WASHINGTON — It was a heat summer season Wednesday, Election Day was looming and President Trump was even angrier than normal on the relentless deal with the coronavirus pandemic.

“You’re killing me! This entire factor is! We’ve obtained all of the rattling instances,” Mr. Trump yelled at Jared Kushner, his son-in-law and senior adviser, throughout a gathering of high aides within the Oval Workplace on Aug. 19. “I wish to do what Mexico does. They don’t offer you a take a look at until you get to the emergency room and also you’re vomiting.”

Mexico’s record in fighting the virus was hardly one for the US to emulate. However the president had lengthy seen testing not as an important approach to monitor and include the pandemic however as a mechanism for making him look dangerous by driving up the variety of identified instances.

And on that day he was particularly livid after being knowledgeable by Dr. Francis S. Collins, the pinnacle of the Nationwide Institutes of Well being, that it might be days earlier than the federal government might give emergency approval to the use of convalescent plasma as a treatment, one thing Mr. Trump was keen to advertise as a private victory going into the Republican Nationwide Conference the next week.

“They’re Democrats! They’re in opposition to me!” he mentioned, satisfied that the federal government’s high medical doctors and scientists had been conspiring to undermine him. “They wish to wait!”

All through late summer season and fall, within the warmth of a re-election marketing campaign that he would go on to lose, and within the face of mounting proof of a surge in infections and deaths far worse than within the spring, Mr. Trump’s management of the crisisunsteady, unscientific and colored by politics all year — was in impact decreased to a single query: What would it not imply for him?

The consequence, based on interviews with greater than two dozen present and former administration officers and others involved with the White Home, was a lose-lose state of affairs. Mr. Trump not solely ended up soundly defeated by Joseph R. Biden Jr., however missed his probability to indicate that he might rise to the second within the closing chapter of his presidency and meet the defining problem of his tenure.

Efforts by his aides to influence him to advertise masks sporting, among the many easiest and only methods to curb the unfold of the illness, had been derailed by his conviction that his political base would insurgent in opposition to something that might smack of limiting their private freedom. Even his personal marketing campaign’s polling knowledge on the contrary couldn’t sway him.

His express demand for a vaccine by Election Day — a push that got here to a head in a contentious Oval Workplace assembly with high well being aides in late September — grew to become a misguided substitute for warning the nation that failure to stick to social distancing and different mitigation efforts would contribute to a slow-rolling catastrophe this winter.

His concern? That the person he known as “Sleepy Joe” Biden, who was main him within the polls, would get credit score for a vaccine, not him.

The federal government’s public well being specialists had been all however silenced by the arrival in August of Dr. Scott W. Atlas, the Stanford professor of neuroradiology recruited after appearances on Fox Information.

With Dr. Deborah L. Birx, the coordinator of the White Home virus activity power, shedding affect and infrequently on the highway, Dr. Atlas grew to become the only real physician Mr. Trump listened to. His theories, a few of which scientists seen as bordering on the crackpot, had been precisely what the president needed to listen to: The virus is overblown, the variety of deaths are exaggerated, testing is overrated, lockdowns do extra hurt than good.

Because the hole between politics and science grew, the infighting that Mr. Trump had allowed to plague the administration’s response from the start solely intensified. Threats of firings worsened the management vacuum as key figures undercut one another and distanced themselves from accountability.

The administration had some constructive tales to inform. Mr. Trump’s vaccine improvement program, Operation Warp Pace, had helped drive the pharmaceutical trade’s remarkably quick progress in growing a number of promising approaches. By the tip of the yr, two extremely efficient vaccines can be accepted for emergency use, offering hope for 2021.

The White Home rejected any strategies that the president’s response had fallen quick, saying he had labored to offer sufficient testing, protecting gear and hospital capability and that the vaccine improvement program had succeeded in report time.

“President Trump has led the biggest mobilization of the private and non-private sectors since WWII to defeat Covid-19 and save lives,” mentioned Brian Morgenstern, a White Home spokesman.

However Mr. Trump’s unwillingness to place apart his political self-centeredness as Individuals died by the 1000’s every day or to embrace the steps essential to take care of the disaster stay confounding even to some administration officers. “Making masks a tradition warfare challenge was the dumbest factor conceivable,” one former senior adviser mentioned.

His own bout with Covid-19 in early October left him extraordinarily unwell and depending on care and medicines not accessible to most Individuals, together with a still-experimental monoclonal antibody therapy, and he noticed firsthand how the illness coursed via the White Home and a few of his shut allies.

But his intuition was to deal with that have not as a studying second or a chance for empathy, however as a chance to portray himself as a Superman who had vanquished the illness. His personal expertise on the contrary, he assured a crowd at the White House only a week after his hospitalization, “It’s going to vanish; it’s disappearing.”

Weeks after his personal restoration, he would nonetheless complain in regards to the nation’s preoccupation with the pandemic.

“All you hear is Covid, Covid, Covid, Covid, Covid, Covid, Covid, Covid, Covid, Covid, Covid,” Mr. Trump said at one campaign stop, uttering the phrase 11 instances.

In the long run he couldn’t escape it.

By late July, new instances had been at report highs, defying Mr. Trump’s predictions via the spring that the virus was below management, and deaths had been spiking to alarming ranges. Herman Cain, a 2012 Republican presidential candidate, had examined constructive for the coronavirus not lengthy after attending a Trump rally the earlier month and not using a masks and would die on July 30.

With the pandemic defining the marketing campaign regardless of Mr. Trump’s efforts to make it about regulation and order, Tony Fabrizio, the president’s major pollster, got here to the Oval Workplace for a gathering in the midst of the summer season ready to make a stunning case: that masks sporting was acceptable even amongst Mr. Trump’s supporters.

Arrayed in entrance of the Resolute Desk, Mr. Trump’s advisers listened as Mr. Fabrizio introduced the numbers. In accordance with his analysis, a few of which was reported by The Washington Post, voters believed the pandemic was dangerous and getting worse, they had been extra involved about getting sick than in regards to the virus’s results on their private monetary state of affairs, the president’s approval ranking on dealing with the pandemic had hit new lows and a bit of greater than half the nation didn’t suppose he was taking the state of affairs critically.

However what set off debate that day was Mr. Fabrizio’s discovering that greater than 70 % of voters within the states being focused by the marketing campaign supported necessary masks sporting in public, at the least indoors, together with a majority of Republicans.

Mr. Kushner, who together with Hope Hicks, one other high adviser, had been attempting for months to persuade Mr. Trump that masks might be portrayed as the important thing to regaining freedom to go safely to a restaurant or a sporting occasion, known as embracing mask-wearing a “no-brainer.”

Mr. Kushner had some cause for optimism. Mr. Trump had agreed to wear one not long before for a go to to Walter Reed Nationwide Navy Medical Middle, after discovering one he believed he regarded good in: darkish blue, with a presidential seal.

However Mark Meadows, the White Home chief of workers — backed up by different aides together with Stephen Miller — mentioned the politics for Mr. Trump can be devastating.

“The bottom will revolt,” Mr. Meadows mentioned, including that he was undecided Mr. Trump might legally make it occur in any case.

That was all Mr. Trump wanted to listen to. “I’m not doing a masks mandate,” he concluded.

Other than when he was sick, he was hardly ever seen in a masks once more.

The president had different alternatives to indicate management moderately than put his political fortunes first.

After he recovered from his bout with the virus, a few of his high aides, together with Mr. Kushner and Jason Miller, a senior marketing campaign strategist, thought the sickness provided a chance to reveal the form of compassion and resolve in regards to the pandemic’s toll that Mr. Trump had to date failed to indicate.

When Mr. Trump returned from the hospital, his communications aides, with the assistance of Ivanka Trump, his daughter, urged him to ship a nationwide deal with saying: “I had it. It was powerful, it kicked my ass, however we’re going to get via it.”

He refused, selecting as a substitute to deal with a boisterous marketing campaign rally for himself from the balcony of the White Home overlooking the South Garden.

Mr. Trump by no means got here round to the concept he had a accountability to be a task mannequin, a lot much less that his management function may require him to publicly acknowledge exhausting truths in regards to the virus — and even to cease insisting that the problem was not a rampaging pandemic however an excessive amount of testing.

Alex M. Azar II, the well being and human companies secretary, briefed the president this fall on a Japanese research documenting the effectiveness of face masks, telling him: “Now we have the proof. They work.” However the president resisted, criticizing Mr. Kushner for pushing them and once more blaming an excessive amount of testing — an space Mr. Kushner had been serving to to supervise — for his issues.

“I’m going to lose,” Mr. Trump instructed Mr. Kushner throughout debate preparations. “And it’s going to be your fault, due to the testing.”

Mr. Morgenstern, the White Home spokesman, mentioned that trade between the president and Mr. Kushner “by no means occurred.”

Mr. Azar, who was typically one of many few individuals sporting a masks at White Home occasions, privately bemoaned what he known as a political, anti-mask tradition set by Mr. Trump. At White Home Christmas events, Mr. Azar requested maskless company to again away from him.

The choice to run the federal government’s response out of the West Wing was made within the early days of the pandemic. The concept was to interrupt down obstacles between disparate companies, assemble public well being experience and encourage fast and coordinated decision-making.

It didn’t work out like that, and by fall the implications had been clear.

Mr. Trump had all the time tolerated if not inspired clashes amongst subordinates, a bent that on this case led solely to coverage paralysis, confusion about who was in cost and an absence of a transparent, constant message about scale back the dangers from the pandemic.

Retaining decision-making energy near him was one other Trump trait, however on this case it additionally elevated the myriad decisions dealing with the administration to the presidential stage, bogging the method down in infighting, elevating the political stakes and inspiring aides to jockey for favor with Mr. Trump.

The consequence at instances was a systemwide failure that prolonged effectively past the president.

“What we wanted was a coordinated response that concerned contributions from a number of companies,” mentioned Dr. Scott Gottlieb, who was commissioner of the Meals and Drug Administration for the primary two years of the Trump administration.

“Somebody wanted to drag that each one collectively early,” he mentioned. “It wasn’t the job of the White Home, both. This wanted to occur nearer to the companies. That didn’t occur on testing, or on an entire lot of different issues.”

The connection between Mr. Azar and Dr. Stephen M. Hahn, the commissioner of the Meals and Drug Administration, grew more and more tense; by early November, they had been speaking solely by textual content and in conferences.

Dr. Birx had misplaced the clout she loved early on within the disaster and spent a lot of the summer season and fall on the highway counseling governors and state well being officers.

Mr. Meadows was at odds with virtually everybody as he sought to impose the president’s will on scientists and public well being professionals. In conversations with high well being officers, Mr. Meadows would rail in opposition to regulatory “bureaucrats” he thought had been extra keen on course of than final result.

A few of the medical doctors on the duty power, together with Dr. Anthony S. Fauci and Dr. Robert R. Redfield, had been reluctant to indicate up in individual on the White Home, nervous that the disdain there for masks sporting and social distancing would depart them liable to an infection.

Vice President Mike Pence was nominally accountable for the duty power however was so cautious about getting crosswise with Mr. Trump as they battled for re-election that, in public at the least, he grew to become practically invisible.

The debates contained in the White Home more and more revolved round Dr. Atlas, who had no formal coaching in infectious ailments however whose views — which Mr. Trump noticed him ship on Fox Information — appealed to the president’s perception that the disaster was overblown.

His arrival at 1600 Pennsylvania Avenue was itself one thing of a thriller. Some aides mentioned he was found by Kayleigh McEnany, the White Home press secretary. Others mentioned John McEntee, the president’s personnel chief, had been Googling for a Trump-friendly physician who can be loyal.

Marc Quick, Mr. Pence’s chief of workers, opposed hiring Dr. Atlas. However as soon as the president and his staff introduced him in, Mr. Quick insisted that Dr. Atlas have a seat on the activity power desk, hoping to keep away from having him develop into yet one more inside — and damaging — critic.

As soon as inside, Dr. Atlas used the perch of a West Wing workplace to form the response. Throughout a gathering in early fall, Dr. Atlas asserted that school college students had been at no threat from the virus. We should always allow them to return to high school, he mentioned. It’s not an issue.

Dr. Birx exploded. What facet of the truth that you could be asymptomatic and nonetheless unfold it don’t perceive? she demanded. You may not die, however you may give it to any person who can die from it. She was furious.

“Your technique is actually going to value us lives,” she yelled at Dr. Atlas. She attacked Dr. Atlas’s concepts in every day emails she despatched to senior officers. And he or she was conscious of a pact she had made with Dr. Hahn, Dr. Fauci and Dr. Redfield even earlier than Dr. Atlas got here on board: They might stick collectively if certainly one of them was fired for doing what they thought of the fitting factor.

Well being officers typically had a tough time discovering an viewers within the higher reaches of the West Wing. In a mid-November activity power assembly, they issued a dire warning to Mr. Meadows in regards to the looming surge in instances set to devastate the nation. Mr. Meadows demanded knowledge to again up their declare.

One final result of the assembly was a Nov. 19 information convention on the virus’s dire menace, the primary in lots of weeks. However whereas Mr. Pence, who led the briefing, typically urged Individuals to “do their half” to gradual the unfold of the virus, he by no means straight challenged Mr. Trump’s hesitancy on masks and social distancing. On the briefing, he mentioned that “choice making on the native stage” was key, persevering with an extended sample of the administration in search of to push accountability to the states.

Mr. Azar had been minimize out of key decision-making as early as February, when Mr. Pence took over the duty power. Mr. Azar would complain to his associates that Mr. Pence’s workers and activity power members went round him to challenge orders to his subordinates.

On tenterhooks about his job status, Mr. Azar discovered a gap that provided a form of redemption, steering his consideration via the summer season and fall to Operation Warp Pace, the federal government’s effort to help speedy improvement of a vaccine, lavishing reward on Mr. Trump and crediting him for practically each advance.

Behind the scenes, Mr. Azar portrayed Dr. Hahn to the White Home as a flailing supervisor — a criticism he additionally voiced about Dr. Redfield. In late September, he instructed the White Home he was prepared to fireside Dr. Hahn, based on officers accustomed to the supply.

For his or her half, Dr. Hahn, Dr. Redfield, Dr. Birx and different senior well being officers noticed Mr. Azar as crushing the morale of the companies he oversaw as he sought to flee blame for a worsening disaster and to strengthen his personal picture publicly and with the White Home.

Well being officers on the duty power a number of instances took their complaints about Mr. Azar to Mr. Pence’s workplace, hoping for an intervention.

Caitlin B. Oakley, a spokeswoman for Mr. Azar, mentioned he had “all the time stood up for balanced, scientific, public well being data and insisted that science and knowledge drive the choices.”

As soon as keen to go to the White Home, Dr. Hahn grew to become disillusioned with what he noticed as its efforts to politicize the work of the Meals and Drug Administration, and he finally shied away from activity power conferences, fearing his statements there would leak.

If there was a bureaucratic winner on this West Wing cage match, it was Dr. Atlas.

He instructed Mr. Trump that the fitting method to consider the virus was how a lot “extra mortality” there was above what would have been anticipated and not using a pandemic.

Mr. Trump seized on the thought, typically telling aides that the true variety of useless was not more than 10,000 individuals.

As of Thursday, 342,577 Individuals had died from the pandemic.

In an Oval Workplace assembly with senior well being officers on Sept. 24, the president made express what he had lengthy implied: He needed a vaccine earlier than the election, based on three individuals who witnessed his demand.

Pfizer’s chief govt had been encouraging the idea that the corporate might ship preliminary outcomes by late October. However Mr. Trump’s aides tried in useless to clarify that they might not fully management the timing.

Dr. Fauci and Dr. Hahn reminded West Wing officers that an organization’s vaccine trial outcomes had been a “black field,” unimaginable to see till an unbiased monitoring board revealed them. A vaccine that didn’t undergo the standard, rigorous authorities approval course of can be a “Pyrrhic victory,” Mr. Azar instructed them. It could be a shot nobody would take.

Dr. Moncef Slaoui, the scientific chief of Operation Warp Pace, mentioned the president by no means requested him to ship a vaccine on a particular timetable. However he mentioned Mr. Trump typically complained in conferences that “it was not going to occur earlier than the election and it will likely be ‘Sleepy Joe’” who would in the end get credit score.

In late October, science and rules labored in opposition to Mr. Trump’s waning hopes for pre-Election Day excellent news. On the F.D.A., scientists had refined the requirements for authorizing a vaccine for emergency use. And at Pfizer, executives realized that the company was unlikely to authorize its vaccine on the premise of so few Covid-19 instances amongst its scientific trial volunteers.

They determined to attend for extra knowledge, a delay of as much as per week.

When Pfizer announced on Nov. 9 — two days after Mr. Biden clinched his victory — that its vaccine was a surprising success, Mr. Trump was livid. He lashed out on the firm, Dr. Hahn and the F.D.A., accusing “deep state regulators” of conspiring with Pfizer to gradual approval till after the election.

The president’s frustration with the tempo of regulatory motion would proceed into December, because the F.D.A. went via a time-consuming technique of evaluating Pfizer’s knowledge after which that of a second vaccine maker, Moderna.

On Dec. 11, Mr. Meadows exploded throughout a morning name with Dr. Hahn and Dr. Peter Marks, the company’s high vaccine regulator. He accused Dr. Hahn of mismanagement and prompt he resign, then slammed down the cellphone. That evening, the F.D.A. approved the Pfizer vaccine.

Within the weeks that adopted, Mr. Pence, Mr. Azar, Dr. Fauci and different well being officers rolled up their sleeves to be vaccinated for the cameras.

Mr. Trump, who after contracting Covid-19 had declared himself immune, has not been vaccinated.

Michael D. Shear, Noah Weiland, Sharon LaFraniere and Mark Mazzetti reported from Washington, and Maggie Haberman from New York. Katie Thomas contributed reporting from Chicago.


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