In the last two months of 2019, analysts at a somewhat obscure part of the U.S. Defense Intelligence Agency began to sound the alarm among American intelligence and national security officials.

The National Center for Medical Intelligence (NCMI) is just one of many medical intelligence units nested within the U.S. intelligence agencies. NBC News referred to it as:

“[T]he intelligence community’s eyes and ears when it comes to global disease outbreaks… the clearing ground for classified information and analysis related to the coronavirus outbreak.”

NBC quoted a retired senior officer at the Center, who described its distinct role among the nation’s public health and national security assets:

“The value that NCMI brings is that it has access to information streams that the World Health Organization does not have, nor does the Centers for Disease Control or anyone else.”

NCMI had been studying developments in Wuhan, a city of 11 million people in central China, using many of the U.S. intelligence agencies’ assets, including electronic surveillance of email, computer intercepts, and satellite imagery.

The Center’s conclusion: a rapidly developing disease outbreak in Wuhan had the potential to be a global “cataclysmic event.”

By Thanksgiving 2019, the NCMI was briefing public health and national security officials across the federal government. It briefed the Joint Staff, the coordinating body of the U.S. armed services. It also briefed senior staff of the National Security Council in the White House.

This in-the-moment surveillance is part of the robust monitoring capabilities that the United States maintains as part of its national security processes. It is intended, among other things, to be an early warning system for both malicious threats to public health – bioterrorists or state actors using biological weapons – and naturally-occurring threats such as SARS, MERS, and Ebola.

What Did the President Know, and When Did He Know It?

As the calendar turned from 2019 to 2020, the National Center for Medical Intelligence’s warnings moved from White House staff to the president.

Beginning in early January 2020, President Trump received more than a dozen classified briefings describing the various intelligence agencies’ alarms about the virus that was already a major health emergency in China. The Washington Post reported:

“The repeated warnings were conveyed in issues of the President’s Daily Brief, a sensitive report that is produced before dawn each day and designed to call the president’s attention to the most significant global developments and security threats.

For weeks, the PDB – as the report is known – traced the virus’s spread around the globe, made clear that China was suppressing information about the contagion’s transmissibility and lethal toll, and raised the prospect of dire political and economic consequences.”

 But President Trump seemed to take little to no notice of the briefings or their significance. The Washington Post reported:

“But the alarms appear to have failed to register with the president, who routinely skips reading the PDB and has at times shown little patience for even the oral summary he takes two or three times per week, according to the officials, who spoke on the condition of anonymity to discuss classified material.”

In addition to Trump’s widely reported indifference to both the written and oral President’s Daily Brief intelligence updates, he also had other things on his mind during this period.

On December 18, 2019, the U.S. House of Representatives had impeached President Trump for abuse of power and obstruction of Congress.

The impeachment arose from Trump’s attempt to extort the newly elected president of Ukraine to discredit Trump’s likely 2020 opponent for re-election, Joe Biden. Trump threatened to withhold military aid unless Ukrainian president Volodymyr Zelenskyy announced, falsely, that Ukraine was investigating Biden and his son for corruption.

The House of Representatives submitted the Articles of Impeachment to the United States Senate on January 16, and the impeachment trial started on January 22. The Senate acquitted Trump on February 5.

On top of all of that, Trump was actively running for re-election.

All of this coincided with the early outbreak of COVID-19, first in China and then around the world, including in the U.S.

In the midst of the impeachment trial, Trump’s National Security Advisor, Robert O’Brien, who headed the National Security Council, and his deputy, Matthew Pottinger, met with Trump.

The meeting was in the Oval Office on January 28, 2020, one week after the first confirmed U.S. COVID-19 case. The two presented President Trump with his Presidential Daily Brief. O’Brien described the escalating coronavirus crisis and told Trump,

“This will be the biggest national security threat you face in your presidency.”

According to Washington Post Associate Editor Bob Woodward, this got Trump’s attention. His head popped up. In his book Rage, Woodward reports:

“This is going to be the roughest thing you face,’ persisted O’Brien from his seat around the Resolute Desk, well aware that Trump was only midway through his impeachment trial in the Senate, which had begun twelve days earlier and was consuming his attention.”

Deputy Pottinger affirmed his boss’s assessment. Pottinger is a decorated former Marine officer. He had lived and worked in China for years as a reporter for the Wall Street Journal. His work there during the SARS crisis gave him firsthand experience of an outbreak. He was also fluent in Mandarin and remained well-connected to both official and unofficial sources throughout China. Woodward reports:

“‘What do you know?’ Trump asked Pottinger.

 For the last four days, Pottinger said, he had been working the phones calling doctors in China and Hong Kong he had maintained contact with and who understood the science. He’d also been reading Chinese social media.

 ‘Is this going to be as bad as ’03?’ he had asked one of his contacts in China.

 ‘Don’t think SARS 2003,’ the expert replied. ‘Think influenza pandemic, 1918.’

 Pottinger said he had been floored.”

Woodward reports that Trump later said he didn’t remember O’Brien’s and Pottinger’s warning:

“‘You know, I’m sure he said it,’ Trump said. ‘Nice guy.”

Dr. Beth Cameron, who under President Obama ran the National Security Council’s Directorate for Global Health Security and Biodefense, said in 2020,

“In a health security crisis, speed is essential… the specter of rapid community transmission and exponential growth is real and daunting.”

But in the early months, when the president could have begun to take the virus seriously, and could have begun to coordinate an all-of-government response, he was AWOL. He either did not read, did not understand, or did not remember the numerous warnings about COVID-19 in his daily intelligence briefing that began in early January. He told Bob Woodward that he didn’t remember his National Security Advisor telling Trump in late January that COVID-19 would be the biggest national security threat he faced in his presidency. 

This neglect set the tone for what would play out for the rest of his presidency: failure to take the virus seriously, and failure to take steps to actually protect the American people from it.