Crimson
Contagion

The Crimson Contagion scenario imagined a group of approximately 30 tourists returning from China who unknowingly carry a novel H7N9 influenza A respiratory virus. The first detected case is a 52-year-old man who arrives in Chicago — the exercise’s host city.

From this single index case, the virus spreads rapidly through the United States. Within 47 days, the virus has infected millions and is doubling in cases every few days. Hospitals begin filling. Emergency departments are overwhelmed.

By the end of the simulation: 110 million Americans are infected, 7.7 million require hospitalization, and 586,000 people die. The numbers are strikingly close to what COVID-19 actually produced in the United States.

The eerie parallel was not lost on public health officials. When COVID-19 emerged from Wuhan just months after the exercise concluded, many participants experienced a sickening sense of déjà vu — they had already seen this movie, and they knew how it ended.

Crimson Contagion identified one of the most critical vulnerabilities in US pandemic preparedness: the nation lacked the domestic manufacturing capacity to produce protective equipment and medical devices at pandemic scale.

N95 masks, surgical masks, ventilators, gowns, and gloves — all were in critically short supply in the simulation. The exercise revealed that US supply chains for these essential items were overwhelmingly dependent on foreign manufacturing, particularly in China.

The after-action report explicitly stated: the US “lacks domestic manufacturing capacity” to meet pandemic demands. This finding was circulated to federal agencies and senior officials.

When COVID-19 hit, the predicted PPE crisis materialized exactly as simulated. Healthcare workers wore trash bags as gowns. N95 masks were rationed and reused. Ventilators were so scarce that governors competed against each other — and against the federal government — in bidding wars. Everything Crimson Contagion predicted, COVID-19 delivered.

Perhaps the most damaging finding of Crimson Contagion was the fundamental confusion about which federal agency would lead the pandemic response. Three major agencies — HHS, FEMA, and the Department of Homeland Security — all had overlapping authorities and competing claims to leadership.

HHS was the designated lead for public health emergencies, but FEMA had the logistics and coordination infrastructure. DHS had the broader homeland security mandate. During the exercise, these agencies could not agree on roles, leading to duplicated efforts, contradictory guidance, and critical gaps.

The exercise also revealed that participating organizations lacked clarity on what information was important to pass to federal partners. Data flowed unevenly — some agencies were overwhelmed with irrelevant reports while lacking the critical intelligence they needed.

During COVID-19, this exact confusion played out in real time. The CDC, HHS, FEMA, and the White House Coronavirus Task Force issued conflicting guidance. States received contradictory directives. The exercise had predicted this failure with precision — and no one acted on it.

Crimson Contagion revealed that the federal government simply did not have enough money to respond to a severe pandemic. Existing appropriations were inadequate, and there was no rapid mechanism to redirect funds at the speed a pandemic demands.

The exercise showed that pandemic spending needs scale exponentially — doubling every few days along with case counts. Traditional budget processes, which operate on quarterly or annual cycles, cannot keep pace with a pathogen that doubles in a week.

When COVID-19 struck, Congress eventually passed over $4 trillion in emergency spending — unprecedented in American history. But the money came late, in waves, and was often poorly targeted. The funding gap that Crimson Contagion identified cost lives in the crucial early weeks of the pandemic.

Twelve states participated in Crimson Contagion: Arizona, Colorado, Connecticut, Idaho, Illinois, Massachusetts, Nebraska, New Hampshire, New Mexico, New York, Pennsylvania, and South Carolina.

Each experienced “multiple challenges” when attempting to request resources from the federal government. The after-action report attributed this to “a lack of standardized, well-understood, and properly executed resource request processes.”

States didn’t know which agency to call, what forms to fill out, or how to prioritize requests. Some states received equipment they didn’t need while lacking critical supplies. The distribution system was chaotic.

During COVID-19, Governor Andrew Cuomo of New York famously described the federal-state resource allocation as an “eBay” system where states bid against each other. This was precisely the dysfunction Crimson Contagion had documented months before.

The Crimson Contagion after-action report — a comprehensive 70-page document outlining every failure and recommendation — was completed as a coordinating draft in October 2019.

In December 2019, HHS Secretary Alex Azar testified before Congress and referenced the exercise. However, the full scope of the findings was not shared publicly, and the recommendations were not implemented.

In January 2020 — just three months after the report was completed — COVID-19 began spreading from Wuhan, China. Within weeks, the exact failures Crimson Contagion had predicted were playing out in real time across the United States.

The New York Times broke the story on March 19, 2020, under the headline “Before Virus Outbreak, a Cascade of Warnings Went Unheeded.” The GAO later confirmed in August 2021 that “federal partners lacked clarity on interagency roles and responsibilities during a pandemic.”

Crimson Contagion joins Dark Winter, Event 201, and Clade X in the pantheon of pandemic exercises that accurately predicted catastrophe — and were systematically ignored until it was too late.