WASHINGTON — As the coronavirus emerged and headed toward the United States, an extraordinary conversation was hatched among an elite group of infectious disease doctors and medical experts in the federal government and academic institutions around the nation.
Red Dawn — a nod to the 1984 film with Patrick Swayze and Charlie Sheen — was the nickname for the email chain they built. Different threads in the chain were named Red Dawn Breaking, Red Dawn Rising, Red Dawn Breaking Bad and, as the situation grew more dire, Red Dawn Raging. It was hosted by the chief medical officer at the Department of Homeland Security, Dr. Duane C. Caneva, starting in January with a small core of medical experts and friends that gradually grew to dozens.
The “Red Dawn String,” Dr. Caneva said, was intended “to provide thoughts, concerns, raise issues, share information across various colleagues responding to Covid-19,” including medical experts and doctors from the Health and Human Services Department, the Centers for Disease Control and Prevention, the Homeland Security Department, the Veterans Affairs Department, the Pentagon and other federal agencies tracking the historic health emergency.
Here are key exchanges from the emails, with context and analysis, that show the experts’ rising sense of frustration and then anger as their advice seemingly failed to break through to the administration, raising the odds that more people would likely die.
A Veterans Affairs official worried in January that the W.H.O. and C.D.C. were slow to address the spread of the virus.
One of the most active participants in the group was Dr. Carter E. Mecher, a senior medical adviser at the Veterans Affairs Department who helped write a key Bush-era pandemic plan. That document focused in particular on what to do if the government was unable to contain a contagious disease and there was no available vaccine, like with the coronavirus.
The next step is called mitigation, and it relies on unsophisticated steps such as closing schools, businesses, shutting down sporting events or large public gatherings, to try to slow the spread by keeping people away from one another. As of late January, Dr. Mecher was already discussing the likelihood that the United States would soon need to turn to mitigation efforts, including perhaps to “close the colleges and universities.”
A former Bush and Obama adviser compared the outbreak to major disasters in world history.
Dr. James Lawler, an infectious disease doctor at the University of Nebraska who served in the White House under President George W. Bush and as an adviser to President Barack Obama, was also a regular participant in the email chain. He stayed in regular communication with federal officials as the United States attempted to figure out how to respond to the virus. From the beginning he predicted this would be a major public health event.
Experts worried that it would be hard to convince society to order restrictions like school and business closures to slow the spread.
Convincing governors and mayors to intentionally cause economic harm by ordering or promoting mitigation efforts — such as closing businesses — is always a difficult task. That is why it is so important, these medical experts said, for the federal government to take the lead, providing cover for the local officials to kick off the so-called Nonpharmaceutical Interventions, such as school and business closures. Again, this group of doctors and medical experts recognized from early on that this step was all but inevitable, even if the administration was slow to recognize the need.
The Diamond Princess was an early case study of how quickly the virus could spread.
Strong evidence was emerging as of mid-February — with the first cases of Covid-19 already in the United States — that the nation was about to be hit hard. These doctors and medical experts researched how quickly the virus spread on the Diamond Princess cruise ship, which was quarantined in the port of Yokohama, Japan, on Feb. 3 before hundreds of United States citizens on the ship returned home.
Dr. Eva Lee, a researcher at Georgia Institute of Technology who has frequently worked with the federal government to create infectious disease projections, helped the Red Dawn group do modeling, based on the virus spread on the cruise ship. (Dr. Lee is facing sentencing on federal charges that she falsified the membership certificate behind a $40,000 National Science Foundation grant for unrelated research.)
February was a tipping point for some experts.
The concern these medical experts had been raising in late January and early February turned to alarm by the third week in February. That was when they effectively concluded that the United States had already lost the fight to contain the virus, and that it needed to switch to mitigation. One critical element in that shift was the realization that many people in the country were likely already infected and capable of spreading the virus, but not showing any symptoms. Here Dr. Lee discusses this conclusion with Dr. Robert Kadlec, the head of the virus response effort at the Department of Health and Human Services and a key White House adviser.
Dr. Kadlec and other administration officials decided the next day to recommend to Mr. Trump that he publicly support the start of these mitigation efforts, such as school closings. But before they could discuss it with the president, who was returning from India, another official went public with a warning, sending the stock market down sharply and angering Mr. Trump. The meeting to brief him on the recommendation was canceled and it was three weeks before Mr. Trump would reluctantly come around to the need for mitigation.
This slow pace of action was confusing to the medical experts on the Red Dawn email chain, who were increasingly alarmed that cities and states that were getting hit hard by the virus needed to move faster to take aggressive steps.
A former high-ranking Trump official weighed in with criticisms.
When Mr. Trump gave a speech to the nation on March 11 in which he announced limits on flights from Europe to the United States — but still no move to curb gatherings in cities where the virus had spread — the experts on the email chain grew angry and fearful. Among those questioning Mr. Trump’s decision was Tom Bossert, who had previously served as Mr. Trump’s homeland security adviser.
Participants were angry the C.D.C. did not push for school closures.
The Red Dawn participants were even more upset when the Centers for Disease Control and Prevention, in mid-March, questioned the value of closing schools, at least for short periods of time. Soon enough, governors ignored this advice, and most schools in the United States were shut. But it happened largely without federal leadership.
See all of the email exchanges.
The New York Times has collected more than 80 pages of these emails, from January through March, based in part on Freedom of Information Act requests to local government officials. Some of the emails were reported on last month by Kaiser Health News. Here is a fuller collection, arranged by The Times in chronological order. This file includes a list of many of the medical experts on the email chains. It also contains related emails from certain state government medical experts who were reaching out to the federal government during the same time period.