Defending himself against the federal government’s increasingly indefensible handling of the coronavirus, President Donald Trump has routinely declared that “nobody” could have predicted, or prepared for, a deadly pandemic that could strike at any moment.
But the man now tasked with running President-elect Joe Biden’s incoming administration saw it coming—and according to public health officials, may be the only person with the first-hand experience necessary to turn the tide of an unparalleled public health emergency.
“Ron Klain did something that was unprecedented in modern American history, in sharp contrast to what President Trump has done with COVID,” Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University, told The Daily Beast. “Klain turned a calamity into a triumph.”
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Klain, newly announced as Biden’s White House chief of staff, isn’t a physician or an expert in infectious disease. But the actions he took as the leader of the American response to the West African Ebola outbreak in 2014 is credited by luminaries in the field with saving hundreds of thousands of lives—and are seen by hopeful doctors and public health experts as a potential blueprint for turning around the hamfisted disaster that has been the Trump administration’s response to COVID-19.
“The principles are, you pay attention to the scientists, you follow recommendations, you have a pandemic plan, and you follow it,” said Dr. Arnold Monto, a professor of epidemiology and global health at the University of Michigan and a former adviser to the World Health Organization. “Those are the principles that he followed, and they are what we need going forward.”
With the title of White House Ebola Response Coordinator—which initially prompted meme-based mockery from those skeptical that a non-doctor could lead the government’s response—Klain was the architect of a novel contact-tracing program that tracked all travelers entering the United States who had originated in West Africa, gave them cellphones in order to maintain contact, and tested their temperatures for three weeks following their entry to the United States.
Klain also directed the government to provide massive training exercises for major medical centers across the country in order to ensure that if an Ebola case arose, those hospitals would have the knowledge to provide care without accidentally spreading the highly contagious pathogen in the process. Before the program, only three U.S. medical centers were trained and prepared to treat Ebola patients. Within three months, nearly 50 had been trained to do so.
Outside of the United States, Klain pushed for the American military to Liberia in a support role, prompting allies to do the same—and prompting Trump, then a dimming reality television star, to call for global isolation of West Africa, death toll be damned.
Public health experts say that the protocols were an enormous success. Only one person died of Ebola in the United States, and the CDC’s most dire predictions of the outbreak remained a nightmare instead of becoming a reality
“Before the Obama administration really became engaged in West Africa, there was an unfolding calamity that was happening in West Africa which could easily have spilled over to North America and the world,” Gostin said. “At the time we engaged, the CDC had projected that if the course went on as expected, there would be 1.1 million cases, with most of them dying, in West Africa, which would have rapidly spread across Africa and to the world, including the United States.”
The global death toll was instead 11,325 people—roughly 1 percent of the worst-case scenario.
“Going forward for any future pandemic or disease policy, it will be important for a person who has this experience that he will have dealt with Ebola before, and who understands the science behind it, and to work with countries… that’s to his advantage,” said Professor Anna Yeung-Cheung, a professor of biology at Manhattanville College. “People freaked out, but it is very crucial in the beginning stage to control pandemics, especially this type of virus, to first meet the virus where it is.”
If the Trump administration had listened to Klain last fall, experts said, the nation might not be on the verge of what Biden has called “a dark winter,” with a record number of COVID-19 patients hospitalized nationwide and forecasts of more than 100,000 new deaths by 2021.
“A few weeks from now, a month from now, a year from now, a group of grim-faced aides will shuffle into the Oval Office and tell the president of the United States, whoever he or she is at that time, that a million people have died in a relatively short period of time in a far corner of the world, that refugees are fleeing this disaster and facing closed borders,” Klain said during The Daily Beast forum on global health on Oct. 24, 2019.
“There are a lot of things that could cause such a nightmare scenario: a climate disaster exacerbated by climate change, a dirty bomb set off by terrorists, a biochemical attack from a rogue state,” Klain continued. “But of all those things, the single most likely thing to create that scenario in the next 10 years is a dangerous epidemic or pandemic.”
In the exchange—which in hindsight makes Klain seem less like a government bureaucrat and more like an oracle—Klain said that preparation for the next Ebola would require greater investment in public health infrastructure, the ability to use the Stafford Act in response to infectious disease outbreaks, a willingness to treat infectious disease outbreaks abroad as national security crises, and, most importantly, “we need to invest in global health security.”
“We’re only as safe here in the U.S. as the most vulnerable health system worldwide makes us,” Klain said at the time.
Trump’s response at the time, Klain said at the time, was exactly the wrong way to address the outbreak—and a grim harbinger of his administration’s handling of COVID-19.
“Isolationism is death,” Klain said, noting that as a private citizen, Trump was “one of the sharpest critics” of the Obama administration’s handling of Ebola, calling the president “stupid” for allowing Ebola patients to be treated in the United States and for sending U.S. troops to fight the outbreak.
“The idea that Trump said in 2014—that Ebola responders who get the disease should be left in Africa to die—is an inhumane philosophy, but it’s also an unsafe philosophy,” Klain said.
Another pitfall Klain warned about was treating a virus as an immigration problem, citing the reaction he received from some on Capitol Hill as the mosquito-borne Zika virus that swept through various parts of North and South America in 2016 and 2017.
“Just keep the immigrants out, keep the people with the disease out of the country,” Klain said he was told, despite the fact that the virus was already raging in Puerto Rico—a part of the United States. “There is no wall we can build that is high enough or wide enough to keep infectious diseases out of our country. We need to fight these diseases where they are and we need to have a global perspective.”
Obviously, the Trump administration has sprinted in the opposite direction: withdrawing from the World Health Organization, allowing China to refuse entry to international medical teams following the first outbreak of COVID-19, and undermining science-based public health guidances in favor of wishful thinking and harmful nonsense.
Those actions at the pandemic’s outset mean it may be too late for the practices that Klain pushed during Ebola to make a difference, experts said.
“Had the administration acted the way the Obama administration did in quickly getting testing and tracing programs with good data systems, it would have been transformational and would have saved probably 100,000 lives in America,” Gostin, who has known Klain for years and appeared with him on the October panel, said. “But I’ve worked in public health for 30 years and I’ve never seen testing and tracing used to bring an outbreak under control once it got too late… It’s just too prevalent.”
“We are a little bit late, in this case,” Yeung-Cheung concurred. “it’s not going to reverse a lot of the damage that’s been done.”
Public health experts repeatedly emphasized that Ebola and COVID-19 are very different beasts, and that specific practices to prevent the spread of the former—spread almost exclusively through close contact with bodily fluids of symptomatic carriers—and the later—spread through aerosols with a high occurrence of asymptomatic infection—couldn’t be directly compared.
“The Ebola response cannot be directly applied to the COVID-19 response,” cautioned Dr. Jeffrey Klausner, an adjunct professor of epidemiology at UCLA and formerly of the CDC, who emphasized that Klain’s coordination of the response went hand-in-hand with his former agency’s implementation of the plan.
“An ‘all-government response’ does require high level coordination and communication but the operations must be led by those with experience and competence like the CDC,” Klausner said, yet another area where he feels that the Trump administration has fumbled the pandemic.
“The lack of CDC leadership in the current COVID-19 response has been devastating,” Klausner said, “and in my opinion has resulted in tens of thousands of unnecessary deaths.”
Still, Klain’s appointment has inspired cautious confidence from those who know him, and who credit him with halting the deadliest outbreak of one of the scariest viruses known to man—if the Trump administration’s refusal to engage for the next two months doesn’t leave the nation in shambles beforehand.
“The hope would be that we’re going to be going in that direction,” Monto said. “My concern is, can we wait until Jan. 20?”
— with additional reporting by Jackie Kucinich
