Welcome back to The Long Version, a newsletter by Jonathan Myerson Katz.
The new disease was spreading uncontrollably. Every hour, the toll of infections and deaths climbed. As a journalist, I had to rely on experts to tell me what was going on, starting with the CDC.
The U.S. Centers for Disease Control and Prevention was founded in 1946, part of the consolidation of New Deal liberal collectivism and the national security apparatus of World War II. It grew out of a wartime program to reduce the number of soldiers dying from malaria. Its founding benefactor was Robert W. Woodruff, president of the Coca-Cola Company—which, along with Georgia’s rampant malaria problem at the time, is how the CDC ended up in the sugarwater magnate’s hometown of Atlanta.
As American wealth and power grew in the post-war years, the CDC grew with it, collecting the best scientists and public health experts in the world. Other nations turned to Atlanta for testing and guidance. Even America’s geopolitical rivals in China named their agency the “CDC” in tribute to the original.
It stood to reason in October 2010 that the government of Haiti would turn to the CDC to test the unknown pathogen killing hundreds in the countryside. Once the disease was confirmed—it was cholera—it made equal sense that we would all turn to the CDC for information about the infection’s source and spread, and what could be done to stop it.
Five days after the CDC report, I followed local rumors about the source of the epidemic to a rural U.N. peacekeeping base. I found U.N. military police clandestinely taking groundwater samples. While Nepalese soldiers around me dug up pipes and destroyed evidence, I broke the story that U.N. soldiers from Nepal had introduced cholera to Haiti by letting their feces contaminate the country’s most important river, the Artibonite.
I knew the U.N. would howl. But I expected the scientists at the CDC to be interested. I’d gotten clues to the exact location of where cholera was introduced, along with the arrival dates of the infected battalion. Those with more knowledge could use those facts to map the spread of the waterborne infection, make recommendations on where to focus supplies and staff, what contaminated water sources to avoid, and so on.
To my shock, the CDC shrugged. Yes, CDC epidemiologist Eric Mintz, told me, their analysis found that the strain circulating in Haiti matched the biotype of a strain circulating in Nepal. But he cautioned that was not a “smoking gun.”
I asked when the CDC would start looking for more definitive evidence.
They had no plans to, the spokesman on the call replied.
It was only years later, after more than 10,000 people were dead, and the U.N. came around to admitting (grudgingly, without holding anyone accountable) that it had sparked the epidemic, that I uncovered the disturbing truth: The CDC—and at least some high-ranking officials in the Obama White House—had known from the beginning that it was possible international responders had introduced cholera to Haiti, and refused to pursue it for political reasons.
If you’ve been paying attention to the burgeoning coronavirus outbreak, you know why I’m re-telling this story. Everything that we know about the spread of Covid-19 in the United States comes from the CDC and its parent department in the executive branch, Health and Human Services. So far, the official totals are 115 people infected, nine dead.
There is strong reason to believe the real toll is much higher, and being underreported for political reasons. That could have disastrous consequences for all of us.
The Merry-Go-Round Broke Down
I’m not alleging a secret conspiracy to murder Americans. That would require planning. So far we’ve seen an incompetent roll-out of viral tests, some or all of which may have been contaminated in the CDC’s lab. We’ve seen a hospital and the CDC bickering about delays in testing that may have allowed the virus to spread, and a lack of monitoring that appears to have missed at least two deaths in Seattle.
We’ve seen the State Department ignore the CDC’s advice on transporting infected people to the United States, and HHS personnel receive them without following protocol on preventing themselves or others from catching the disease. Trump responded to the former by slamming his underlings. Health and Human Services Secretary Alex Azar reacted to the later by investigating the whistleblower.
In Haiti, the political pressure was to protect the U.N. peacekeeping mission, which both Republican and Democratic presidents had relied on to provide outsourced military control of the nearby country. Today with the coronavirus, the pressure is more explicitly partisan: Trump knows that a social crisis and flailing economy are bad for his reelection campaign.
The president is lying—repeatedly, and possibly to himself—about the scale of the threat. He has lied about the number of infections: On February 26, he claimed falsely that there were only 15 cases in the United States, and that “the 15 within a couple of days is going to be down to close to zero.” The official number has since increased by nearly 800%.
He has chosen political flunkies with the opposite of scientific expertise, chiefly Vice President Mike Pence, to oversee the response. He has sidelined public health experts like Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Disease, from making public statements. And he has blamed his usual bugaboos, the media and Democrats, for overhyping the outbreak into proportions he label a “hoax.” (He assumed, probably with good reason, that his rally audience had no idea what had been happening in the rest of the world. Then he lied about the number of infections again.)
Everyone has found it easy to blame Sec. Azar of HHS. He’s an attractive target: a former pharmaceutical lobbyist and executive (everybody boos) with no fanbase to rush to his defense. This week Politico published a hit piece based on interviews with “17 current and former officials and individuals close to the Trump administration,” knocking Azar for his “management failure.”
But as Jeremy Konyndyk, an expert on global outbreak preparedness with the Center for Global Development, said:
Indeed, Trump nominated Azar—corporate lackey that he is—precisely because he seemed like a reliably loyal and reliably corrupt replacement for his wildly corrupt predecessor at HHS, former Georgia Republican congressman Tom Price. Trump sat by while John Bolton dismantled the National Security Council team in charge of pandemic response, and boasted about cuts to the CDC and NIH budgets. Blaming Azar for botching the response is like blaming the dog for eating the box of cupcakes he left him alone to guard. What did he expect him to do?
It is more worrying that respected officials such as Fauci are out in public defending an incompetent administration and shielding it from criticism—leaving it to anonymous whistleblowers to offer glimpses of the dysfunction at the threat of losing their jobs. Like the CDC in Haiti, I feel certain that the professionals feel that they are making the best choices under the circumstances: balancing the pressure from their bosses’ boss with other concerns, justifying that without the administration’s support they can’t do their work. But they will have to fight harder.
All we got
You might think that my personal experience with the CDC (and, separately but relatedly, the World Health Organization) might have permanently convinced me to give up on them. The problem is, we don’t have any other options. By the time a pandemic gets to the point where everyone can personally report on the scale of the problem just by looking out their window, it’s too late.
The CDC and broader federal, state, and local health bureaucracies have to be reliable sources. We have to be able to trust their numbers, follow their advice, and react accordingly. Trump’s “What Me Worry?” approach to coronavirus can’t last long. Barring a miracle, at some point the numbers will rise to a point no one can hide, people will freak, and the president will transition seamlessly to his “very strong, very tough” racist macho posturing.
If the CDC has abdicated all communication about the outbreak to the politicians at the top before then—if they have failed to address the failures of testing, and not come clean about any pressures they face ahead of time—they will have burned through their credibility. They won’t be able to reassure people not to make dumb, panicky decisions, and convince them not to listen to snake oil salesmen who could end up getting a lot more people killed.
In Haiti, the failure to commit resources to investigating origins of the cholera epidemic led to widespread distrust, then riots. Treatment became harder to provide, and families became fearful of all foreigners—including doctors entrusted with saving their lives. Millions are still living with the consequences.
I always wondered what would happen if an outbreak happened here: if U.S. officials would cave to political pressure when American lives were at stake. I’m kind of surprised, honestly—and not encouraged by the answer so far. Let’s hope there’s time for a better one.
Jonathan Myerson Katz is a journalist. He is the author of The Big Truck That Went By: How the World Came to Save Haiti and Left Behind a Disaster, which includes the story of the U.N. cholera epidemic. His next book, Gangsters of Capitalism, traces the origins and contradictions of America’s empire. Follow him on Twitter @KatzOnEarth.
Photos: CDC illustration of SARS-CoV-2, the coronavirus that causes Covid-19/Alissa Eckert, MS; Dan Higgins, MAM; Haiti cholera clinic, 2010, by Emilio Morenatti/AP