By mid-February, some of the nation’s top health care officials were privately expressing alarm over evidence that the coronavirus was spreading from patients without symptoms in a chain of emails obtained by USA TODAY.

By mid-February, some of the nation’s top health care officials were privately expressing alarm over evidence that the coronavirus was spreading from patients without symptoms in a chain of emails obtained by USA TODAY. 

The agencies they help lead failed to translate the information into rapid action, leaving cities and counties to forge their own containment strategies. 

Since then, more than 12,000 Americans have died from the virus.  

The email thread was called “Red Dawn Breaking” – a riff on a 1980s movie. In their candid notes, some of the nation’s leading infectious disease experts and most powerful health care officials traded critical information as the threat mounted.

On Feb. 23, Dr. Robert Kadlec, assistant secretary for preparedness and response at the Department of Health and Human Services, highlighted flaws in the government’s approach in an exchange with dozens of high-level federal officers and outside experts, according to the previously unreported emails.

A leading researcher in projecting the toll of a pandemic outbreak had just shared studies showing the disease was spreading widely among people without symptoms in the Wuhan, China region, where the global outbreak started. Some carriers even tested negative for COVID-19. 

“Is this true?!” Kadlec responded. “If so, we have a huge whole (sic) on our screening and quarantine effort.”

The United States had been trying to hold off the disease with measures ranging from health screenings at airports to restrictions on travelers from China and ramp up limited testing for the virus. Kadlec did not respond to a request for comment.

Duane Caneva, chief medical officer at the Department of Homeland Security, kicked off the Red Dawn email threads earlier in the month as an informal forum for the country’s experts to help one another respond to the emergency.  

Kadlec’s email was circulated to a running chain of the top pandemic planners outside government as well as a long list of insiders: senior officers at his agency, Health and Human Services, at the Department of Homeland Security and scientists at the Centers for Disease Control and Prevention.  

Several are longtime friends who worked together in the George W. Bush administration, where they designed many of the response procedures the government has rolled out in recent weeks.  

Their behind-the-scenes distress stood in contrast to the official positions of federal agencies at the time and, most notably, that of their top boss.

On the day Kadlec sent his email, President Donald Trump repeated at a news conference a refrain he had recited for weeks: “We have it very much under control in this country.”  

That was the day Trump received a second warning from a top adviser that a coronavirus pandemic could cost the country trillions of dollars and endanger millions of Americans, according to The New York Times.

By then, the Red Dawn experts were deep into email discussions about a threat far worse than Americans had been told. The government officers on the chain traded notes about a drastic, last-resort option to contain the spread: mass closures of schools, businesses and communal spaces.   

Eva Lee, a leading infectious disease modeler in the USA, shared several studies and her own projections with Kadlec and others on the Red Dawn chain.

A Georgia Tech professor who worked on pandemic responses in both the Bush and Obama administrations, Lee shared with the group mounting evidence that people who tested negative and patients without symptoms appeared to be spreading the disease.  

Kadlec seemed uncharacteristically unnerved by her information, she said in an interview, which she assumed would translate into actions at the highest levels above him.  

“I was hoping that someone would act,” Lee said. “I guessed, naively, that maybe we will start moving.”  

A quick response to the knowledge was critical. Just a few weeks’ head start could drastically reduce the final death toll, a senior medical adviser in the Department of Veterans Affairs had noted even earlier, in an email Feb. 17.  

The adviser, Dr. Carter Mecher, laid out the pushback and concerns that would be raised about the closures, even sharing data with the group about the impact on the millions of American children relying on schools for daily meals. 

Yet it would be a full month before the White House released an initial 15-day plan to “slow the spread” – a plan that fell far short of a national stay-at-home directive. 

Trump’s tepidly worded action paper asked Americans to work and take classes from home when possible and to avoid discretionary travel.   

The delays at the federal level left states and communities on their own to make decisions about when, and if, to order residents to shelter in place.  

Governors and mayors found themselves subject to blistering second-guessing from health experts urging immediate and sustained action and business leaders who feared a ruinous impact on the local economy and stressed-out households.  

They were forced to make critical decisions without testing data to accurately track the rising number of infections after failures at the CDC and the Food and Drug Administration to develop and scale up an essential screening measure.

The coronavirus test that wasn’t: How federal health officials misled state scientists and derailed the best chance at containment

On the Red Dawn threads, experts traded their own research, international headlines and analysis from other publicly available data coming out of China and the cruise ships that carried some of the first American patients.  

National officials activating response plans across federal agencies in February and into March were warned through the emails of early signs the virus appeared to be spreading in California and Washington state.  

The names copied on the correspondence – a portion of which USA TODAY obtained from direct recipients and public records requests – include division-level leaders at the CDC’s public health offices; Dr. Gregory Martin, a division director at the State Department; Mecher at Veterans Affairs; as well as Kadlec’s lieutenants at the preparedness agency inside HHS. 

Caneva and Martin did not immediately respond to requests for comment, and Mecher declined to comment.

The White House did not address the early warnings in the Red Dawn emails to officials who advise Trump or the subsequent delays to respond. 

"President Trump took bold action to protect Americans and unleash the full power of the federal government to curb the spread of the virus,” White House spokesman Judd Deere said. 

HHS, which oversees the CDC and FDA, did not address the emails or what precise steps were taken to inform local authorities about the new information in them. 

Gretchen Michael, an agency spokeswoman in Kadlec’s division, said the HHS departments “have been and continue to be committed to providing the latest information about this new virus to state and local health officials.”  

Federal health official wrote, 'You can’t outrun it'  

Experts in the Red Dawn group treated a cruise ship forced to quarantine after docking in Japan in early February as a research opportunity – a floating laboratory with reliable data.  

Mecher, a senior medical adviser for the U.S. Department of Veterans Affairs, sent an email Feb. 27 calculating how the spread documented onboard applied to an early case in California: “We already have a significant outbreak and are well behind the curve.” 

In the email, Mecher raised the possibility of closing schools and instituting  social contact restrictions.  

Mecher had helped design how such measures should be applied for a national pandemic mitigation plan in 2007. He had studied how social distancing improved outcomes between cities in the Spanish flu outbreak in 1918.   

For at least 10 days, he had been pushing the group about the need to plan for social distancing measures.  

“We are now well past the equivalent 5:45 moment at Mann Gulch,” Mecher wrote in his email Feb. 27, referring to the moment in a historic wildfire when responders realized too late that they needed to turn around. “You can’t outrun it.” 

That topic was not emphasized at a White House roundtable that same week between federal planners and state and local public health officers, in Washington for an annual series of meetings on Capitol Hill.  

Earlier in the day, Dr. Nancy Messonnier of the CDC had detailed to reporters the range of social changes that would probably be needed to contain the virus, from teleworking to canceling large events and closing schools. She described telling her children at breakfast that “we as a family need to be preparing for significant disruption of our lives.” 

The comments by Messonnier, who directs the agency’s National Center for Immunization and Respiratory Diseases, helped propel the stock market into a downward spiral.  

In a White House annex, more than 40 people – not yet concerned about social distancing – packed around conference tables arranged in a square for the public health planning discussion. Many of the officials had never been invited to a White House meeting, which had been added to their agenda.

Among those attending were health officers from New York and Washington, states soon to become early hot spots for the disease. Federal health leaders included Kadlec, who two days earlier had sent the email warning about inadequate screening.  

To the state and local health officers, the rock star in the room was Anne Schuchat, the CDC’s principal deputy director. 

Discussion centered on containing the threat by screening, testing and tracking the contacts of anyone exposed, recalled Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officials. 

“It was still a containment conversation, like we have got to get out there and test and find people and try to get this under control,” he recalled of a meeting that went on long enough for his back to hurt. 

State health officers left impressed that the federal leaders had listened more than they presented.  

That evening, Caneva, the Homeland Security medical officer, fired off an email to the Red Dawn chain noting a “good discussion.” 

“We are all in this together, and preparedness and response slowly transitions to community mitigation efforts and the frontline boots on the ground,” he wrote. “Still only 14 cases detected.” 

The word “detected” was singled out in italics. 

'The cat is out of the bag,' a county health official said of the spreading virus 

Washington State Secretary of Health John Wiesman was among the health officers who ended up cutting short his visit to the capital that week.  

Back in his home state, planners in Seattle were reviewing a state guide to restrictions that might be needed to contain a virus for which there was no medication or vaccine.  

Public records show health officials decided that the new coronavirus did not appear deadly enough to outweigh the economic toll of widely imposing the most restrictive types of distancing measures. 

By week’s end, a man in his 50s succumbed to COVID-19 symptoms in Kirkland, a Seattle suburb. He was the first to die in the USA.  

Soon worrisome reports about a cluster of cases linked to a cruise in mid-February surfaced in California – evidence of the type of worries raised in the Red Dawn email chain. 

In Placer County, public health officer Aimee Sisson thought the virus was probably out in Northern California by the time she announced March 4 the death of a man, the state’s first COVID-19 victim.  

She recalled counting back through the cruise passenger’s contacts during the days it took for him to progress from infection to hospitalization 20 minutes from the state capital, as well as other cases from the same voyage beginning to surface.

Sisson told USA TODAY that she sensed “the cat (was) out of the bag” and was ready to strongly alert her community about what was coming.  

The federal posture at the time remained cautious. 

An official from the CDC questioned her choice of wording in a news release advising the community to prepare for the transmission of the virus, emails obtained from Placer County through a public records request show. 

“In the quote, you mentioned community spread and that could lead people to think you currently have community spread cases,” CDC press officer Scott Pauley wrote, “but I do get that it’s possible you will have the possibility of that in the coming days.” 

Sisson included the language anyway, telling residents that although the case did not appear to be a locally acquired infection, “we expect to see additional cases in coming days, including cases of community spread, not linked to travel.”  

She told USA TODAY that she did not feel pressured by the CDC to tone down her approach. 

Sisson used her megaphone at a news conference about the death to warn residents that the risk to their community no longer was low.  

“While we are not at the point where I would consider canceling events, closing schools or requiring widespread social distancing measures, we do want the public to prepare for that possibility,” she said. 

The CDC official dispatched to talk to reporters downplayed the threat during the same news conference. Asked whether people should avoid cruise travel, Dr. Chris Braden noted that some communities were seeing cases but many more were not, “so it is very hard to make generalizable statements.” 

An assistant director at the California State Health Department was similarly vague, yet Dr. Charity Dean may have known better: She was on the Red Dawn email chain, where she had been warned about other flares arising in the state. 

Dean could not be reached for comment. 

In a statement to USA TODAY, CDC spokesman Benjamin Haynes said the agency provides guidance to states and local communities to help them decide what measures to use.   

“All CDC recommendations are based on the best available data and science we have at that time,” Haynes said.  

It was two weeks before the state’s governor became the first in the nation to issue a stay-at-home order. By then, 15 more had died in California, and the U.S. death toll had begun its steep climb.

Brett Murphy and Letitia Stein are reporters on the USA TODAY investigations desk. Contact Brett at brett.murphy@usatoday.com or @brettMmurphy and Letitia at lstein@usatoday.com, @LetitiaStein, by phone or Signal at 813-524-0673. 

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