Four weeks in July: Inside the Biden administration's struggle to contain the delta surge
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WASHINGTON - Early last month, as the planned Fourth of July blowout at the White House approached, top health officials inside the Biden administration began calling each other with a flurry of anxious questions.
Would the president declare victory too soon? Would the event be seen as beating a virus that was not yet defeated? And would the massive party, with 1,000 guests, contribute to the virus's spread?
While many in the White House had set their gaze on the present - eager to mark the progress that President Joe Biden had made as coronavirus cases dipped below 12,000 per day for the first time since March 2020 - health officials were focusing abroad, where a new variant, delta, had sent cases skyrocketing. Even at home, in lightly vaccinated communities across Missouri and Arkansas, health officials were nervously watching cases rise, driven by delta.
The fears prompted the health officials to relay their concerns to the White House - leading aides to pare back some of the more boastful language in Biden's original speech, officials said.
Even so, in an address titled "Remarks by President Biden Celebrating Independence Day and Independence from COVID-19," Biden hit a triumphant note.
"Today, we're closer than ever to declaring our independence from a deadly virus," Biden said to a crowd of mostly unmasked guests gathered on the South Lawn of the White House. "We've gained the upper hand against this virus. We can live our lives, our kids can go back to school, our economy is roaring back."
But in the days after the White House groundskeepers had stowed the white folding chairs and pulled down the paper lanterns, a measure of concern set in among some aides.
"We're going to pay for it," one administration official said privately shortly after the event.
Over the next month, the surge of delta cases that overran the country forced Biden and his top aides and Cabinet members to reckon with their overconfidence, which led to a host of decisions - on masks, vaccines and other pivotal issues - that had to be reversed or revised as the crisis spiraled out of control. The administration had been caught flat-footed - and then took weeks to enact a plan in an attempt to catch up.
"This has been nonstop scrambling," said Irwin Redlener, who directs the National Center for Disaster Preparedness at Columbia University's Earth Institute.
This account of the key decisions made as delta surged across the country during the fateful month of July was based on interviews with 24 administration officials and others in close contact with Biden's health response. Many spoke on the condition of anonymity to detail sensitive conversations.
The White House - and the country - has had to contend with a variant that is more than twice as transmissible as previous strains of the virus and so contagious that it behaves almost like a different virus. Those infected with it carry viral loads 1,000 times greater than earlier strains.
The Biden administration initially thought vaccinated people couldn't spread the virus, as had been the case with other variants. But delta proved that assumption wrong - leading the Centers for Disease Control and Prevention to ask vaccinated people in large swaths of the country to put their masks back on.
They thought more people in the United States would get the free and easily accessible shots that others across the globe are desperate to have - but hit a wall in early July with fewer people willing to be inoculated.
Despite pressure from outside experts and some within the administration, the White House also began the month reluctant to require that members of the military be vaccinated. And there was often hesitancy to engage in conversations about booster shots and the possibility of breakthrough cases in fully vaccinated people as the White House was focused on methods to persuade, rather than require, people to get vaccinated.
"One thing CDC and the administration could have done better was prepare people mentally that this isn't over, that we're still in this and there's incredible uncertainty," said Richard Besser, a former acting director of the CDC and president and chief executive of the Robert Wood Johnson Foundation.
By the end of July, as cases skyrocketed, the White House began to take a more muscular approach to vaccinations. But these measures came only after the virus exacted a massive toll, with nearly 1.3 million new infections, 8,633 deaths and signs of a weakening economy as Americans pulled back on retail purchases in July as the variant flared.
Biden has acknowledged that he has not yet used the full authority of his office to fight the pandemic - and he has shown little interest in ideas that have proved effective elsewhere, such as vaccine passports or broader mandates.
"I think if delta hadn't happened, we'd all be pretty happy," said Carlos del Rio, the executive associate dean of the Emory University School of Medicine. "They're trying to have science guide what they do as much as possible. I think the problem is that the science is changing. And with the virus changing, it makes it really hard to know what to do."
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July 4: The seven-day average for new coronavirus infections stood at 12,879, one of the lowest rates since the start of the pandemic.
Biden hosted only a handful of events at the White House during the first five months of his term, as the new administration sought to model best behavior. The massive Fourth of July fete would signal a return to normalcy and show that the White House was reopening to the public, according to one White House aide involved with the planning.
The president posed with the Washington Nationals' four racing presidents, took selfies with guests who squeezed around him and served lemonade from a converted Airstream stand with "Fourth of July 2021" written on the side. Families lounging on the grass remained there until after dark to see the South Portico of the White House lit up in red, white and blue and view the national fireworks display.
In the weeks since, administration officials have defended the decision to go forward with the event.
"We had made a lot of progress," White House covid-19 response coordinator Jeff Zients said in a recent interview. "That was important. We thought it was important, the president thought it was important to highlight that progress."
Zients also emphasized that Biden's address included notes of caution, flagging the fourteenth paragraph of the speech.
"Don't get me wrong, covid-19 is - has not been vanquished," Biden said. "We all know powerful variants have emerged, like the delta variant, but the best defense against these variants is to get vaccinated."
Zients said he and his team kept a close eye on delta in June and July, and that they had recently launched an effort to make additional federal resources available to states grappling with the variant. Over the next few weeks, the effort would be ramped up to more than 500 people deployed in 10 states.
But even so, the general sense in the White House in early July was that the fight against the pandemic was receding. The White House was close to Biden's goal of getting at least one shot of a vaccine to 70% of eligible adults. Officials discussed how they would talk about the planned phaseout of unemployment assistance and an end to the pause on student loan repayments.
"It was sort of this recognition that we were going to have to explain to people how we were moving to a different phase, and why that meant the wind-down to the number of programs," said one administration official, describing the discussions in early July.
During this period, some outside advisers urged the administration to move quickly to require vaccinations for members of the military, but officials dragged their feet.
White House officials also were reluctant to have a public conversation in July about the potential need for booster shots, according to two people familiar with the conversations. Although they privately acknowledged that boosters were likely to be needed - especially for the immunocompromised and the elderly - they worried about how discussion of boosters might affect vaccine hesitancy at the same time they were trying to persuade millions more Americans to get shots, the two people said.
A White House official said that U.S. data supporting the need for boosters did not exist at that time and argued that it would have made little sense for authorities to prepare the public for a shot that might not be needed. Nevertheless, the White House did take the precaution of ordering boosters in June and July - just in case they turned out to be needed.
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July 9: The seven-day average for new cases is 17,968, up 40% from July Fourth
Outside experts saw the pandemic differently in early July and began agitating for strong measures, including vaccine mandates.
Ezekiel Emanuel, a bioethicist at the University of Pennsylvania who was a member of Biden's coronavirus transition task force, began organizing a petition among major medical organizations that called for all health-care workers to be vaccinated.
Leaders reacted enthusiastically, Emanuel said, though many organizations needed board approval to sign on. By the following week, the groups agreed to a draft letter.
Emanuel kept the White House apprised of his efforts, including speaking with Zients shortly before publicly releasing the letter. In that conversation, Emanuel explained that he had more support than he had anticipated: upward of 50 groups were expected to sign on.
Zients responded that the letter would start a "tidal wave," Emanuel recalled.
Alarm bells were also ringing inside other agencies. In June, four unvaccinated health-care workers at the Department of Veterans Affairs died of covid-19. VA has lost 166 employees to the virus since March 2020, according to the department. That is part of what prompted VA Secretary Denis McDonough - formerly President Barack Obama's chief of staff - to suggest a vaccine mandate for tens of thousands of VA health-care workers, according to VA spokesman Terrence Hayes.
McDonough declined to be interviewed for this story.
Later, in mid-August, Health and Human Services Secretary Xavier Becerra would issue a similar directive covering staffers at the National Institutes of Health and the Indian Health Service.
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July 19: The seven-day average for new cases is 34,852, up 171% since July Fourth
At the White House, the pandemic came closer. A member of the White House staff and one of House Speaker Nancy Pelosi's aides reported testing positive for the virus on July 19. Both had been vaccinated. The reality of breakthrough infections was so fresh that the White House at that point didn't have a policy for how to deal with such cases, one official said.
Around this time, top health officials intensified their outreach to public health experts to get feedback on changing tactics. The spike in infections among the unvaccinated concerned them. But anecdotal reports and some studies began to show that vaccinated people could spread the virus, too.
"There was a recognition from the week of the 19th that the entire public health community felt differently than they did," said one public health expert familiar with the White House's outreach. "The White House was going against mainstream public health at that point."
Inside the administration, some public health officials were debating a change to masking guidelines, with some pushing to ask vaccinated people to begin wearing masks indoors again.
But as Biden prepped for a CNN town hall that week, none of these questions were settled. Biden and his senior staff sought to use the event to strike a balance between telling the vaccinated part of the country that covid was less of a threat while also telling the unvaccinated that it still was.
Biden flew to Cincinnati for his town hall, which focused on covid in the opening sections - but he signaled nothing about the debate within the administration over masks for the vaccinated.
"The ground was shifting underneath them," one person in frequent contact with the White House said. "At some level, they experienced it like everybody else did. You see case counts go up and ask: 'Is this a trend? Is it real? Is it going to continue to go up?' "
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July 23: The seven-day average for new cases is 48,041, up 273% since July Fourth
By the end of that week, Zients and his team had concluded that a new approach was needed - one that would prod the unvaccinated and call out leaders whom the White House saw as blocking progress.
"My team gets together and we argue, 'What are the levers available to us with government to tackle this virus? What, what, what more can we do?' " Zients said.
He said the shift was prompted by a realization that vaccination rates were stagnating. "We've got to get the vaccination rate higher, we've got to get as many Americans vaccinated as fast as possible," he said when asked to describe the changes he was seeking.
On Friday, July 23, Zients - along with other top health officials - met with Biden to pitch the new strategy, which would include the mandates for VA health-care workers, creating inconveniences and restrictions for unvaccinated federal workers and urging the military to mandate the vaccine.
"We briefed him on the plans, and he asked questions, as he always does, and he signed off," Zients said. "It was time, we thought, to move to embracing and modeling requirements."
After the president blessed the move, the White House worked with the U.S. Chamber of Commerce to reach out to businesses, urging them to follow the federal government's lead and issue their own mandates.
Some in the administration wanted him to go further and pushed for the federal government to tell employers such as nursing homes to issue mandates or potentially lose federal funding. Biden announced that step Wednesday.
"We got to a point in our wartime response, if you will, that every option was on the table," Zients said.
But one area that Zients did not reconsider was deploying vaccine passports or some kind of federal verification of vaccination status.
The concept had been floated among White House officials as early as the spring, but there was resistance to embracing such measures, despite success in other countries.
White House officials were scared off by internal polls that showed interest in vaccination decreased whenever the word "passport" was used, one of the people said, adding that officials wanted people to feel that the vaccines were safe and that the federal government was not using vaccination status as a way to collect personal data.
They were also influenced by Florida Gov. Ron DeSantis, a Republican, who seized on the passport idea and held it up as an example of government overreach and an avatar for liberal overreaction to the pandemic. He issued an executive order banning them and then signed a law that did the same.
Eager to avoid a fight with the up-and-coming Florida governor that could become a distraction, the White House jettisoned the idea, according to a person familiar with the discussion. DeSantis's statements played a significant role in the White House's decision to not push ahead with the initiative - so much so that some officials felt the White House was letting a potential 2024 rival push the administration around.
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July 26: The seven-day average for new cases is 55,986, up 335% since July Fourth
By the last full week of July, the White House was ready to begin unveiling the first elements of its more aggressive approach.
Announcements were issued in quick order. On Monday, July 26, VA said front-line health-care workers would have to be vaccinated. The next day, the CDC walked back its masking guidance from May and asked vaccinated Americans to cover their faces indoors in high-transmission communities. Biden also unveiled a directive that Thursday for federal workers to get vaccinated or wear masks and socially distance themselves, and asking the military to follow suit.
Vaccine mandates were issued by some businesses, including United Airlines, Kaiser Permanente and Tyson Foods.
And on the last Friday of July, the Food and Drug Administration announced it was redeploying staffers and adding resources to accelerate an effort to grant full approval for the Pfizer-BioNTech vaccine.
Over the next few days, the White House started challenging DeSantis, who threatened to defund the salaries of school administrators who issued mask mandates. White House press secretary Jen Psaki said from the podium that the administration would find ways to use federal funds to make up for potential Florida cuts.
By July 31, the seven-day average for new coronavirus infections was nearly 78,000 - more than six times the level during the celebration 27 days earlier.
In early August, another high-profile party was planned - this one on Martha's Vineyard in honor of former president Barack Obama's 60th birthday, which was then scaled back because of the delta surge.
Zients was among several top White House officials invited to the party, according to a person familiar with his schedule. He did not go.
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The Washington Post's Jacqueline Dupree contributed to this report.
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