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By Saturday, officials in Washington state revealed the first U.S. death attributed to the virus — the person misidentified by Trump at a hastily called news conference as a “wonderful woman” in her 50s who had underlying health problems. The CDC later said that it had erroneously identified the patient as female in a briefing earlier Saturday with Trump and Pence and that the patient was a man.

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Sen. Mitt Romney (R-Utah) — a target of Trump’s ire for his vote to convict the president of an impeachment charge — was among those who stood in the private briefing to register objections.

“One, I’m very disappointed in the preparation that’s been done over the last few years anticipating the potential of an outbreak of substance,” Romney said in an interview later.

“We’ve had SARS, we’ve had MERS, Ebola,” Romney continued, rattling off previous global outbreaks. “We should have stockpiled the kind of protective gear that our medical professionals will need and our citizens will need, and we haven’t. And looking forward, the [spending] number that’s being suggested strikes me as being inadequate to the level of risk.”

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The decision to tap Pence and streamline all communication through the vice president’s office was primarily driven by a potent combination of a lack of leadership and structure inside the White House, four senior officials said, as well as a faulty CDC coronavirus diagnostic test, botched and conflicting messaging from senior health officials, and Trump’s obsession with the falling financial markets, two senior administration officials said. Many HHS employees fretted that financial concerns, rather than public health considerations, were dictating the administration’s response, one of the officials added.

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Even before the emergence of the first “community spread” cases of the new coronavirus — meaning the source of the infection is unknown and indicating that the virus is likely to be spreading — a trail of incidents offered warning signs of the challenges to come.

In mid-February, for example, the State Department overruled the CDC in bringing 14 cruise ship passengers back from Japan who tested positive for the virus on the same plane as noninfected passengers. Trump, who had been told that no healthy passengers would be on the plane with sick ones, complained to Azar and other officials over not being informed of the change of plans.
Another failure in the U.S. response has been a faulty CDC coronavirus diagnostic test. The United States has tested far fewer people than other nations have, and the criteria for who gets tested remained exceedingly narrow until Thursday.

Personal animosities between Azar and senior members of the White House — including Mulvaney and Joe Grogan, the director of the Domestic Policy Council — also complicated response efforts, several senior administration officials said. Several officials said those relationships have never recovered from past battles, while two others said Azar and Mulvaney have had their best working relationship in two years.