What it’s like to live and work for the coronavirus task force

(Justin Merriman / for the Washington Examiner)

Instead, his weeks are filled with daily calls or meetings with members of the administration’s coronavirus task force. The former McKinsey & Company senior partner, West Point, U.S. Army Ranger School, and Harvard Business School grad, veteran of the Army’s 82nd Airborne Division, and one-time Republican primary candidate for governor has been counseling members of the administration’s coronavirus task force in response to the pandemic.

Mango’s style is low-key. His ability to avoid the headlines, along with his business expertise (he organized and ran McKinsey’s healthcare division) and tactical thinking from his military background, is, in large part, why he is so valuable to the Trump administration.

He joined Health and Human Services Secretary Alex Azar for his trip to western Pennsylvania last week to discuss with local business leaders, hospital executives, educators, and manufacturers their concerns about opening up for business in the weeks and months ahead. He was also on hand for Azar’s announcement in Beaver County that a federal investigation had begun into coronavirus deaths at a local nursing home facility.

In the interview, conducted outside the iconic PPG Place in downtown Pittsburgh, Mango discussed his role in the administration’s coronavirus task force, what was happening in the early days of the outbreak, and his role as the facilitator of what’s next.

Editor’s Note: This transcript has been lightly edited for clarity.

Washington Examiner: What unique expertise did you bring to the table to the administration and HHS, especially in the early days of the crisis?

Paul Mango: I think having spent that much time deep in the industry, understanding the underlying economics, the relationships between health insurers, hospitals, and doctors, which is not that easy. That was one thing. I think second, the secretary is an executive, so he’s a CEO, very CEO-like. He wanted much more structure to the process of evaluating and analyzing policy. So we introduced what I would say more analytical rigor to his multibillion-dollar decisions. And then, third, I think just helping him with an extensive set of relationships.

Washington Examiner: Take the reader into the moment when your office first started hearing what was going on with this virus.

Paul Mango: I’ll talk about the moment, and then maybe I can talk about the evolution. We were all just getting back from Christmas vacation. And prior to leaving for vacation, we had set out an agenda for 2020. You know, here’s what we want to get done. When we come back, we’ll hit it hard. It was literally Jan. 3 or 4 when Dr. Redfield from the CDC said, “We think something’s going on in China.” And then within a couple of weeks, we were literally in full-on mode, trying to contain this thing.

And then the president at the end of January issued the travel ban. And that was the phase that we would call containment. We were trying to prevent the virus from coming here. And it wasn’t evident early on that this is what they call human-to-human transmission. I should say, there was a belief that this was animal-to-human and that it could be continued because we just didn’t know what we didn’t know. And then, when we saw the first couple of cases of human-to-human transmission in the states, we knew we had to move into a different phase, which was not containment, but what they call mitigation.

So all the social distancing, the masks, governors started shutting down schools by the end of February, that type of thing. And we waited a couple of weeks, and then we realized that there were some real significant, dangerous hot spots. Obviously, New York, New Jersey, New Orleans was one, early on it was Seattle. By the way, Seattle was the first place they contained it. So at that time, there was a very important introduction of FEMA to this equation. FEMA became the lead agent, and HHS was its partner, but FEMA is a logistical machine, and we needed them very bad. Because we had a Strategic National Stockpile, it had masks, it had ventilators, it had various pharmaceuticals, and we worked very closely.

Washington Examiner: You needed FEMA for delivery and infrastructure?

Paul Mango: We needed their logistics infrastructure to get products very quickly out to the right place at the right time to work with local government officials from mayors to county executives to governors. They’re very, very good at that because they do it for hurricanes and earthquakes and fires. So it was a very strong partnership. I would say for six weeks, straight, 14 hours a day, they didn’t stop anything. And we were trying to put out fires, like let’s get to 2,500 ventilators to New York City. Let’s get a million masks to Chicago, that type of thing. And we were simultaneously, we knew that we had assignment, they work with the industry to begin to ramp up increased production. So we’re shipping stuff. We created an airbridge.

So the vast majority of our protective equipment up until this time comes from Asia. That’s where it’s manufactured. There was a huge interruption of production over there for about six weeks when Wuhan broke out. They restarted their factories, but there were no longer any planes coming from Asia to the U.S., literally 100% of the flights from China were stopped. Direct flights. Many of those suppliers used to put those supplies in the cargo holds of commercial airlines. So they had no way to get it here except by boat, which takes 45 days. So what we did was we had suppliers and distributors who own product and warehouses in China. And instead of waiting 45 days, we worked with FEMA to start an airbridge, where they had literally a hundred flights. I think we’re up to about 115 flights, completely full of medical supplies and equipment that we then pushed through the Strategic National Stockpile out to the hospitals. So we accelerated all that. So we’re working with FedEx and UPS and various airlines while we’re trying to anticipate and distribute all the medical product distributors.

So this was a very important relationship because it was their products. We didn’t own the product. We said they couldn’t afford to fly it here because that’s their economics for that charter airline. So we got the charter airlines and everything we brought into the country. We had rights to 50% of the distribution. Now, they would still sell it, but we would say, give it to New York City. So that permitted us to take what was the limited supply and get it to the right place at the right time. Because the country had, it was very unusual. They had these extreme hot spots, thousands of people sick, hundreds of people dying a day, in another parts of the country there was nothing. Nothing going on. So the real task was how do we reallocate supply to the right place at right time?

So every day we would look at the statistics with what’s happening in the hospitalizations, how many people were on ICU? How many are on ventilators? And we would make daily decisions as to where products should go. We’ve worked with the distributors, we’ve created an ID system. So we could follow the product right to the local hospital that was like weeks’ worth of kind of just on the fly, innovating and kind of improvising. So that was kind of the third phase, which was fighting fires, for lack of a better term.

The fourth phase was okay, we feel we have this under control. How do we begin to think about restarting the economy? And there was a lot of effort from our Centers for Disease Control and Prevention, which we put out and have put out tremendous amount of guidance. I think last week they just put out stuff on churches, but that, that’s where that comes from.

We’re working very closely with them, and we’re still going through that. But I think we’re actually in the most important phase right now, the secretary is needing the president’s direction. We completely restructured our homeland security efforts. Post-COVID-19, we’ll be completely restructuring our pandemic response. That’s why the president went to Maine. That was about changing the role of the Strategic National Stockpile. We’re going to have more products, different products, public-private partnerships to work faster.

Washington Examiner: Will there be a push to make more products in America?

Paul Mango: It’s already happening and very closely with our organization site called BARDA, which is the organization that reduces vulnerability to foreign countries. So we’re hundreds of millions of dollars into that. We are working very hard to bring a lot more product activity that survival kind of supplies.

Washington Examiner: Question about rural hospitals. How concerned are you about their ability to sustain, whether it’s a knee operation or a shoulder surgery or pregnancies or childhood vaccinations?

Paul Mango: Essentially, screenings as you’re describing, cancer screenings, vaccinations, regular checkups are down at unbelievable levels. We have to get that going again, or we’re going to have, even if we conquer COVID, we’re going to have all types of other health issues.

Washington Examiner: Operation Warp Speed, what is its immediate objective?

Paul Mango: The immediate objective, is to get a vaccine, not only on the street but in the arms of Americans before year-end. And that project has been going very, very well, but it has a longer-term objective. And that is to get various government agencies that wouldn’t normally work together to permanently work together differently. So you have the FDA, who has to approve all of these things, NIH, which oversees the clinical trials for new drugs and vaccines. And then I mentioned before BARDA, which is our Biological And Research Development Authority, which does permits. So if the NIH says here’s a promising vaccine, BARDA can throw a bunch of money behind that and say, ‘let’s really ramp it up and get it manufactured quickly.’ And then the FDA has to approve it. And those are not three organizations that naturally interact with each other every day. So we’re creating a new structure there that will be durable.

The third one you probably heard a lot about is lab test. So what we learned was from supply chain issues through to collecting data from those who are performing tests, that we have such a distributed laboratory service industry, thousands of hospitals, major commercial labs, six major ones. You have public health labs. They weren’t integrated in a way where we could get the data flow every day, which is what we needed. We need that every day to analyze how many positive versus negative tests there are. Antibody positive just makes a big difference in fighting a disease like this, to know what the test results are. And to know demographically, are these people all over 70? Are they under 20? Are they from minority populations? Because if we’re going to attack this thing successfully, we need to know who was disproportionately affected. We weren’t getting that information. So we have a third effort that is very much into your tour, expanding capacity of laboratory testing, very quickly getting information making sure the supply chain issues are supported. That’s one of our biggest bottlenecks. And you probably read about this. We ran out of the stupid swabs. You can actually get those tests on the market now, you can actually get it done with a Q-tip.

Washington Examiner: Do you work with Dr. Deborah Birx and Dr. Anthony Fauci on a regular basis?

Paul Mango: Yes. I see Dr. Birx three or four times a week. She is very close with us. We just had a meeting last night in our building. I’ve been working closely with FEMA, very closely with the White House, principally with Jared Kushner and also Dr. Birx.

But virtually every issue she’s involved with involves HHS, if not every day, three or four times a week, and we’re making sure she gets what she needs from our CDC, from our FDA. She’s part of the Operation Warp’s oversight committee that is making decisions on which vaccines, in which their products are the most promising. So she is deeply embedded in what HHS is doing. And my role is to facilitate among all of our leaders to make sure she gets what she needs to get it, get the job done.

Washington Examiner: Dr. Fauci?

Paul Mango: Again, he was with us last night. Probably not very many days that go by that we don’t talk to him.

Washington Examiner: Are you the facilitator of sort of this, the next step forward?

Paul Mango: Yes. And the secretary has asked me to play that role. So what you have is the precedence.