I Alone Can Fix It: Donald J. Trump's Catastrophic Final Year

by Carol Leonnig

“Look,” Hahn replied, “we’ll make a decision based on the data. We’re not caving. We’re trying to satisfy legitimate concerns about the data.”

  The Republican National Convention was the following week, beginning August 24, and it was obvious to the public health professionals that Trump wanted to be able to announce an emergency use authorization for convalescent plasma by then.

  By the end of the day Friday, August 21, the data Collins and his NIH team needed to be convinced that convalescent plasma had proved effective for enough patients to justify wide-scale use was not yet in hand. The next day, as the doctors saw more data come in, the evidence of efficacy was unconvincing. Yet an announcement of the emergency use authorization had already been drafted. The FDA press release, traditionally a dull, factual document, had an unusual political pizzazz. Released on August 23, it proclaimed: “Another Achievement in Administration’s Fight Against Pandemic.”

  On August 23, the principals were called to the White House for a special announcement. Beforehand, Trump huddled with Hahn, Collins, Meadows, Alex Azar, and other advisers in the Oval Office to prepare what they would say. There was no firm evidence of convalescent plasma reducing the rate of deaths, but Marks and his team calculated that based on available data it would reduce the relative risk of death by about 35 percent. Scientists believed the actual rate could vary between 10 percent and 50 percent.

  “Why’d you pick thirty-five percent?” Trump asked. “Why don’t we say fifty?”

  “Well, Mr. President, that would make us a target for criticism,” Azar said. He explained that they believed 35 percent would be the safest and most accurate way to describe it.

  “I like fifty,” Trump said. “Doesn’t fifty just sound better to you? Five-zero. Fifty.”

  “No, the number is thirty-five,” Hahn said. “We can’t say fifty because that’s not what the data show. Thirty-five percent is the number that Peter’s team came to.”

  Trump, fond of overselling when promoting anything, be it one of his golf properties or a trade deal, came back to his 50 percent point two or three additional times, but Azar, Hahn, and others pushed back each time. They ended up using the seemingly more conservative 35 percent number publicly, but even that would prove impossible to defend.

  Trump stepped into the press briefing room and announced his administration was authorizing a miracle treatment that could save countless lives. Flanked by Hahn and Azar, the president announced that the FDA had agreed to give emergency permission for doctors to treat COVID-19 patients with convalescent plasma because of what he described as overwhelming evidence that showed that it had an “incredible rate of success” in preventing deaths from the disease.

  “Today’s action will dramatically expand access to this treatment,” Trump said. “We’re removing unnecessary barriers and delays. . . . We are being very strong and we are being very forthright, and we have some incredible answers, and we’re not going to be held up.”

  The president told reporters that new studies had proven that treating patients with this blood product laced with antibodies cut the rate of deaths by 35 percent, what Trump called “a tremendous number.” Hahn repeated the 35 percent claim in his remarks.

  There were inaccuracies in the presentation, which would anger doctors across the country, as well as scientists inside the FDA. The administration’s claim relied on a preliminary study by the Mayo Clinic that never claimed to meet the well-established medical standards for assessing the treatment’s success rate. The study showed that patients who received the plasma treatment within three days of being hospitalized had lower rates of death over the next thirty days than those patients who got the treatment later. The actual data was statistically interesting but not conclusive. It found the death rate among those who got the earlier plasma treatments was 8.7 percent, while those who had later plasma treatments had a death rate of 11.7 percent. FDA scientists had also warned the study didn’t use the standard required for measuring a treatment’s verified success. It had not picked patients randomly nor compared patients who received the treatment with patients who received a placebo.

  Azar echoed the president, but in language that skirted a conclusion. He did not explicitly claim the plasma treatment cut deaths by 35 percent. “We dream in drug development of something like a thirty-five percent mortality reduction,” he said. “This is a major advance in the treatment of patients.”

  One senior member of the coronavirus task force recalled, “It was just one of those completely disastrous moments that you could hardly believe you were a part of.”

  The backlash against the venerable FDA was one of the most brutal in its history.

  “I watched this in horror,” Eric Topol, an expert on clinical trials and the influential director of the Scripps Research Translational Institute, told The Washington Post after watching Trump’s announcement with Hahn at his side. “These are basically just exploratory analyses that don’t prove anything. It’s just extraordinary to declare this as a breakthrough.” Other health professionals decried what they saw as the FDA’s manipulation of science to fit the president’s political messaging.

  Within roughly twenty-four hours, Hahn apologized for overstating the evidence of plasma treatment’s effectiveness and its ability to save lives. He tweeted the night of August 24, “I have been criticized for remarks I made Sunday night about the benefits of convalescent plasma. The criticism is entirely justified. What I should have said better is that the data show a relative risk reduction, not an absolute risk reduction.”

  Hahn told others he felt burned by Trump and Meadows. He believed the president’s announcement on the eve of the Republican Convention gave the appearance that the FDA’s process had been corrupted by politics. Going forward, the FDA commissioner resolved to be better attuned to the political machinations of the White House—even if doing so had a cost for Trump. In particular, Hahn steeled himself for more political manipulation of the highly sensitive vaccine trial process, which the president wanted completed before the election. He was determined never to be put in this position again.

  * * *

  —

  On August 24, Republicans opened their national convention, which would run for four days. Their mission was urgent: to convince voters pessimistic about the state of a country battered by the pandemic, the recession, and racial upheaval that Trump deserved four more years at the helm.

  The convention originally had been scheduled to take place in Charlotte. But after Trump publicly feuded over public health restrictions with North Carolina’s Democratic governor, Roy Cooper, he moved most of the programming to Jacksonville, Florida, where the Republican governor, Ron DeSantis, was a much more eager and accommodating host. Then Republicans scrapped plans for an in-person convention in a cavernous arena and changed to a hybrid model, setting some of the marquee speeches live before large crowds outdoors.

  Kushner and Hope Hicks helped orchestrate the convention, in close consultation with Trump, who micromanaged the speakers’ list and choreography. The president was adamant about having high production values. Hicks wanted the event to feel different from the 2016 Republican Convention in Cleveland, where Trump had become the party’s unlikely nominee, and saw this convention as an opportunity not merely to amplify the president’s MAGA base, but to grow his support beyond it. She asked Tony Sayegh, a longtime GOP operative who had run public affairs at Trump’s Treasury Department, to oversee programming, along with Lara Trump.

  The Trump team envisioned every night of the convention as a cross between a State of the Union address, in which ordinary Americans sitting with the first lady in the balcony are singled out for their extraordinary achievements, and Tucker Carlson’s show. It would be, in their words, “a people’s convention.” They decided to feature Alice Johnson, whom Trump had released from her lifetime prison sentence over a drug offense and later granted a full pardon; Natalie Harp, a can
cer survivor who claimed Trump had saved her life thanks to his “Right to Try” law permitting experimental treatments; Carl and Marsha Mueller, the parents of a humanitarian aid worker who was killed by Islamic State terrorists; and other everyday Americans with diverse testimonials.

  At a time of national despair, Trump wanted to project optimism, and programming was planned around themes of “promise,” “opportunity,” and “greatness.” Yet Trump and other speakers also used the platform to inflame culture wars, delivering fiery denunciations of “socialism” and claiming that Americans would not be safe under a Biden presidency. For instance, Mark and Patricia McCloskey, a St. Louis couple who had stood outside their home pointing guns during a Black Lives Matter demonstration, gave a particularly provocative speech warning the American suburbs would fall into dangerous chaos if Democrats were elected.

  Trump told aides he wanted the convention to be an entertaining television show. Of course, the president thought of himself as the lead actor and wanted a role each night—akin to his time as star of The Apprentice—in addition to his formal acceptance speech. From the White House, he hosted a discussion with frontline workers in the pandemic and with Americans who had been released from prisons overseas, issued a pardon, and conducted a naturalization ceremony.

  Trump wanted to deliver his speech on the convention’s final night from a special and symbolic venue. Advance staffer Max Miller took the lead on scouting locations steeped in history. Miller and other advisers considered Gettysburg National Military Park at the Civil War battlefield in rural Pennsylvania, but ruled it out because the floodlights required to illuminate the dark field would attract bugs, especially on a hot and steamy August night, and the image still would just be the president in an empty field. They also considered Mount Vernon, the George Washington estate along the Potomac River in Virginia, but it is privately owned, which presented complications. They thought about the National D-Day Memorial honoring the “Bedford Boys” in rural southwestern Virginia, as well as Fort McHenry in Baltimore, which Vice President Pence ended up choosing as the venue for his acceptance speech. Ultimately, Trump decided to give his speech in his own backyard, the South Lawn of the White House, a move that broke yet another norm and swiftly drew complaints about his use of federal property for political purposes.

  On August 27, as the South Lawn was being transformed into a campaign rally site for Trump’s big acceptance speech, something frightening was occurring at the NIH offices in Bethesda. Anthony Fauci’s work demands had become so intense that days would go by before he had a chance to read the bills and other letters that were piling up at home. So that morning he grabbed the mail stack to bring to the office, figuring he would go through it when he had a spare moment between meetings. When he did, he came across an ordinary-looking envelope. Fauci’s name and home address were printed in a strange font, but his mind was racing about his work and he didn’t think much of it. He inserted his file opener, tore the seal open, and pulled out the letter. As Fauci unfolded it, powder burst all over his face, on his tie and shirt, and around his office. There was nothing printed on the letter; it was a blank sheet of white paper.

  Fauci had investigated enough of these incidences before to know immediately that the powder either was an innocuous hoax or anthrax, meaning he would have to go on ciprofloxacin for a month, or ricin, meaning he likely would die. There was no antidote to ricin.

  Since Trump and some of his aides and allies started attacking Fauci earlier that year, the doctor had been receiving threats on his life. He had been provided a round-the-clock government security detail. After opening the envelope with powder, Fauci stayed in his office alone and called out to his assistant to summon the security agents who were standing guard down the hallway, outside Fauci’s office suite. They ran in and said to Fauci, “Don’t move. Just stay in your office.” They called a hazmat team, which quickly arrived on the scene. Agents wearing full protective suits stripped Fauci naked in his office and brought him to a separate room at NIH, where other hazmat agents sprayed him down with a decontaminating chemical. Then they dressed Fauci in a hazmat suit, which ballooned around the diminutive doctor’s five-foot-seven frame. They gave Fauci’s contaminated clothes to the FBI for testing to determine what the powder was.

  Fauci headed to the NIH basement to take a long shower, scrubbing the chemicals out of his skin, and then called his wife, who was with one of their adult daughters at the time, to tell them what had happened. He scared the hell out of them. Like Fauci, his wife, Christine Grady, knew the three possibilities for what had been in that envelope.

  Fauci’s security detail drove him home, where he waited for four hours for the FBI to complete its tests. He was anxious, wondering whether he might fall dead or just have been inconvenienced for a day. Thinking it might be anthrax, he called in a prescription for ciprofloxacin. Finally, he got the call: No protein was found in the powder. That ruled out anthrax, and it very likely eliminated the possibility of ricin. It had been a hoax. Maybe baby powder. Perhaps flour. It didn’t matter. Fauci was safe. He breathed a sigh of relief.

  At the White House, meanwhile, an estimated fifteen hundred guests gathered on the South Lawn in violation of social distancing recommendations, and only a small fraction wore face masks. The grand portico of the mansion that had been home to every president since John Adams was illuminated as the backdrop for this most political of speeches. The president spoke from a red-carpeted stage adorned with American flags and bookended by massive campaign signage. Enormous screens erected on the lawn alternately displayed the Trump-Pence campaign logo and propaganda-style campaign videos.

  Trump’s speech was jarringly dark and divisive. He depicted Biden in the most dangerous and sinister terms and charged that he was beholden to the far-left wing of the Democratic Party, as some sort of “Trojan horse for socialism.”

  “Joe Biden is not the savior of America’s soul,” Trump said. “He is the destroyer of America’s jobs—and, if given the chance, he will be the destroyer of American greatness.”

  Trump cast Biden as somehow un-American.

  “Your vote will decide whether we protect law-abiding Americans or whether we give free rein to violent anarchists, agitators, and criminals who threaten our citizens,” Trump said. “And this election will decide whether we will defend the American way of life or whether we allow a radical movement to completely dismantle and destroy it.”

  Trump’s remarks lasted seventy minutes, among the longest acceptance speeches in convention history, and was followed by fireworks over the National Mall. Some of the blasts over the night sky bore the president’s name, T-R-U-M-P. This was Trump’s Washington. The power was his. He didn’t plan to relinquish it. It would have to be taken from him.

  PART THREE

  Twelve

  Self-Sabotage

  As summer gave way to fall, Deborah Birx hit the road, preaching caution to a nation beleaguered and restless after months of pandemic restrictions. Though her travels took her across the country, she focused on cities and towns in the South and Midwest, where support for President Trump was strong and skepticism of public health guidelines ran deep. In Nashville on July 27, she told Tennessee’s governor he should mandate masks and shut down bars. In Little Rock, Arkansas, on August 17, Birx directed residents to stop hosting parties in their backyards. And on a tour of the University of Alabama on September 11, she admonished young men for not wearing masks like many of their female classmates.

  Birx’s roving public health safety tour came naturally to her, since she had previously served as a global health ambassador in AIDS hot spots near and far. She told White House colleagues, “I need to get on the ground to see what they’re doing right and what they’re doing wrong.” But Birx’s evangelism jarred with messages coming out of Washington. Trump and his aides pulled the plug on regular virus briefings, blocked many media appearances for Anthony Fauci and other health experts,
and carried on campaigning and governing like normal. Trump all but abdicated responsibility for ending the pandemic.

  Birx’s role was born of necessity. She was still working as the White House coronavirus response coordinator, albeit effectively sidelined by Scott Atlas. Birx figured that if she didn’t have the ear of decision-makers in Washington, she would try to shape the views of those in the states. She scheduled meetings with governors and state health officials to brief them on national trends, help them analyze data in their states, outline best practices to slow the spread, and answer questions about how CDC guidelines might apply in their communities or for their industries.

  On September 1, Birx traveled to Chicago to meet with Governor J. B. Pritzker and senior members of his team. The conversation was tense. Birx said Illinois was experiencing a spike in infections in many rural counties and showed them a chart with the data. Pritzker thought to himself, Duh, don’t you think we’re monitoring our own state? His chief of staff, Anne Caprara, spoke up.

  “I think, Dr. Birx, that part of the problem is that in the rural areas, which tend to be more conservative, they’re getting messages from the White House that tell them they shouldn’t wear masks and they shouldn’t stay in, so all the mitigation efforts that are working in Chicago aren’t working in these areas,” Caprara said.

  “Are you guys doing a public information campaign? Are you showing farmers in the ads?” Birx asked.

  “Excuse me?” Caprara said.

  “Farmers,” Birx said. “Like people outside of Chicago.”

  Caprara thought, We have all kinds of other people, too! Not just farmers. But she went back to the original point about the administration’s messaging.

  “The problem we are concerned about is that people are hearing from the president that this vaccine is going to show up two to three days before the election,” Caprara said. “You guys are already sowing disinformation and discontent and people are mistrusting the vaccine by [the president] talking about it as if it’s a political thing.”