'Any Way You Cut It, This Is Going to Be Bad:' VA Official Sounded Early COVID-19 Warning


A Department of Veterans Affairs health adviser has emerged as a key sentinel among federal and academic infectious disease experts to sound an alarm on the COVID-19 pandemic, according to emails published Saturday by the New York Times.

Dr. Carter Mecher, the VA's senior adviser to the Office of Public Health, warned as early as Jan. 28 that the World Health Organization and Centers for Disease Control and Prevention "were behind the curve," in responding to the novel coronavirus and swift action was needed to stop it, according to an email thread obtained by the Times through a Freedom of Information Act request.

"You guys made fun of me, screaming to close the schools. Now I'm screaming, close the colleges and universities," wrote Mecher to the group, nicknamed "Red Dawn" for the 1984 movie that pitted actors Patrick Swayze and Charlie Sheen against a foreign enemy invasion. Red Dawn was hosted by Dr. Duane Caneva, chief medical officer at the Department of Homeland Security.

Upon analyzing early data from China, Mecher said it appeared that the virus looked as transmissible as the flu, but with a greater ability to replicate and a case fatality rate comparable to the worst flu season.

"This is really unbelievable ... any way you cut it, this is going to be bad," Mecher wrote.

From Jan. 28 through the middle of March, the email chain grew from a handful of physicians and researchers with the Departments of Homeland Security, Health and Human Services, Defense, VA, academia and the private sector to a group that included dozens others in the federal government. It eventually included Surgeon General of the United States Jerome Adams and Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases.

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Caneva wrote that the chain was started "to provide thoughts, concerns, raise issues, share information across various colleagues responding to COVID-19."

From its inception, two of the most outspoken voices were Mecher and Eva Lee, director of the Center for Operations Research in Medicine and Health Care at the Georgia Institute of Technology.

The group studied the disease spread on the Diamond Princess cruise ship, quarantined in Yokohama, Japan, on Feb. 3. They also discussed the potential for an overwhelmed hospital system in the U.S., and started calling for social distancing on Feb. 9.

"[It's] over 10 to 30 times more deadly than seasonal flu," Lee wrote following an analysis of cases in Hubei. "Moreover, this is only a lower bound because the government basically shut down and isolated the entire infected zone."

By mid-February, Mecher was asking about the strategy for primary care and hospital response, including isolating people at home and encouraging virtual medical appointments and telework. He also inquired about nursing home spread and the lag time of testing.

"We are going to have a devil of time with lab confirmation -- it is just too slow ... that means we are going to have to fly blind early on," Mecher wrote Feb. 20.

That week, the U.S. State Department issued a travel alert recommending that U.S. citizens reconsider any planned travel on cruise ships, and CDC officials said they were seeing community spread of the coronavirus in some Asian countries.

"If you're watching the news, you may be hearing about schools shutting down and businesses closing in countries in Asia to reduce the potential spread of this virus," said Dr. Nancy Messonnier, director of the Center for the National Center for Immunization and Respiratory Diseases. "The day may come where we need to implement such measures in the U.S. communities."

President Donald Trump held two campaign rallies the same week, but did not mention the virus, which had 15 U.S. cases at the time.

By Feb. 28, Mecher was forecasting total veteran deaths from the novel coronavirus, based on how the virus affected Diamond Princess passengers: more than 461,000 veterans ill and 30,736 dead across the U.S., including 221,703 hospitalized and 14,780 in VA facilities over three months.

"Now you understand the challenge," he wrote.

On March 2, Lee, (who has been convicted of falsifying a certificate needed for a $40,000 grant from the National Science Foundation on other research), said non-pharmaceutical interventions, or NPI, such as school closures, telework, travel restrictions, hand-washing and social isolation should be put in place.

"We need actions, actions and more actions," she wrote.

"Six deaths in Seattle. Seattle missed the window. It is too late for NPI," Mecher responded.

Mecher helped write the 2007 White House National Strategy for Pandemic Influenza under President George W. Bush and served as director for Medical Preparedness Policy on the White House Homeland Security Council under President Barack Obama. He also has served as chief medical officer of the VA's Southeast Network, responsible for VA health services in Georgia, Alabama and South Carolina.

By March 12, Mecher, a self-described "dufus from the VA" in his emails, was still searching for solutions: " I think we ran out of time for Seattle. But there are other cities and communities where we still can make a difference," he wrote. "I don't understand why California and NYC are not acting more aggressively."

As of April 13, the U.S. had nearly 561,000 confirmed cases of COVID-19 and 22,861 deaths.

New York has been the hardest hit, with 188,000 cases and 9,385 deaths and ordered a lockdown on March 20. By contrast, California, where Gov. Gavin Newsom ordered the nation's strictest lockdown measures on March 19, has had roughly 22,000 confirmed cases and 651 deaths.

Within the VA system, 3,754 veterans had tested positive for the coronavirus as of April 11, and 200 have died. It is not known how widespread the impact of the illness has been on the entire veteran population; dozens have died in nursing homes, including 37 at the New Jersey Veterans Home in Paramus, N.J.

The Times story was based on several emails first obtained by Kaiser Health News and a more extensive FOIA search.

Mecher, in one of his last emails obtained by the Times, penned on St. Patrick's Day, said the most difficult message to convey to government and health leaders, as well as the general public, was the need to "take action before the storm arrived and the sun was shining."

"The story line of the articles written about the variation in outcomes in U.S. cities [during the flu pandemic of 1918] is now unfolding and writing itself in real time before our very eyes," he wrote.

-- Patricia Kime can be reached at patriciankime@gmail.com. Follow her on Twitter @patriciakime.

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