Autopsy of a pandemic: 6 doctors at the center of the US Covid-19 response

This past January, just a few days after the inauguration of President Joe Biden, six of the doctors responsible for the previous administration’s Covid-19 response agreed to sit down — in strict confidence — and talk with me about the events of the past year.

Over the period of a few weeks, in Houston, Washington, DC, and Baltimore, our team secured nondescript, large hotel ballrooms with plenty of space and ventilation to allow these extraordinary one-on-one conversations to take place with Dr. Deborah Birx, Dr. Anthony Fauci, Dr. Brett Giroir, Dr. Stephen Hahn, Dr. Robert Kadlec and Dr. Robert Redfield.

Given our shared medical backgrounds, I explained to each of the doctors that I was going to frame the discussions in a way that would be tough, but familiar: as an autopsy.

We were going to meticulously dissect and discuss how the United States became home to the worst Covid-19 outbreak on the planet.

There is no question an autopsy or post mortem is painful and gruesome to witness. And, it does nothing for the deceased patient on the table — in this case, the nearly 550,000 Americans who have died from Covid-19. And, yet we do it because there are often important lessons to learn; lessons that can still be applied during this ongoing pandemic and for future pandemics, which all of the doctors agree is inevitable. Autopsies are particularly important if the death was thought to have been preventable.

And here again, the doctors were in agreement — while Covid-19 is a serious disease, the vast majority of deaths in the United States could’ve been avoided.

Most of the doctors I interviewed are household names nowadays, but you have probably only previously heard them in soundbites or seen them briefly at the lectern in the White House briefing room. All but one of the doctors are private citizens now, unbridled and unrestrained by the watchful eyes of the White House, and they had a lot to say. Our cathartic and frank discussions lasted hours on end, covered a wide range of topics and were at times horrifying in what they revealed.

The first cut

When I met up with Dr. Robert Redfield on a snowy February day in Baltimore, his mood was both reflective and determined. A trained virologist, Redfield was tapped by President Donald Trump back in 2018 to lead the CDC after a long career in public health. Before the pandemic, the new director had been largely focused on two other epidemics: opioids and HIV/AIDS. Alongside his colleagues Fauci and Birx, Redfield has been best known for decades for his work as one of the world’s leading AIDS researchers.

As with his term as CDC director, Redfield’s earlier career had not been without controversy. In the ’80s and ’90s, as one of the Army’s top AIDS researchers, he was accused of overselling the effectiveness of a possible AIDS vaccine, though Redfield stood by his work. During the Covid-19 pandemic, critics argued Redfield failed to protect the credibility of the massive scientific agency he was tasked to lead and was outmaneuvered by an executive branch found to be meddling in science-based CDC guidance involving school closings and religious gatherings. Redfield dismissed those concerns, however. When I asked him if he felt prepared for the job, he told me, “I think I trained my whole life for this.”

When we sat down to talk, just days after his successor, Dr. Rochelle Walensky, had taken the helm at the CDC, Redfield wanted to start at the beginning: China.

While every doctor harbored deep suspicions about the information initially coming from China, Redfield was the most vocal about it. He believes the current pandemic began in Wuhan as a localized outbreak in September or October of 2019 — much earlier than the official timeline — and then spread to every province in China over the next couple of months. The United States wasn’t formally notified of the “mysterious cluster of pneumonia patients” until December 31, 2019. Those were critical weeks and months that countries around the world could’ve been preparing.

“So they had about a 30 day head start,” Kadlec affirmed days before I sat down with Redfield.

Kadlec was the HHS assistant secretary for preparedness and response, known as the ASPR. “They were already buying things on the market well in advance of what we were,” he told me. “Even things that were made here in the United States, we found that the domestic supplies were drying up because of foreign purchases.”

And while the rest of the world was told the only initial Covid-19 cases in China had originated from a wet market in Wuhan, Redfield is confident the evidence suggests that was simply not the case. According to Redfield, even his counterpart at the China CDC, Dr. George Gao, was initially left in the dark about the magnitude of the problem until early January. He described a private phone call he had with Gao in early January 2020, when Gao became distraught and started crying after finding “a lot of cases” among individuals who had not been to the wet market. Gao, Redfield says, “came to the conclusion that the cat was out of the bag.”

The initial mortality rates in China were somewhere between “5-10%,” Redfield told me. “I’d probably be cryin’ too,” he added.

One of the most significant things “that affected our success in this pandemic was not being allowed into China” earlier, he told me. Fauci echoed a similar sentiment when I asked him about it.

“I think it would have been a significant difference,” Fauci said. “I think if we had sent our people into Wuhan and been able to talk to the Chinese scientists in a conversation that might have lasted an hour, you could have gotten so much information right from the get go. They would have told us, don’t believe what you’re reading. This is spread asymptomatically. It spreads highly efficiently and it’s killing people.”

Neither President Trump’s calls to President Xi Jinping nor Secretary Alex Azar’s pleas to China’s minister of health could get them in, according to Redfield.

The question laid bare from our autopsy was, why?

The earliest symptoms

If US investigators had been allowed into China, there is something else they may have discovered: the origins of the virus. Where and how this outbreak began is not simply an exercise of curiosity, or an attempt to assign blame. It is a necessity for scientists and public health experts around the world to try and stop future pandemics.

So far, the official word has been that this pandemic started when the novel coronavirus was introduced through an intermediary species or jumped directly from a bat to a human, something that Redfield, the former head of the CDC, believes doesn’t make “biological sense.”

Reminding me that his career has been spent as a virologist, he told me “I do not believe this somehow came from a bat to a human. And at that moment in time, the virus came to the human, became one of the most infectious viruses that we know in humanity for human to human transmission … Normally, when a pathogen goes from a zoonot to human, it takes a while for it to figure out how to become more and more efficient.”

Without assigning intentionality, Redfield told me he believes the origin of the pandemic is a lab in China that was already studying the virus, exposing it to human cell cultures.

“Most of us in a lab, when trying to grow a virus, we try to help make it grow better, and better, and better, and better, and better, and better so we can do experiments and figure out about it. That’s the way I put it together.”

It is a controversial, politically charged theory — one the World Health Organization calls “extremely unlikely,” and there has been no clear evidence to support this “lab leak” theory.

Yet, more than a year after the outbreak, a team of WHO scientists inside Wuhan has still been unable to determine the definitive origin of the virus. At this point, it is not clear they ever will.

In response to the Biden administration’s call for more transparency from China about data from the earliest days of the outbreak, China released a statement out of its Washington embassy alleging that the United States is now “pointing fingers at other countries.” Meanwhile, Chinese officials and state media have been increasingly promoting an unsubstantiated, so-called “multiple-origin” theory, suggesting the pandemic may have started in various locations around the world, even a US military lab.

Final cause of death

Over nearly 20 hours of interviews, I asked each doctor the question that ends every autopsy. What do they believe was the final cause of death? What led to the preventable deaths of so many Americans?

From the role of leadership and the cost of unpreparedness to the obligations of citizens to care for one another, Redfield and the Covid doctors shared their painful lessons from the worst public health crisis of our lifetimes.

Their answers offer an illuminating and frightening glimpse into what exactly happened over the past year, and also a plan for how to handle the next one.

“As bad as this was,” Kadlec told me, “it could be worse. And there will be another pandemic, guaranteed.”