming an outbreak or slowing a pandemic in many ways comes down to the ability to quickly divide the population into those who are infected and those who are not.

Doing so, however, hinges on having an accurate test to diagnose patients and deploy it rapidly to labs across the country. The time it took to accomplish that in the United States may have been more costly to American efforts than any other failing.

“If you had the testing, you could say, ‘Oh my god, there’s circulating virus in Seattle, let’s jump on it. There’s circulating virus in Chicago, let’s jump on it,’ ” said a senior administration official involved in battling the outbreak. “We didn’t have that visibility.”

The first setback came when China refused to share samples of the virus, depriving U.S. researchers of supplies to bombard with drugs and therapies in a search for ways to defeat it. But even when samples had been procured, the U.S. effort was hampered by systemic problems and institutional hubris.

Among the costliest errors was a misplaced assessment by top health officials that the outbreak would probably be limited in scale inside the United States — as had been the case with every other infection for decades — and that the CDC could be trusted on its own to develop a coronavirus diagnostic test.

The CDC, launched in the 1940s to contain an outbreak of malaria in the southern United States, had taken the lead on the development of diagnostic tests in major outbreaks including Ebola, zika and H1N1. But the CDC was not built to mass-produce tests.

The CDC’s success had fostered an institutional arrogance, a sense that even in the face of a potential crisis there was no pressing need to involve private labs, academic institutions, hospitals and global health organizations also capable of developing tests.

Yet some were concerned that the CDC test would not be enough. Stephen Hahn, the FDA commissioner, sought authority in early February to begin calling private diagnostic and pharmaceutical companies to enlist their help.

FDA leaders were split on whether it would be bad optics for Hahn to be personally calling companies he regulated. When FDA officials consulted leaders at HHS, they understood it as a direction to stand down.

At that point, Azar, the HHS secretary, seemed committed to a plan he was pursuing that would keep his agency at the center of the response effort: securing a test from the CDC and then building a national coronavirus surveillance system by relying on an existing network of labs used to track the ordinary flu.

In task force meetings, Azar and Redfield pushed for $100 million to fund the plan, but were shot down because of the cost, according to a document outlining the testing strategy obtained by The Washington Post.

Relying so heavily on the CDC would have been problematic even if it had succeeded in quickly developing an effective test that could be distributed across the country. The scale of the epidemic, and the need for mass testing far beyond the capabilities of the flu network, would have overwhelmed the plan, which didn’t envision engaging commercial lab companies for up to six months.

The effort collapsed when the CDC failed its basic assignment to create a working test and the task force rejected Azar’s plan.

On Feb. 6, when the World Health Organization reported that it was shipping 250,000 test kits to labs around the world, the CDC began distributing 90 kits to a smattering of state-run health labs.

Almost immediately, the state facilities encountered problems. The results were inconclusive in trial runs at more than half the labs, meaning they couldn’t be relied upon to diagnose actual patients. The CDC issued a stopgap measure, instructing labs to send tests to its headquarters in Atlanta, a practice that would delay results for days.

The scarcity of effective tests led officials to impose constraints on when and how to use them, and delayed surveillance testing. Initial guidelines were so restrictive that states were discouraged from testing patients exhibiting symptoms unless they had traveled to China and come into contact with a confirmed case, when the pathogen had by that point almost certainly spread more broadly into the general population.

The limits left top officials largely blind to the true dimensions of the outbreak.

In a meeting in the Situation Room in mid-February, Fauci and Redfield told White House officials that there was no evidence yet of worrisome person-to-person transmission in the United States. In hindsight, it appears almost certain that the virus was taking hold in communities at that point. But even the country’s top experts had little meaningful data about the domestic dimensions of the threat. Fauci later conceded that as they learned more their views changed.

At the same time, as the president’s subordinates were growing increasingly alarmed, Trump continued to exhibit little concern. On Feb. 10, he held a political rally in New Hampshire attended by thousands where he declared that “by April, you know, in theory, when it gets a little warmer, it miraculously goes away.”

The New Hampshire rally was one of eight that Trump held after he had been told by Azar about the coronavirus, a period when he also went to his golf courses six times.

A day earlier, on Feb. 9, a group of governors in town for a black-tie gala at the White House secured a private meeting with Fauci and Redfield. The briefing rattled many of the governors, bearing little resemblance to the words of the president. “The doctors and the scientists, they were telling us then exactly what they are saying now,” Maryland Gov. Larry Hogan (R) said.

That month, federal medical and public health officials were emailing increasingly dire forecasts among themselves, with one Veterans Affairs medical adviser warning, ‘We are flying blind,’” according to emails obtained by the watchdog group American Oversight.

Later in February, U.S. officials discovered indications that the CDC laboratory was failing to meet basic quality-control standards. On a Feb. 27 conference call with a range of health officials, a senior FDA official lashed out at the CDC for its repeated lapses.

Jeffrey Shuren, the FDA’s director for devices and radiological health, told the CDC that if it were subjected to the same scrutiny as a privately run lab, “I would shut you down.”

On Feb. 29, a Washington state man became the first American to die of a coronavirus infection. That same day, the FDA released guidance, signaling that private labs were free to proceed in developing their own diagnostics.

Another four-week stretch had been squandered.

Life and death

One week later, on March 6, Trump toured the facilities at the CDC wearing a red “Keep America Great” hat. He boasted that the CDC tests were nearly perfect and that “anybody who wants a test will get a test,” a promise that nearly a month later remains unmet.

He also professed to have a keen medical mind. “I like this stuff. I really get it,” he said. “People here are surprised that I understand it. Every one of these doctors said, ‘How do you know so much about this?’ ”

In reality, many of the failures to stem the coronavirus outbreak in the United States were either a result of, or exacerbated by, his leadership.

For weeks, he had barely uttered a word about the crisis that didn’t downplay its severity or propagate demonstrably false information. He dismissed the warnings of intelligence officials and top public health officials in his administration.

At times, he voiced far more authentic concern about the trajectory of the stock market than the spread of the virus in the United States, railing at the chairman of the Federal Reserve and others with an intensity that he never seemed to exhibit about the possible human toll of the outbreak.

In March, as state after state imposed sweeping new restrictions on their citizens’ daily lives to protect them — triggering severe shudders in the economy — Trump second-guessed the lockdowns.

The common flu kills tens of thousands each year and “nothing is shut down, life & the economy go on,” he tweeted March 9. A day later, he pledged that the virus would “go away. Just stay calm.”

Two days later, Trump finally ordered the halt to incoming travel from Europe that his deputy national security adviser had been advocating for weeks. But Trump botched the Oval Office announcement so badly that White House officials spent days trying to correct erroneous statements that triggered a stampede by U.S. citizens overseas to get home.

“There was some coming to grips with the problem and the true nature of it — the 13th of March is when I saw him really turn the corner. It took a while to realize you’re at war,” Sen. Lindsey O. Graham (R-S.C.) said. “That’s when he took decisive action that set in motion some real payoffs.”

Trump spent many weeks shuffling responsibility for leading his administration’s response to the crisis, putting Azar in charge of the task force at first, relying on Pottinger, the deputy national security adviser, for brief periods, before finally putting Vice President Pence in the role toward the end of February.

Other officials have emerged during the crisis to help right the United States’ course, and at times, the statements of the president. But even as Fauci, Azar and others sought to assert themselves, Trump was behind the scenes turning to others with no credentials, experience or discernible insight in navigating a pandemic.

Foremost among them was his adviser and son-in-law, Jared Kushner. A team reporting to Kushner commandeered space on the seventh floor of the HHS building to pursue a series of inchoate initiatives.

One plan involved having Google create a website to direct those with symptoms to testing facilities that were supposed to spring up in Walmart parking lots across the country, but which never materialized. Another centered on an idea advanced by Oracle chairman Larry Ellison to use software to monitor the unproven use of anti-malaria drugs against the coronavirus pathogen.

So far, the plans have failed to come close to delivering on the promises made when they were touted in White House news conferences. The Kushner initiatives have, however, often interrupted the work of those under immense pressure to manage the U.S. response.
Anthony S. Fauci, left, director of the National Institute for Allergy and Infectious Diseases, attends a White House briefing with Trump on April 1. He is one of the core members of the administration’s coronavirus task force. (Jabin Botsford/The Washington Post)

Current and former officials said that Kadlec, Fauci, Redfield and others have repeatedly had to divert their attentions from core operations to contend with ill-conceived requests from the White House they don’t believe they can ignore. And Azar, who once ran the response, has since been sidelined, with his agency disempowered in decision-making and his performance pilloried by a range of White House officials, including Kushner.

“Right now Fauci is trying to roll out the most ambitious clinical trial ever implemented” to hasten the development of a vaccine, said a former senior administration official in frequent touch with former colleagues. And yet, the nation’s top health officials “are getting calls from the White House or Jared’s team asking, ‘Wouldn’t it be nice to do this with Oracle?’ ”

If the coronavirus has exposed the country’s misplaced confidence in its ability to handle a crisis, it also has cast harsh light on the limits of Trump’s approach to the presidency — his disdain for facts, science and experience.

He has survived other challenges to his presidency — including the Russia investigation and impeachment — by fiercely contesting the facts arrayed against him and trying to control the public’s understanding of events with streams of falsehoods.

The coronavirus may be the first crisis Trump has faced in office where the facts — the thousands of mounting deaths and infections — are so devastatingly evident that they defy these tactics.

After months of dismissing the severity of the coronavirus, resisting calls for austere measures to contain it, and recasting himself as a wartime president, Trump seemed finally to succumb to the coronavirus reality. In a meeting with a Republican ally in the Oval Office last month, the president said his campaign no longer mattered because his reelection would hinge on his coronavirus response.

“It’s absolutely critical for the American people to follow the guidelines for the next 30 days,” he said at his March 31 news conference. “It’s a matter of life and death.”

Julie Tate and Shane Harris contributed to this report.