Rage

by Bob Woodward

  * * *

  On New Year’s Eve, December 31, 2019, Dr. Robert Redfield also saw the first report of an unexplained pneumonia in a large city in China and immediately went on alert.

  Redfield, 68, an expert virologist and the director of the Centers for Disease Control and Prevention (CDC), the public health agency charged with protecting Americans’ health, read an “urgent notice on the treatment of pneumonia of unknown cause” released online by the Wuhan Municipal Health Committee in China. One of the CDC’s major responsibilities was to monitor global health threats to try to stop them before they reached the United States.

  Redfield had 23,000 people, including contractors, working for him all over the world, compared to Fauci’s 2,000. Redfield, with his distinctive gray chin curtain beard, liked to keep a low public profile. The CDC considers itself “the nation’s health protection agency.” As director, Redfield’s immediate focus is on the cause of the disease, or what is called the etiology.

  A devout Catholic, Redfield had gone through a religious awakening during a private 10-minute conversation with Pope John Paul II in 1989 and believed in the redemptive power of suffering. Redfield prayed every day, including a prayer for President Trump.

  He treated the information out of China with urgency.

  The CDC’s first formal report, filed the next day despite the federal holiday, is a remarkably detailed three-page document (see photo insert). Titled “China Pneumonia of Unknown Etiology Situational Report,” it is dated January 1, 2020, and marked “For Internal Use Only/Not for Distribution.” The report was disseminated to other top health officials, including Health and Human Services secretary Alex Azar.

  In a section headlined “Topline Messages,” the report stated:

  The current situation relates to an epidemic of pneumonia of unknown etiology centralizing on a local seafood market, Hua Nan Seafood Market in Wuhan, China

  Despite news reports mentioning the possibility of SARS, there is no actual evidence implicating SARS

  27 cases reported to date…

  The clinical syndrome includes fever, few with difficult breathing, and with bilateral lung infiltrates on chest x-ray

  The seafood market has been closed for disinfection since they also sell wild animals.

  In other sections, the report said:

  There has been no obvious transmission among people to date

  There has been no hospital staff who have been infected to date

  The Wuhan Municipal Health Commissioner released an announcement just before 2PM December 31

  Laboratory testing is underway for respiratory pathogens to include SARS

  The cases so far have been limited to Wuhan.

  The report included a map showing Wuhan’s location in China, and three pictures of the market.

  * * *

  On January 2, the second CDC Situational Report was updated to include the significant information that the Hua Nan market was said to sell bats, a known reservoir of diseases that are transmissible and deadly to humans, and other wild animals. “The seafood market has been closed for disinfection since they also sell animals including chicken, cat, dog, bat, marmot, snake, seafood and other animals.” The report also noted, “Two media reports of illness outside of Wuhan were published today.”

  Redfield worried about the possible emergence of a pandemic bird flu coming out of China yet again—H5N1 and H7N9 had killed an extraordinary 60 percent and 40 percent respectively of people infected.

  On January 2, Redfield shared his concerns with the National Security Council’s biodefense directorate, which reported to Pottinger and O’Brien.

  * * *

  Redfield and Fauci conferred about what China was reporting. In each of the 27 cases, the illness had allegedly jumped from an animal to a human.

  Fauci and Redfield thought that seemed like a stretch. All 27 people were infected from animals in the same market? Did all those people actually go to that market or eat animals and get it from animals? Or was it likely there was human-to-human spread, which could vastly increase the likelihood of a major outbreak?

  Significantly, the CDC’s January 3 Situational Report noted there were now 44 cases. Lab testing had ruled out seasonal and avian influenza and some other common respiratory pathogens, although SARS was still a possibility. “Hong Kong, Taiwan, Singapore and the Amur Region in Russia have implemented border screening of people traveling from Wuhan,” it reported. This level of caution was relatively rare.

  Redfield sent an email to George Gao, the head of the Chinese CDC, who has an Oxford PhD in biochemistry and is an expert in coronaviruses, on the afternoon of Friday, January 3, to set up a private phone call. Redfield knew Gao well and had worked with him over the years.

  Are you certain that it’s not human-to-human spread? Redfield asked. Some of those infected were from the same family and lived together, Redfield noted, increasing the chances of human-to-human spread.

  They had been at the same market, Gao said.

  Redfield was skeptical.

  Why don’t we send our disease detectives, Redfield said to Fauci, from their Epidemic Intelligence Service, to Wuhan to see what was going on?

  Fauci said if the disease was really only traveling from animals to humans, the spread would likely be inefficient, and a massive outbreak was unlikely.

  Redfield wanted to get his experts to the scene in Wuhan. The proven way to contain the spread of an infectious disease was to first have an understanding of its scale and characteristics. The way to do that was to have his medical experts—epidemiologists, virologists, CDC doctors, but no political people—on the ground at the earliest stages of an outbreak to see for themselves. Time was critical. If the CDC team could get into Wuhan, they would be able to give him an assessment and also help the Chinese. Perhaps that assessment would be the difference between containment and disaster. Redfield sent Gao another email the next day.

  “CDC has substantive experience,” he wrote, “in identifying the etiology of pneumonia outbreaks caused by novel pathogens. CDC also has a long history of working collaboratively with the government of China on pneumonia and respiratory infectious diseases.”

  He continued, “I would like to offer CDC technical experts in laboratory and epidemiology of respiratory infectious disease to assist you and China CDC in identification of this unknown and possibly novel pathogen.”

  At this point, Fauci thought, they would have to just count on the Chinese being honest and see what happened.

  Redfield again spoke with Gao. He reported to O’Brien and Pottinger. The call was both troubling and bizarre. China was stonewalling.

  He filled Pottinger in on the details. Gao was not forthcoming at all. Redfield was deeply concerned by Gao’s tone, which was different from his previous experiences with him. Gao sounded like a hostage and expressed serious anxiety. When pressed, he offered nothing about possible human-to-human spread. In an unexpected turn Gao wanted the United States to send their experts but he said he couldn’t issue the invitation. Instead could Redfield request the Chinese ask for U.S. experts?

  Redfield was beyond frustration. Each day counted. On January 6 he converted his January 4 email word-for-word to a formal letter to Gao on the U.S. Department of Health and Human Services letterhead. Redfield figured the formal letter would give Gao some ammunition with his superiors. The Chinese sat on it.

  Redfield pinged Gao through the U.S. embassy in Beijing asking if there was a response. Can we come to China? The answer came back: Thanks again for the offer.

  What’s going on? Redfield complained to Fauci. They weren’t getting a yes and they weren’t getting a no. From his past relationship with Gao, he did not expect this. He tried everything to get an affirmative invitation. Nothing.

  They were at the most critical stage. He needed on-the-ground data.

  One explanation, Redfield and Fauci agreed, was that the Chinese are proud, with sophisticated medical doctors and equipment, and pro
bably felt they didn’t need help from anybody else. Fauci threw up his hands. Here we go again. China being China—remote, aloof and secretive. Since they knew of no cases of the strange pneumonia in the United States, it would be hard to press much harder.

  By January 5, according to the CDC Situational Report #5, there were 59 cases in Wuhan, more than double in four days. SARS and MERS (Middle East Respiratory Syndrome) had been ruled out. Local health experts were recommending wearing masks and avoiding closed and airless public places and crowded places. Media speculation about SARS continued to swirl.

  The CDC posted a Level 1 travel notice for Wuhan on January 6. Level 1 was the lowest, which served to simply alert travelers of the presence of a health problem in the area and urged them to “practice usual precautions” and “avoid living or dead animals, animal markets, and contact with sick people.”

  The Situational Report for January 6 noted the sprawling seafood market was located next to a train station “which serves as a transportation hub at the center of China’s domestic train routes and will soon be especially congested as we enter Chinese New Year.”

  The Chinese New Year celebration would begin on January 24 and span 16 days. One Bloomberg News story, dubbing it the “World’s Biggest Human Migration,” reported that three billion trips would be taken within China and to other countries for the holiday.

  The CDC report also noted that “viral pneumonia in Wuhan has been a hot topic on Chinese social media for the past week.” According to the CDC, a hashtag, translated as #WuhanReportedMysteriousPneumonia, was being actively censored on Chinese social media.

  * * *

  Redfield grew increasingly worried as reported cases increased. On January 7, he stood up his Incident Management Structure, a process reserved only for serious health matters. In two years as CDC director, he had only done this twice before. It was first dubbed “2020 China Pneumonia Response,” then almost immediately renamed “2020 Pneumonia of Unknown Etiology Response.” The initiative was launched with the main objectives “to prepare for potential domestic cases and to support the investigation in China or other countries if requested.”

  The CDC Situational Report said there was no specific screening at train stations or airports in Wuhan. “Media has begun to report high demand of N95 respirators in China,” it noted. The N95 was a sophisticated mask used by health care workers.

  Redfield called and suggested to Gao that the Chinese go out and test people who had not been to the market. Soon Gao reported that they had identified cases not associated with the market. The January 8 Situational Report noted that now there were only “some epidemiologic links” to the market.

  Thailand and Vietnam had been added to the list of countries conducting border screening of people from Wuhan, and the CDC was engaging with “personal protective equipment supply chain partners” to “increase awareness of supply chain status.” The report noted that The Wall Street Journal was reporting China had discovered a new strain of coronavirus, and a Wikipedia article had been established for the outbreak.

  On January 10, Chinese scientists published the genome of the virus online, giving international scientists their first glimpse of the new coronavirus.

  Fauci called his team from the Vaccine Research Center together. Let’s start making a vaccine, Fauci directed. Who the hell knows where this is going? So the center began work right away and launched the vaccine project Moderna later bought that was a positive prospect for a vaccine.

  Fauci was intensely focused on the efficiency of transmission question. Just how infectious was the new virus? The feedback he got from China was happy talk. The official Chinese line continued to be that the virus was not a big deal. It is not that efficient. It is less deadly than SARS. We have it under control.

  The CDC Situational Report for January 13 alerted readers that “Thailand reported a confirmed case of nCoV in a traveler from Wuhan City to Thailand. This is the first infection with novel coronavirus 2019 detected outside China.”

  That report hit Redfield hard. It told him, almost for sure, that there was human-to-human spread and the disease was being carried outside China.

  Meanwhile, Redfield had another phone conversation with Gao. You can’t believe what’s going on over here, Gao said. It’s much, much worse than you’re hearing.

  Holy shit, Fauci said. They haven’t been telling us the truth. It is really transmitting efficiently.

  The CDC began developing a diagnostic test and issuing warnings for airports and ports of entry to the U.S. about travelers from Wuhan. It held a call with over 300 attendees from state and local health departments in the U.S.

  On January 15, the CDC Situational Report hedged, saying:

  “Some limited human-to-human spread may have occurred.… The possibility of limited human-to-human transmission cannot be ruled out, but the risk of sustained human-to-human transmission is low.”

  * * *

  Pottinger, who had begun making his own calls to sources from his days as a Wall Street Journal reporter on SARS, told Redfield he was gathering evidence not only of human-to-human spread but also asymptomatic spread, meaning a person without symptoms could be a carrier and infect others. Was it possible that a former journalist would get to the bottom of the new virus faster than the doctors? Redfield wondered. They would have to wait and see.

  On January 17, Redfield activated the entire CDC and assigned thousands of his staff to work on the new virus. Screening of travelers from Wuhan began at airports in New York, San Francisco and Los Angeles. He feared the greatest health crisis since 1918 might be upon them.

  Pottinger also calculated the death rate for Hubei province, whose capital was Wuhan, could be six times normal. He based his estimate not on information from the intel community or reported death rates out of China, but from Chinese social media and phone conversations with people on the ground. He determined this could translate into thousands more deaths in Wuhan in one month.

  THIRTY-ONE

  Trump surprised me at home with a call about 1:30 p.m. on Monday, January 20, Martin Luther King Jr. Day. I literally had just walked in and did not have my tape recorder. So the account of this call is based on my handwritten notes.

  A Very Stable Genius, a book by my two Washington Post colleagues Philip Rucker and Carol Leonnig, was being released. The book was highly critical of him. “It won’t do well,” Trump told me.

  The book went on to became a number-one national and New York Times bestseller.

  I asked Trump if he had read it.

  “No, I just read a review,” he said. He disputed a scene in the book which suggested he did not seem to know much about Pearl Harbor during a private tour of the USS Arizona Memorial, which rests above the sunken hull of the battleship bombed by the Japanese in 1941. Rucker and Leonnig reported that chief of staff John Kelly was stunned that Trump did not know the history of Pearl Harbor and needed it explained to him.

  “I know everything about Pearl Harbor,” Trump said to me. “How can they say I don’t know?” He then accurately recited some of the history. “This is all made up.”

  I said that they were excellent reporters who had sources. “This is a good faith effort,” I said.

  “Well,” he said, “70 percent of it’s made up.”

  “They have sources,” I repeated. I said I thought he was misguided in his blanket criticism of the media as “fake news.” Yes, everyone got things wrong sometimes. But he ought to understand the common denominator was the “good faith effort” with real sources.

  “Well,” he joked, “I have Russia and Sean Hannity with me.”

  Trump cited a Rasmussen poll showing he had a 51 percent approval rating among likely voters as of January 16. He said it was wonderful.

  “You don’t believe polls, do you?” I asked.

  “Well, no,” Trump said, “I don’t. I don’t believe them.” Polling had widely predicted a Hillary Clinton victory in 2016.

  What do you think of
The New York Times editorial page, which just endorsed Amy Klobuchar and Elizabeth Warren for the Democratic nomination for president? I asked.

  “I so dream about running against Elizabeth Warren,” Trump said, loudly and with apparent sincerity.

  Trump said that Henry Kissinger had been in the Oval Office recently and told him how great he looked, given the impeachment. “During all of Watergate and Nixon’s impeachment investigation, he was a basket case.”

  I had the letters that Kim Jong Un had written to Trump. I said I wanted to get the other side—the letters Trump had written to Kim.

  “Those are so Top Secret,” Trump said. He did not want me to have them. “You can’t mock Kim. I don’t want to get in a fucking nuclear war because you mocked him.”

  I said I would be careful and stick to what was in the letters. “I’m not going to mock him.”

  Later in the interview, we returned to the Trump-Kim letters. “Don’t mock Kim,” Trump repeated. “I don’t want a fucking nuclear war,” he said again. He returned to the new nuclear weapons he had. “I have such powerful weapons. They’re so powerful you wouldn’t believe it. You wouldn’t even put them in your book.”

  About two minutes after our call ended, at 1:53 p.m., Trump retweeted the tweet he had originally sent on January 16 publicizing the Rasmussen poll. Adding to his earlier tweet, Trump wrote, “And they say you can add 7% to 10% to all Trump numbers! Who knows?”

  Rasmussen polls have consistently shown higher results for Trump than those conducted by other firms. The national average of presidential job approval polls that day showed he had an approval rating of about 44 percent. Rasmussen was called one of the most accurate of all major pollsters in 2016, showing Clinton up two points on the day before the election. Most other polls had Clinton leading by three to six points.