As a mysterious respiratory illness tore through China and other countries in mid-January, Kyle Coleman, an emergency management coordinator in Texas, took inventory of his team’s personal protective gear at a warehouse in Bexar County.
The hazmat suits and gloves were in good condition. Some of the respirator masks had expired. Three pallets of hand sanitizer seemed like enough because they seldom used more than one pallet a year.
Over several weeks in January, Coleman followed the outbreak of the novel coronavirus: the first death reported in China on Jan. 11, the spread to Thailand and Japan, and then the first U.S. case in Washington state confirmed on Jan. 21.
The next day, President Trump, in an interview on CNBC, assured the public: “We have it totally under control.”
But Coleman thought it was only a matter of time before it arrived in Bexar County, home to nearly 2 million residents, including those in the city of San Antonio. So on Jan. 23, Coleman purchased another 25,000 respirator masks.
“You would read one story one day, and then you get another story the next day, and it wasn’t the same message coming out.”
“You would read one story one day, and then you get another story the next day, and it wasn’t the same message coming out,” Coleman said. “But it kind of looked like it was bad, so we started ordering supplies.”
Coleman’s decision to order more masks while they were still available would prove critical. His action was part of a patchwork mobilization by some local emergency management and public health officials to fight the virus even as Trump publicly downplayed its emerging threat.
In mid-January in New York, Westchester County officials identified staff who would need personal protective equipment. On Jan. 21, state officials in Tallahassee placed orders for masks, gowns and respirators. On Jan. 27, San Francisco ramped up its emergency operations center. In other communities nationwide, emergency management officials dusted off pandemic plans that had been in place since the 2009 outbreak of H1N1.
Across the country, state and local officials, frustrated by what they described as a lack of leadership in the White House and an absence of consistent guidance from federal agencies, took steps on their own to prepare for the pandemic and protect their communities. In some cases, these actions preceded federal directives by days or even weeks as local officials sifted through news reports and other sources of information to educate themselves about the risks posed by the coronavirus.
In other instances, cities and counties wrestled with how to handle individuals who tested positive or were placed under mandatory quarantine, and in the end, who was going to pay for it all. With scant information about the virus and no warnings against large gatherings, cities such as New Orleans moved ahead in February with massive celebrations that may have turned them into hotspots for the virus.
The Post interviewed 33 emergency managers, public health officials, local leaders and consultants in 14 communities across the country. Some local officials defended the federal government’s response, saying it was hard to anticipate the size and scope of the risk.
“It’s real hard to criticize what they were doing because this is new for everybody,” said Fort Worth Mayor Betsy Price, a Republican. “And it’s really hard to be a leader and make those tough decisions, and nobody predicted that we’d be where we are now.”
Officials from the Centers for Disease Control and Prevention did not respond to messages seeking comment.
Judd Deere, a spokesman for the White House, said the president took “decisive action” to close borders, expand testing and accelerate the development of a vaccine.
“This President has taken an unmatched approach to communicating and working with our Nation’s Governors and local officials to guarantee they have the resources they need and the ability to make the best on-the-ground decisions for their communities,” he wrote in a statement.
Now, New York and other cities are beset by a growing number of infected people, a shortage of supplies and strained hospitals. These are the harsh realities that local emergency responders and public health officials had feared from the start.
“The leader in global pandemics and protecting the United States starts at the federal level,” said Nick Crossley, the director of emergency management in Hamilton County, Ohio, and past president of the U.S. Council of International Association of Emergency Managers.
He praised Republican Gov. Mike DeWine for taking bold steps early, including declaring a state of emergency when there were only three reported cases on March 9, four days before the federal government followed suit. Thirty states had declared a state of emergency by the time Trump declared a national emergency on March 13.
“They didn’t move fast enough,” said Crossley, of the federal government. “And what you’ve seen is more local and state officials sounding the alarm.
“We needed a national response to this event.”
8,234 cases worldwide, five cases in the United States
On Jan. 30, Alan Petty, a retired Florida Army National Guard colonel, made a surprise visit to Florida’s emergency command center, a stout one-story building in Tallahassee designed to withstand the state’s frequent hurricanes.
Workers at the command center were gearing up operations for the Super Bowl in Miami, which was just a few days away. But Petty, who had spent 26 years in the state’s National Guard and had overseen its emergency response efforts, had other plans.
Petty had been keeping tabs on the coronavirus as it ricocheted around the world. He knew the virus would probably strike Florida soon. As a consultant, Petty conducted “Thunderbolt” surprise drills for the state’s emergency responders.
At the command center, he gathered officials around a large table in a conference room and laid out a doomsday scenario: An employee participates in an IT conference in California with more than 1,000 attendees from around the globe. After returning to work in the command center, the employee falls ill with the coronavirus, potentially contaminating the facility.
Petty, 59, told state officials that they had to figure out how to run the command center remotely. Could emergency personnel use their home Internet to order safety equipment, set up mobile hospitals and send nurses to areas that were hit hard?
Officials spent three hours war-gaming how they would respond. The drill prompted the state to send 300 employees home early to test their remote work capability. That unmasked a serious problem: A quarter of the team could not perform their jobs at home because they needed access to secure computer systems.
“That’s why you do simulations,” said Jared Moskowitz, director of Florida’s Division of Emergency Management, who said they later fixed the problem.
After the drill that day, Petty climbed into his truck and began the three-hour drive to his home in St. Augustine. He turned on the radio and thought about his adult sons, one of whom is a firefighter. Then he heard the news: The United States had identified its first case of person-to-person transmission involving someone who had not traveled overseas. Also, the World Health Organization classified the coronavirus as a public health emergency of international concern.
“I knew this was going to happen,” Petty said, “but I had no idea it would happen the same day.”
9,927 cases worldwide, seven cases in the United States
With seven reported infections in the United States by the end of the day, Health and Human Services Secretary Alex Azar declared a public health emergency on Jan. 31, and Trump announced strict travel restrictions, barring most foreign visitors coming from China. He also imposed the nation’s first mandatory quarantine in 50 years.
Americans who had visited China’s Hubei province would be forced to quarantine for 14 days, and those who visited other parts of China would be screened for symptoms and asked to isolate themselves for two weeks.
Chicago Mayor Lori Lightfoot was caught off guard. The directive came with little guidance. Where were local governments supposed to quarantine the travelers? What would they do if someone refused to quarantine? Who was going to pay for the resources needed to quarantine people?
“In the first few sets of conversations, we were not hearing answers to those questions,” Lightfoot, a Democrat, said of her talks with federal officials. “It was kind of like, either silence, or ‘Do the best you can,’ which was obviously not acceptable.”
On Sunday, hours before the Super Bowl, she locked herself in her home office, away from her 12-year-old and barking dog, to host a conference call with other big-city mayors and their staffers. For more than 45 minutes, they vented about a lack of federal direction and questioned whether they would be reimbursed for their efforts.
“We didn’t have a sense of how the numbers were going to look like, how we could actually operationalize it,” Lightfoot said.
So she drafted a letter to Trump on behalf of the mayors from Detroit, Los Angeles, New York, San Francisco and Seattle. They insisted on clear, written directions from the federal government, according to the letter, and worried about diverting health-care resources during flu season, when hospitals were already stretched.
“We are concerned about our public health system’s capacity to implement these measures, recognizing they may inadvertently distract us from our ongoing tried-and-true efforts to isolate confirmed cases and closely monitor their contacts,” according to a previously unreported Feb. 6 letter. “We also worry about the potential to again overwhelm laboratory capacity, recognizing that national capacity has not been adequate to quickly test our highest-risk individuals.”
23,892 cases worldwide, 11 cases in the United States
In San Francisco, city leaders were on high alert, but wanted to avoid panic.
So far, San Francisco had no reported cases of the coronavirus, but Lunar New Year celebrations were in full swing and sick passengers were probably traveling back and forth to San Francisco. The city had already ramped up its emergency operations center, one of the country’s first to fully mobilize for the coronavirus.
On Feb. 4, city officials gathered with dozens of Chinatown leaders at the City College of San Francisco’s Chinatown campus to assuage fears, tamp down growing xenophobia and combat misinformation spreading on social media.
Grant Colfax, the director of the city’s public health department, and his colleagues ticked through a presentation. One slide cautioned everyone about the lack of information: “The issue is evolving quickly. There is still a lot that we don’t know.”
But they stressed that the risk of contracting the virus remained low at that moment for Bay Area residents. The city’s large Lunar New Year parade would go on as planned, and schools would remain open.
The community leaders were calm, but their questions revealed growing anxieties — how could they keep kids safe in schools? Should they be wearing protective masks?
Healthy people do not need masks, city officials explained, and they should be reserved for individuals with symptoms or medical professionals.
Colfax referred to the illness as the novel coronavirus, unlike some leaders and news outlets, which had been calling it the “Wuhan virus” or “Chinese virus.” Colfax, a gay man who had gone to medical school during the AIDS crisis, worried about the stigma and xenophobia surrounding the coronavirus — it reminded him of how the gay community had once been blamed for AIDS.
The Bay Area’s Asian community was already a target of abuse because of the disease’s explosion in China. In late January, the University of California at Berkeley apologized for a post on its health center’s Instagram that listed “xenophobia” and fears of interacting with Asian people as a “normal reaction” to concerns about the coronavirus.
“We know that xenophobia, stigma and discrimination are exactly the sorts of things that impede a response to an epidemic because they drive the very communities [we need to work with] underground,” Colfax said in an interview.
Mount Kisco, N.Y.
40,150 cases worldwide, 11 cases in the United State
In Westchester County, Health Commissioner Sherlita Amler was grappling with the fallout from the CDC’s airport screenings. She received only about 48 hours’ notice that she needed to house an individual who had recently traveled to China and landed at JFK. The person had no symptoms but was instructed to quarantine and had no place to stay.
Hotels were out of the question. Apartment buildings were not ideal because of shared common space like elevators. Eventually, Amler identified a property the county owned in a rural area and dispatched staff to Target and Bed Bath & Beyond to stock up on dishes, towels, sheets, food, televisions — anything and everything a person could need for 14 days.
Before the first traveler arrived Feb. 10, Amler stayed up until midnight spreading white sheets on the bed. A colleague from the county’s technology office hooked up the Internet to support video software so the health staff could check in with the quarantined individual to make sure she was safe.
Weeks earlier, Amler had started fitting employees for personal protective equipment and training them on how to use the gear. In January, she watched what was happening in Wuhan with growing concern: “It seemed impossible that it wouldn’t eventually spill out of China into the rest of the world.”
By mid-February, Amler had one quarantined individual in a county property. The person had tested negative for covid-19, the disease caused by the virus, and her team was monitoring more than two dozen other people in their homes, ensuring they had food, medication and access to medical care if needed.
“Most of the time, we know the natural course of the disease. We know how long you’re incubating. We know at what point you are no longer infectious to others,” Amler said. “But with covid-19, we’re just now figuring those things out.”
With so little information on the illness, it was unlike any other outbreak she had ever confronted. The 64-year-old doctor had served as health commissioner since 2011 and handled various crises, including H1N1, Zika and measles.
Following guidance from the CDC, Westchester and other municipalities were advising residents to wash their hands and stay away from sick people who were coughing or sneezing.
“Do what you would to protect yourself from the flu,” the county advised in a Feb. 18 news release.
79,561 cases worldwide, 51 cases in the United States
Trump continued to reassure the public that there was little to worry about. On Feb. 24, he tweeted, “The Coronavirus is very much under control in the USA.”
But Colfax and his public health staff in San Francisco were seeing something else when they studied the “curves” of the pandemic — graphs showing how many cases were reported in other regions over time.
Wuhan’s curve was climbing exponentially, and other countries, such as Italy, were seeing soaring infection rates as well. Colfax noticed that in every infected region, officials were more and more aggressive about restricting their populations.
“It became apparent that no jurisdiction that was where the virus was being introduced, was sort of, in retrospect, thinking, ‘Oh, we overreacted,’ ” Colfax said.
On Feb. 24, Colfax and other health officials assembled their research and met with Mayor London Breed. They made an urgent request: Declare a state of emergency.
“Whoa, hold on,” Breed, a Democrat, remembered thinking. “Wait a minute. Do we have to go this far?”
The California counties of San Diego and Santa Clara already had declared a state of emergency earlier in the month, but both had confirmed coronavirus cases within their borders. San Francisco still had no cases.
Breed considered the economic damage it could wreak on the city: Chinatown was already a ghost town, and local hotels and restaurants could lose business if people thought there was an emergency in San Francisco.
But by the end of the meeting, Breed was convinced. They needed to declare a state of emergency so that they could tap into state and federal funds and supplies, and redeploy city employees. The next day, San Francisco became one of the first major cities in the United States to do so, after Santa Clara and San Diego counties did earlier in the month.
It would take another 17 days, as the virus infected people in nearly every state, before Trump declared a national emergency.
“We see the virus spreading in new parts of the world every day, and we are taking the necessary steps to protect San Franciscans from harm,” she said at a news conference announcing the decision.
But in some cities, little had changed.
In New Orleans, officials moved ahead with Mardi Gras festivities in late February that packed people into the streets. It was a decision the mayor would later defend as coronavirus cases traced to the celebration piled up.
“No red flags were given,” by the federal government, New Orleans Mayor LaToya Cantrell, a Democrat, later said in a CNN interview. “If we were given clear direction, we would not have had Mardi Gras, and I would’ve been the leader to cancel it.”
On Feb. 27, at a White House reception, Trump predicted that the coronavirus would disappear.
“Like a miracle,” he said.
86,011 cases worldwide, 68 cases in the United State
The last day of February marked a major turning point for the coronavirus in the United States: The first American who had been diagnosed with the illness died.
In a Saturday news conference, Trump described the patient from the Seattle area as a “medically high-risk” person who had died overnight. A CDC official said that the man, who was in his 50s, had not traveled recently — another sign that the virus was snaking through local communities.
During the announcement, Trump asked the media to avoid inciting panic as there was “no reason to panic at all.”
“We’re doing really well,” he said. “Our country is prepared for any circumstance. We hope it’s not going to be a major circumstance, it’ll be a smaller circumstance. But whatever the circumstance is, we’re prepared.”
That same afternoon in San Antonio, the CDC mistakenly released a woman from quarantine who was infected. The woman was one of dozens of evacuees from Wuhan whom the federal government had brought to a nearby military base and then isolated at the Texas Center for Infectious Disease.
The woman first tested negative, had a second inconclusive test and then tested negative again. She was tested a fourth time by the hospital without the CDC’s knowledge but was released before the results showed she had the virus.
By then, the woman had been dropped off at a Holiday Inn near the San Antonio airport and headed to a mall where she shopped at Dillard’s, Talbots and Swarovski and ate in the food court.
The next morning, Coleman, Bexar County’s emergency management coordinator, got a call from the regional health authority about what had happened.
Shocked, he immediately called his boss, Bexar County Judge Nelson Wolff.
“Damn,” Wolff responded, seething with anger.
Wolff had written a letter several days earlier raising concerns about the risks of moving evacuees off the military base.
As local officials learned details about the infected woman’s movements and how she had been transported at 2 a.m. back to the Texas Center for Infectious Disease, they waited for the CDC to issue a statement. Hours passed, but they heard nothing.
“They were like quiet little mouses,” Wolff said. “They were all scared to talk because I think they felt they were going to get in trouble with the president of the United States because he was saying there was not a problem.”
The next day, San Antonio officials declared a public health emergency and filed a lawsuit to prevent the CDC from releasing the 120 people in quarantine until they were confirmed negative for the virus or completed a 28-day quarantine. A judge denied the motion, but the CDC agreed that evacuees must have two consecutive negative tests that are 24 hours apart and that no one with a pending test can be released.
Coleman and his team again took stock of the emergency supplies. He wished they had ordered more hand sanitizer: In less than two months, they had plowed through what they normally use in a year.
When he tried to order more masks, none were immediately available. By then the entire country was scrambling for protective gear.
Mount Kisco, N.Y.
92,840 cases worldwide, 118 cases in the United States
Westchester County’s health commissioner was sleeping when the phone rang at 1 a.m. with the news she had been dreading: The county’s first positive case of the coronavirus involved a man from New Rochelle, who was hospitalized.
Amler and the health department quickly traced his steps and put the man’s wife and family under quarantine. They learned he had attended services at Young Israel of New Rochelle on Feb. 22, and a funeral and bat mitzvah at the temple on Feb. 23.
At the direction of state authorities, Amler instructed Young Israel to immediately halt all services and told congregants who attended the same services or events during those two days that they must self-quarantine until March 8.
Within days, state authorities set up an emergency operations center in New Rochelle and created a one-mile containment zone. Inside the perimeter, schools and community centers shuttered and large gatherings were prohibited.
Through it all, local officials faced backlash from some community leaders who thought they were overreacting.
“Having to make those initial decisions and helping people make those initial decisions is never easy,” Amler said.
She also worried about her public health colleagues, many of whom had families and were putting themselves at risk. Amler thought about her husband, a physician, their six children and six granddaughters.
“This is not a sprint,” Amler told her staff. “We’re in a marathon. We just have to kind of work together and support each other and get through this.”
97,886 cases worldwide, 217 cases in the United States
Days after San Francisco’s emergency declaration, Breed stood in front of news cameras to announce the city’s first two cases of the coronavirus.
“We have been planning this for weeks, and so we are prepared as a city,” she said.
Colfax stepped up to the podium inside City Hall and put on his glasses to read from a statement about the two patients. One was a man in his 90s, who was in serious condition, and the other was a woman in her 40s, who was in fair condition.
They were not related, had not traveled to any coronavirus-affected areas and had no contact with known coronavirus patients: It was spreading in the community.
By then, Miami Mayor Francis X. Suarez, a Republican, had announced the cancellation of the Ultra Music festival, a three-day celebration that draws about 50,000 people. Miami was the first city to call off a major music festival, and Suarez faced tremendous backlash.
“I’m really reluctant to downplay this when I’ve seen what a city can go through during a hurricane when it’s without power for eight or nine days,” Suarez said.
In Oklahoma City, the coronavirus became a reality for Mayor David Holt, a Republican, when the NBA abruptly canceled a Thunder basketball game after a Utah Jazz player tested positive on March 11. Until then, Holt said, the coronavirus felt “distant on many levels.”
Days later, Holt huddled on the phone with other leaders from the United States Conference of Mayors. For about 20 minutes, Seattle Mayor Jenny Durkan, a Democrat, detailed the crisis seizing her city.
“She sounded like the main character in a Stephen King novel,” Holt recalled. “She had hundreds of cases, she had dozens of deaths.”
Oklahoma City had no coronavirus cases at that moment, but residents there and across the country had little or no access to tests.
“Any struggles that we’re having, whether it be testing or other issues, or even just convincing our public of the seriousness of the matter, there are some roots back to the time period in January and February, when not all national leadership was expressing how serious this was,” Holt said.
While the mayors held their conference call on March 13, Trump declared a national emergency to combat the coronavirus.
By then, Suarez had tested positive for the coronavirus and was in quarantine. As of Sunday, he remained in isolation, leading the city by phone calls and video chats. He wanted to stop flights into Miami and the governor to order residents to shelter in place as California and other states had already done.
And he worried about Miami becoming the next New York City, the hardest hit in the nation with more than 33,000 cases.
“You have the president saying he would like everybody to be at work by Easter. While aspirationally that’s great,” Suarez said, “we want our decisions to be driven by what’s in the best interest of the health and welfare of our residents.”
John Sullivan is a Washington Post reporter and a senior editor at the Investigative Reporting Workshop.