We had a crisis at home, and it involved toilet paper. Not that we didn't have any; we were among the lucky families who did. It was that somebody was eating it all ... along with the spare napkins and surgical masks. Our dog seemed to prefer paper to food. And if one of us caught him with a wad of paper in his mouth, Brodie looked right at us and dared us to come and get it.
It was chaos all over the country, and the Edina war room was no exception. Brodie had a paper mask he had snatched from the counter between his teeth and was running clockwise through the rooms of the house. I finally gave up and called John Doerr to talk through with him my conversation with Kushner and the federal government's abdication of pandemic leadership. When he heard the details, he was despondent. We had averted two potential disasters--the first in March, when people began to stay home, and the second in April, when we avoided the Easter Sunday Massacre- but now we were at an impasse. As we moved through April, the country, abandoned by the Trump administration, seemed to be out of gas for May. I remembered Bill Joy telling me not to enable Trump by sending him a plan that would allow him to shirk responsibility. I had told myself, We're saving the next life, and besides, what else can we do? But I was concerned. We had developed criteria for opening up the country, but with the White House having used them to get itself off the hook, they were now being ignored. I feared chaos and wondered whether we'd done the right thing. 
"What should we do at this point?" John, as always, was focused on where we were, not how we'd gotten here. 
"Focus on the states." 
But John reminded me of the obvious: "I'm really worried. That's not nearly as good." 
He was right. How was our model of federalism supposed to work in this pandemic? I thought about each state's borders with others-_Kentucky with Tennessee, Wisconsin connecting to Michigan's Upper Peninsula, a bunch of states crammed together in the Northeast, the Dakotas abutting Minnesota. Each state had different ideas of what would work; each state had its own system for deciding when things should open and close. We were going to need public transparency and accountability for when states would reopen. 
Crowdsourcing Pandemic Management Ryan Panchadsaram, John's chief of staff, texted one day to ask if we could talk about an idea he and I had previously tossed back and forth. Ryan talked about creating a public scorecard on each state's progress: cases, hospitalizations, testing, and contact tracing. My relationship with Ryan actually predated mine with John. Ryan, who lived in San Francisco, had been a core part of the Healthcare.gov turnaround team, where everyone called him "Ryan P." A former Microsoft product manager, he'd been dogged at ferreting out undiscovered problems with Healthcare.gov, often contacting individuals wa'd had problems with the site and tracing their is: ; all the way down to a new undiscovered problem. I began calling him the "chief curiosity officer."
I Ryan's idea was to build an open-source scorecard filled with everything the public needed to know about how a state was doing on public health measures. Any reasonable administration would have already made this material publicly available through the CDC. (Of course, a better administration would not have abandoned its post.) But we had "federalism" without even the basic tools the states or the public needed. I had suggested Ryan talk with the United States of Care team: Mark McClellan, who had run both CMS and the FDA and was now at Duke University, and former CDC director Tom Frieden. Together they could build a credible dashboard. 
After Birx's press conference, the phone call I received from Kushner, and Trump's tweet making it clear the states were going to be left on their own, I hoped Ryan was going to tell me he had something ready. He was, in fact, calling to say that not only would he be able to launch a scorecard, but he could take Birx's criteria and use them to make a heat map and a public website that would give details of how each state was doing, what stage it was at, and what needed to happen to make progress. Ryan moves fast. By the next day-April 17, a day after the press conference Ryan sent me a link to the first draft of the website, Covid Exit Strategy (covidexitstrategy.org). 
The first thing I noticed was that no state met the criteria of being ready to open, and wouldn't be ready for some time, yet many were still announcing plans to open in May. 
And one other thing looked wrong immediately: every state was behind where it needed to be to open except one--the state that so far had had more than 20,000 deaths, New York. I called Ryan. 
"How could New York be the state closest to being ready to reopen, Ryan? Look at the massive death toll. No one will believe that." 
"It's what the data says, Andy. They are rocking on testing. They are the only ones close to meeting the White House standard." 
Ryan loved data. But I didn't want him to embarrass himself. "No one will buy this," I warned. "No, New York is doing really well." "Tell that to New Yorkers." "They'll see it. It's the South I'm really worried about." I suggested that either his data or his criteria might be wrong. But as it turned out, it was me who was wrong. Just as quickly as New York's cases had surged, they began receding, and I got a basic lesson on how the time lag between when infections begin and when the severe cases become visible could be deceiving. It's a lesson that subsequently eluded many governors. 
What happened in New York? The state was actually following Italy's curve, as Birx had predicted the whole country would. Governor Cuomo had made investments in testing and contact tracing. But it was more than that. Everyone in New York City knew someone who'd had COVID-19 or been sick themselves. Many had lost friends and family. They had the sound of wailing sirens and the images of mass burials and portable morgues seared into their brains. New Yorkers had joined that fraternity of other places around the globe, such as Hong Kong, that had experienced deadly pandemics.3 Ryan saw this happening in the data. 
Ryan's map showed New Jersey and Connecticut following similar curves. But if things were going well in the Northeast, the states in the South, particularly Florida, Texas, and Arizona, were about to head in a different direction. Their Republican governors seemingly believed they had avoided the COVID-19 pandemic. None understood that it was only a matter of time until it reached them. A common refrain on the political right at the time was that the coronavirus was a blue-state and big-city problem, and people in rural America didn't need to worry. 
By the end of April, instead of behaving like a unified country, in which lessons from one place would be absorbed in other places, we had southern states opening up rapidly and with few precautions. The governors wanted to see their economies bounce back, and because they hadn't experienced what New York had, they assumed they had done it better. Never mind that they hadn't met any of Birx's suggested guidelines for reductions in cases, adequate testing, and sufficient contact tracing. 
I often chatted with Chris Cuomo on his prime-time CNN show in April and May. Not only was Chris the New York governor's brother, but he was also fighting a difficult case of COVID-19 himself for much of that time. When the White House Task Force was sidelined, many of the things they were working on, like a plan to increase testing, were mothballed, and Chris wanted to know what was going to happen without federal oversight and not enough diagnostic testing needed to open the country. On his May 7 show, I warned that we were not adequately preparing to make it through the summer and fall. We had chosen instant gratification over an approach that would solve the problem. "
[This] is not impossible," I said. "We need a little patience, and we need to do the real work. You can't quit in the middle. You can't announce a program to test people like we did three weeks ago and then three weeks later, when it's not done, just give up. 
But giving up is what I saw everywhere. Rather than follow the guidelines Birx laid out, many states just wanted to put the whole thing behind them like it was a bad dream. Republicans I talked to, including former HHS secretary Mike Leavitt and former FDA commissioners Scott Gottlieb and Mark McClellan, told me it was fairly pointless to talk to most Republican governors about anything except economic growth. My concern was that, just as I had failed to see New York's progress, governors would fail to see the problem until it was too late. I wrote on Twitter about the optical illusion we were about to witness, and my tweets were reprinted by Medium on the last day of April: 
Welcome to 30 days of bliss. The type of bliss that often comes from ignorance. Many of the politicians in the country believe it will not be possible to keep strict social distancing rules in May. They feel pressure from a small minority to make adjustments -so people can get haircuts, gather on beaches, go to church in person, visit malls, etc. The 30 days will be blissful because people won't pay the price for May's experiment until June. But if people believe we are opening during a time when the curve is flat, they are wrong. 
We are continually going to be looking at lagging data. Today we are seeing the results of early to mid- April. If you get infected today, at a minimum you'll likely experience 5 infectious days without symptoms, and 28 infectious days without symptoms for those who never show them. [Note: Subsequent studies showed that the most infectious period tapered off after approximately 10 days.] Without tests or contact tracing, you can infect many people before you know it (if you ever know it).
COVID-19 hasn opped being infectious just because we've socially isolated. Nothing magic happened while we were home. Pick a part of the country that hasn't done social distancing in April, prisons. The Bureau of Prisons just tested 2,000 prisoners and found 70% tested positive. In addition to being ashamed, we should be warned. The virus has gone nowhere. It is waiting us out. 
On Memorial Day, we could still be looking at what could appear to be positive data that doesn't account for this lag. We might even view Memorial Day as an opportunity to celebrate together at beaches and BBQs. I know I would like that. And while most people will likely remain cautious, there's an increasing number of people who think to themselves, "If someone dies, it probably won't be me. I'm healthy and young." A new analysis today shows people dying of COVID-19 do so on average 10 years prematurely. 
The Birx White House plan called for declining cases and testing and tracing, but Trump and many governors of both parties don't want to wait. They don't want to be the bad guys, don't want to deliver an uncomfortable message. The White House Task Force remained sidelined and wouldn't publicly meet again until June 25, a full seven weeks after its last meeting. Meanwhile, Birx was chirping about how swimmingly things were going, but Ryan's Covid Exit Strategy data showed the opposite. Who was right? States would require more than just good data to open safely.