SATURDAy, MARCH 21 , 2020. THE WASHINGTON POST EZ RE A
The Coronavirus Outbreak
BY PHILIP RUCKER
AND ASHLEY PARKERPresident Trump was reeling
from one of his worst weeks ever:
The novel coronavirus was killing
Americans, wrecking the econo-
my and subsuming him and his
presidency.
But in the pandemic, Trump
saw an opportunity to cast him-
self in a new role: “Wartime
president,” as he later dubbed it.
Aides noted that Trump was
punctual for last Saturday’s
White House task force meeting,
donning a navy “USA” cap and —
instead of simply watching as
Vice President Pence and the
assembled health officials briefed
the public that afternoon, as he’d
initially planned — joining them
at the rostrum.
All week, Trump reveled in his
newfound character — that of a
crisis commander steering his
skittish nation through battle
with what he called an “invisible
enemy.” He parried questions,
barked orders and stood stoically
by as he accepted praise, day after
day, from his underlings for his
“strong leadership” and “decisive
actions.”
But on Friday, Trump faltered.
He argued based on “just a feel-
ing” that, despite no scientific
evidence yet, an anti-malaria
drug could cure the coronavirus.
He complained that he has not
been credited for fixing a nation-
wide testing system that clearly i s
still broken. And when asked
what message he had for Ameri-
cans who were scared, he lashed
out.
“I say that you’re a terrible
reporter,” Trump answered to
NBC News correspondent Peter
Alexander. “That’s what I say.”
Trump’s past seven days at the
helm of the coronavirus effort
illuminated his mercurial nature
and underscored his difficulty
overseeing the national response
to a global catastrophe largely
out of his — or any other leader’s
— control.
Trump — whose moods often
determine policy and are almost
directly correlated to the vagaries
of 24-hour news cycles — has
been lapsing into his self-de-
structive ways even when aides
stress the importance of steady
leadership during a national
emergency.
Fixated on his portrayal in the
media, Trump has used this past
week to try to rewrite history in
hopes of erasing the public’s
memory of him dismissing the
severity of threat and bungling
the early weeks of the adminis-
tration’s response.
“I’ve felt that it was a pandem-
ic long before it was called a
pandemic,” Trump said Tuesday.
Only five days earlier he had
declared, “It’s going to go away,”
and two days before that he had
said, “It will go away. Just stay
calm.”
After the coronavirus was first
detected in China and swept
across Europe, and even after the
first reported case in the United
States on Jan. 21, Tr ump tried to
wave off the danger. He was then
in the throes of the impeachment
battle and distracted by the Dem-
ocratic presidential primaries.
The president accused the media
of perpetuating a hoax, arguing
that news organizations were
drumming up hysteria over the
growing public health crisis as a
way to hurt his presidency.
The nadir for Tr ump came
March 6, when he visited the
Centers for Disease Control and
Prevention headquarters in At-
lanta and appeared to make a
mockery of the scientists’ warn-
ings. He then decamped for the
extended weekend to Palm
Beach, Fla., where he played golf
and hung out with friends at his
Mar-a-Lago Club, which itself
turned into a coronavirus petri
dish.
Trump’s public posture beganto shift, however, once the finan-
cial markets started to plummet.
He was particularly taken with
the numbers — not just the cra-
tering Dow Jones industrial aver-
age but also the briefings he
received from Vice President
Pence, multiple times a day, with
fresh data and figures showing
how the virus could devastate the
nation if left unchecked.
A new study released earlier
this week by the Imperial College
London — which projected that
2.2 million would die in the
United States alone if no steps
were taken to curb the outbreak
— was particularly influential
among Trump’s inner circle.
Trump also was influenced by
his conversations with business
leaders and wealthy supporters,
who lit up the presidential phone
line with angst and alarm over
the Wall Street meltdown. Theirmessage: Get it together. The
world’s collapsing and you’re
flaunting that you don’t care.
Trump then took a series of
steps in quick succession to try to
gain control over the spiraling
crisis. He delivered a prime-time
address to the nation. He banned
travel from Europe. And he de-
clared a national emergency.
Though Trump claims his Jan.
31 restrictions on travel from
China as evidence that he always
has taken the coronavirus seri-
ously, one senior White House
official said his March 11 an-
nouncement prohibiting most
travel from countries in the Euro-
pean Union — a critical diplomat-
ic ally and trade partner — h elped
truly underscore for Trump the
severity of the crisis.
Trump was angry that his er-
ror-riddled prime-time Oval Of-
fice address to the nation, in
which he announced the Europe
ban, was widely panned, and
frustrated that so few allies de-
fended him on television the next
day. But on March 13, a news
conference in the Rose Garden —
at which he announced a new
testing website and new testing
locations, both of which were
half-baked at best — buoyed his
spirits because he finally felt he
had at least the illusion of con-
trol, aides said.
Officials also pointed to HopeHicks — Trump’s former commu-
nications director and close con-
fidante who recently returned to
the White House after a stint in
Los Angeles — as a calming
presence who helped focus
Trump.
Each day after the task force
meets and before members pres-
ent their latest message to the
public, a small group retreats to
the Oval Office to strategize
about the news conference. The
group includes whatever officials
are speaking that day, as well as
Pence, Hicks, White House chief
of staff Mark Meadows, the vice
president’s chief of staff Marc
Short, and Trump’s son-in-law
and senior adviser Jared Kush-
ner. Hicks often offers tonal sug-
gestions, helping steer Trump
toward the sort of more mea-
sured language that his advisers
have long been pushing.
On Monday, Trump adopted
the far more serious tone that his
advisers had encouraged. He
echoed the guidance of infectious
disease experts and offered direc-
tion about what people should
and shouldn’t do. He advised
against gatherings of more than
10 people, as well as discretion-
ary travel, and urged whoever
could work from home to do so.
He even hit the pause button on
his various feuds with Democrats
and the media.“My focus is really on getting
rid of this problem — this virus
problem,” he said Monday. “Once
we do that, everything else is
going to fall into place.”
Trump spoke of the coronavi-
rus as if it were a foreign adver-
sary at war, drawing parallels
between the ways Americans are
adapting their lives to adhere to
social distancing guidelines to
the sacrifices citizens made dur-
ing World War II. Speaking about
his own leadership, Trump said
Wednesday, “I view it as, in a
sense, a wartime president.”
Historian Michael Beschloss
said Trump’s conception of him-
self as a wartime leader is poten-
tially apt.
“The war metaphor is actually
a good one if what it means is that
the president is acting as a com-
mander in chief does, which is
trying to orchestrate all of the
power of the federal government
to solve the problem and to level
with the American people,” Bes-
chloss said. “But this is not a war
against a foreign enemy. It is not
military. Waging a war is not the
same thing as fighting an illness.”
The president’s resolve, how-
ever, did not last. Trump has
never demonstrated the ability to
sustain discipline or message
control over an extended period
— frequently following fleeting
periods of calm with bursts of
seeming self-sabotage — and this
week was no different.
On Thursday, Trump snapped
at a reporter who began a ques-
tion by stating that “the economy
is essentially ground to a halt.”
“Thanks for telling us — we
appreciate it,” Trump said, before
adding, “Everybody in the room
knows that.”
By Friday, Trump was in full
tirade mode. Seemingly desper-
ate for a miracle medicine, he
kept on pushing an anti-malarial
drug as a potential cure-all,
prompting Anthony S. Fauci, the
director for the National Insti-
tute of Allergy and Infectious
Diseases, to gently offer a more
nuanced view.
But even the normally placid-
faced Fauci could barely contain
himself when Tr ump referred to
“the State Department or, as they
call it, the ‘Deep State’ Depart-
ment.” Fauci, standing just be-
hind Trump’s left shoulder but
still on camera, smirked and
touched his fingertips to his brow
to cover his face as he struggled
to suppress a chuckle.
Other moments were less hu-
morous. When Alexander, the
NBC reporter, asked Trump what
message he had for “A mericans
who are watching you right now
who are scared,” Trump angrily
attacked him as “a terrible re-
porter” and called it “a very nasty
question.”
When Alexander later posed
the same question to Pence, it
was Trump’s No. 2 who offered
the words one might ordinarily
expect from a wartime president:
“Don’t be afraid. Be vigilant.”
[email protected]
[email protected]Uneven performance by Trump i n ‘wartime president’ role
JABIN BOTSFORD/THE WASHINGTON POST
President Trump takes questions from reporters Thursday during a
coronavirus task force briefing at the White House. The president
has used the past week to try to improve public perception of his
response to the crisis. At left, his briefing notes show “Corona”
crossed out and replaced with “Chinese” before the “Virus.”BY CHRISTOPHER ROWLANDThe U.S. has all but exhausted
its supplies of two anti-malarial
drugs that are being used by some
doctors in the U.S. and China to
treat the coronavirus, but which
lack definitive evidence as effec-
tive treatment or approval from
the Food and Drug Administra-
tion.
Hopes that the decades-old
drugs could be effective against
the coronavirus were also boosted
by President Trump, who told a
White House press briefing on
Thursday the compounds were “a
game-changer” and have shown
“very, very encouraging results.''
He made similar remarks again
Friday.
The sudden shortages of the
two drugs could come at a serious
cost for lupus and rheumatoid
arthritis patients who depend on
them to alleviate symptoms of
inflammation, including prevent-
ing organ damage in lupus pa-
tients.
Several new studies have
shown the possible benefits of
hydroxychloroquine and chloro-
quine, but medical experts are
cautioning there is no solid evi-
dence they have any effect on
coronavirus. At Trump’s behest,
the FDA is considering launching
a broad clinical study to docu-
ment whether they really work.
Even with the deep uncertain-
ties, some doctors have been pre-
scribing the drug as a preventive
measure as well as a treatment.
The phenomenon, known as “off-
label” prescribing, has depleted
already limited supplies.
“It’s gone. It’s not in the phar-
macy now,” said Alexander
Morden, a physician in Queens
who is taking the drug in the hope
of staving off infection. He s aid he
has prescribed hydroxychloro-
quine to about 30 of his patients
as a prophylactic and as a treat-
ment to another dozen who have
already been infected.
Data gathered in the first 17
days of March by Premier Inc., a
large group purchasing organiza-
tion for 4,000 U.S. hospitals,
showed a 300 percent week-over-
week increase in orders of chloro-
quine and a 70 percent week-
over-week boost in orders of hy-
droxychloroquine.
“Both drugs are pretty much
depleted right now in the distri-
bution channel and wholesale
distributors are reporting both
products on back order,” s aid Sou-mi Saha, senior director of advo-
cacy at Premier.
In a typical month during 2019,
sales of chloroquine to Premier’s
4,000 hospitals were 149 bottles
of 100 pills, Saha said. In the first
17 days of March, those hospitals
bought 2,357 bottles.
For hydroxychloroquine, those
purchases were 16,000 bottles in
the first 17 d ays of March, which is
well more than twice the normal
consumption, she said.
Those large purchases likely
represented hospitals stocking up
on supply, she added, so there
may be more reserve inventory
sitting on hospital pharmacy
shelves.
In M assachusetts, one hospital,
Boston Medical Center, said it
ordered hydroxychloroquine ear-
ly in the pandemic and is giving it
to suspected coronavirus patientswith breathing trouble.
The hospital reviewed emerg-
ing information about the use of
the drug on the coronavirus in
other countries and decided it
would be prudent to try it in
patients who are displaying signs
of respiratory distress, said Dr.
Ta mar Barlam, chief of BMC’s
division of infectious disease. T he
safety of the drug is well estab-
lished, she said, and it could re-
duce the body’s dangerous in-
flammatory response to the virus.
She said more than a dozen pa-
tients have been treated with the
drug but that it’s t oo early to say if
it has any benefit.
The drugs should be used ex-
clusively in ill patients and not
tried prophylactically by doctors
and others, she said.
“The issue for me that’s dis-
turbing is that people are getting
their own prescriptions, or have
prescribing rights, doctors or
de ntists, and writing themselves
large prescriptions of the drugs,
and doing it for themselves and
family,” s he said. “If there’s h oard-
ing, that is just going to be a big
problem, and that is something
that pharmacies and the health
care system need to put a stop to
pretty quickly.”
Much of the frenzy has been
fueled by three recently pub-
li shed studies, on small groups of
patients from China, Japan and
France, that indicated possible
benefits of the drugs. But those
were not randomized clinical tri-
als tested against a placebo,
which is considered the gold stan-
dard for proof of efficacy.
Trump on Friday continued ex-pressing optimism about the use
of the drugs from the White
House lectern, even as Anthony S.
Fauci, head of the National Insti-
tute of Allergy and Infectious Dis-
eases, stood beside him trying to
tamp down the hype. Fauci called
evidence thus far “anecdotal.”
“It was not done in a controlled
clinical trial, so you really can’t
make any definitive statement
about it,” Fauci said at a press
briefing.
Later in the exchange, Trump
said he has high hopes for at least
one of the drugs: “It may work, it
may not work. I feel good about it.
That’s all it is. Just a feeling. You
know, I’m a smart guy. I feel good
about it. And we’re going to see.”
But with the run on the drugs,
doctors warned of risks to lupus
and rheumatoid arthritis pa-
tients.
There are no good alternatives,
and withdrawal from the drugs
can trigger new inflammatory
flare-ups, said Dr. Karen Costen-
bader, director of the lupus pro-
gram at Brigham and Women’s
Hospital in Boston and the chair
of the Lupus Foundation of Amer-
ica’s medical-scientific advisory
council.
“These are essential long-term
medications that are the founda-
tion of treatment for many chron-
ic and severe autoimmune diseas-
es,” she said. “There are already
shortages and there is a lot of
concern. Several pharmacies in
the New England area have de-
pleted their supplies already.”
Manufacturers of hydroxychlo-
roquine include generic manu-
facturers Actavis, which is ownedby Te va, and Sandoz. Novartis, the
parent company of Sandoz, said it
was prepared to donate 130 mil-
lion doses of hydroxychloroquine
around the world by the end of
May, if its use is approved by
governmental authorities. “The
company is also exploring further
scaling of capacity to increase
supply and is committed to work-
ing with manufacturers around
the world to meet global de-
mand,” Novartis said.
Another generic company, Ris-
ing Pharmaceuticals, manufac-
turers both hydroxychloroquine
and chloroquine. It recently re-
versed a doubling in prices that it
imposed last year and said on
Friday that it cut prices even fur-
ther and would donate 1 million
tablets in areas of greatest need.
“A s it became clear in January
that this growing crisis was upon
us in the U.S., Rising Pharmaceu-
ticals put these plans in motion to
respond,” said Ira Baeringer, Ris-
ing’s chief operating officer.
Bayer, the German drug giant,
announced this week that it
would donate 3 million tablets of
its version of chloroquine to the
U.S. government for a large clini-
cal trial the FDA is considering.
Community pharmacists are
reporting shortages of both
drugs, as large purchases soak up
existing supply, said Ronna Haus-
er, a pharmacist and the vice
president of policy and govern-
ment affairs operations at the
National Community Pharma-
ci sts Association.
“The cascade effect is starting,”
she said.
[email protected]Hospitals, doctors wiping out supplies of unproven coronavirus treatment
GERARD JULIEN/AGENCE FRANCE-PRESSE/GETTY IMAGES
Chloroquine and hydroxychloroquine are in high demand but have
not yet been verified as an effective treatment for the new virus.