“The biggest current threat to the president’s re-election is this thing getting out of control and creating a health and economic impact,” said Chris Meekins, a Raymond James financial analyst and former Trump administration HHS emergency-preparedness official.

An HHS spokesperson said the administration is committed to protecting public health and preparing for multiple scenarios due to the novel nature of the virus.

“As we’ve said all along, the risk to Americans is low, but we expect the numbers to increase,” the spokesperson said, declining to characterise the nature of the discussions.

But there has been tension within the Trump administration over the response so far. Four officials acknowledged that the process has hit bumps, with high-pressure debates over resources and planning occasionally reopening fault queues between the White House and HHS that first emerged over Trump's broader health agenda.

Some of the biggest challenges have been within the health department, with the Centres for Disease Control revising its quarantines, opposing the evacuation of the Diamond Princess cruise ship – despite evidence that a quarantine imposed by Japanese authorities had failed and infections were spreading – and raising general questions about the agency’s level of preparedness.

Only 34 cases have been confirmed in the United States, including those brought home from the cruise ship. But the outbreak, now in its third month, has exploded overseas. More than 75,000 cases of the respiratory illness have been confirmed in China and at least 2,200 people have died.

Infections are surging in areas outside the epicentre in Hubei Province, spreading rapidly to South Korea, Singapore, Iran and Japan in recent days.

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The virus currently has no cure, can be spread by people who have no outward symptoms and appears to pose a significant risk to the elderly. CDC Director Robert Redfield acknowledged last week that officials expect person-to-person transmission in local communities, whether this year or next.

The White House stressed that its inter-agency response team led by Health and Human Services Secretary Alex Azar is working “around the clock”.

“President Trump’s top priority is the health and welfare of the American people, which is why he established the President’s Coronavirus Task Force to contain the spread of the virus,” a spokesperson told POLITICO. “Every precaution is being taken as this situation continues to change hourly.”

Meanwhile, the White House remains worried about growing economic risks, with Chinese production plunging in recent weeks and US companies like Apple and Walmart with significant investments in the country reporting they’re taking financial hits.

Senior officials fear that a sustained outbreak could slow global markets and upend a strong US economy that has been central to Trump’s political pitch.

The administration’s fumbled evacuation of about 400 Americans from the marooned cruise ship brought into focus multiple gaps in preparedness, said four individuals with knowledge of the episode.

US officials spent 10 days with little information about conditions aboard the ship, relying on Japanese health department reports rather than dispatching CDC staff. That left US health officials at odds over whether an evacuation was necessary before political pressure intensified.

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Officials managing the evacuation last Saturday were later surprised to learn, while bussing evacuees to a Japanese airfield, that 14 Americans they were transporting were reported to have tested positive for coronavirus. The State Department decided to fly the Americans back over CDC’s objections, The Washington Post first reported.

Officials continue to second-guess the original, swift decision to leave Americans aboard the ship for days, even as infections multiplied.

“I think that was one of the cruellest human experiments I've seen in my entire career,” said Michael Osterholm, director of University of Minnesota’s Centre for Infectious Disease Research and Policy, who has advised federal health officials on the response. “That was truly one of our public health lesser moments.”

The fate of Trump’s response rests on Azar, who has modelled plans based on his experience fighting Sars and other pandemics as a senior health official in the George W. Bush administration.

The health secretary – who is steering the response in addition to his other duties – has been near constantly flanked by top scientists like CDC’s Redfield and veteran infectious disease specialist Anthony Fauci at White House meetings, congressional briefings and televised updates.

The wide-ranging administration strategy has pulled together disparate offices like the Transportation Department and border patrol to handle the practicalities of travel and homeland security, as well as scientists at the National Institutes for Health, working to devise potential treatments.

It has also drawn in top political officials like Joe Grogan, the White House Domestic Policy Council chief, who was picked for the coronavirus task force amid worries about how the outbreak would affect Trump’s broader agenda.

Azar has frequently leaned on Robert Kadlec, his assistant secretary for emergency and preparedness, whose team played a key role in evacuating the Diamond Princess last week.

Kadlec – viewed by Azar as a problem-solver who was tapped to reunify separated migrant families in 2018 – also had prepared national disaster management personnel to handle pandemics by putting them through specialised training to handle infectious disease issues two years ago, said two individuals.

One question that has been raised at senior meetings is whether the official US count of coronavirus cases is too low, given the virus’ ability to incubate for weeks. POLITICO reported on Thursday that only three of the nation’s more than 100 public health laboratories had even verified the CDC’s coronavirus diagnostic test for use, further delaying screening efforts.

“[S]ince most people with the virus suffer only a mild illness, dozens and perhaps even hundreds of cases may be circulating undetected,” Luciana Borio, a former National Security Council fellow, and Scott Gottlieb, the former FDA commissioner, argued in a Wall Street Journal op-ed on Friday, calling for more screening.

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Meanwhile, the administration has kept in constant contact with Congress about its response efforts – a sharp departure for an administration that has been in a near constant state of warfare with congressional Democrats, lawmakers and aides said.

Officials including Azar, Redfield and Fauci have provided multiple briefings on their latest findings, in some cases spending more than an hour behind closed doors fielding questions and concerns.

“The administration is fully engaged,” congressman Greg Walden of Oregon, the top Republican on the House Energy and Commerce Committee, said following a meeting earlier this month. “We're holding our own right now, which is where you want to be.”

The administration also has quietly worked with blue states like California and officials in staunchly Democratic cities like New York.

“The federal government is working closely with state, local, tribal, and territorial partners, as well as health sector partners outside the government, to respond to this public health threat,” said the HHS spokesperson.

Still, there are signs that the bipartisan solidarity is beginning to fray.

The White House last week invited several top-level Democrats and Republicans to a West Wing briefing led by acting chief of staff Mick Mulvaney, billing it in part as an opportunity to offer critiques of the administration's response.

That guest list included the chairs and ranking members of relevant committees, along with Senate Majority Leader Mitch McConnell and top House Republican Kevin McCarthy.

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But neither Senate Minority Leader Chuck Schumer nor House Speaker Nancy Pelosi – who have clashed repeatedly and publicly with the president – received an invite, multiple aides confirmed. HHS referred questions to the White House, which declined to comment.

Some Democrats, meanwhile, have stepped up their rhetoric against the administration, targeting in particular Trump’s 2018 decision to eliminate the position dedicated to handling global health security threats.

“You’re kind of dealing with a government that doesn’t care about government, and then overlay your normal bumbling incompetence onto the possibility of a global pandemic,” Senator Brian Schatz of Hawaii said on MSNBC this week.

“To the extent that we’ve been fortunate with this disease, it’s because of the epidemiology of the disease, not because of some sort of coordinated response.”

Schatz, along with several other Democrats like Massachusetts Senator and presidential hopeful Elizabeth Warren, have pushed for the appointment of a single National Security Council official to coordinate the administration's efforts.

Others questioned whether the administration is adequately preparing for the potentially disastrous consequences of a months-long outbreak, including disrupted drug supply chains, shortages of protective equipment and a growing financial toll on hospitals.

During one Capitol Hill briefing, Azar appeared dismissive of questions about the funding outlook for state and local providers, aides said, telling members that the federal government had already given them lots of money in the past.

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Pelosi, meanwhile, has made a point to lavish praise on Fauci – a long-time NIH official beloved on both sides of the aisle – telling reporters after one closed-door briefing that she had full confidence in his ability to manage the response.

As for Azar? “All I know about Azar is that he used to work for a pharmaceutical company,” she said.

More substantially, both Republicans and Democrats have been struck by HHS’ refusal to seek additional funding to fight the disease, rather than shifting funds from other parts of the department. The resistance has prompted speculation that Azar is loath to offer any sign the outbreak could worsen on his watch.

“They don’t want to make it a bigger thing,” one senior Democratic aide said. “They squeeze the other coffers dry to cover themselves on coronavirus.”

Meekins – the former HHS official-turned-financial analyst, who this week warned investors the chance of “notable widespread cases” in the United States is 20 per cent – said that a significant outbreak this year could overshadow the president’s other initiatives ahead of November.

“This is one of those things where if you prevent a problem, you get very little credit – but the downside is if it goes wrong,” Meekins said.

Yet there’s one boon for Trump, amid the growing scrutiny: he does not have to deal with the kind of fearmongering he helped stoke as a private citizen during the 2014-2016 Ebola outbreak in Africa.

Among elected officials, only Republican Senator Tom Cotton of Arkansas has publicly suggested the virus could have more questionable, man-made origins than China is willing to let on, though he has emphasised that he has no evidence and merely wants the issue investigated.

Administration officials have not ruled out that the virus originated from a lab accident, carefully choosing their words when asked directly about the possibility.

“It is important not to speculate and while we do not yet know the source of origin of this virus, we will not jump to any conclusions. We await the scientific evidence,” said the HHS spokesperson.

Trump’s deputies in the meantime have urged the president to restrain his public rhetoric. Officials also are working to navigate the delicate relationship with China, already strained by trade battles and other policy clashes, without further antagonising global partners or overly alarming Americans.

But one specific episode underscores fears that Trump may not be willing to stay silent for long, especially if the virus' spread threatens his political prospects. In a Feb. 7 tweet, Trump asserted that efforts to combat coronavirus “will be successful, especially as the weather starts to warm & the virus hopefully becomes weaker, and then gone”.

He has repeated the claim that the virus will dissipate in April to a group of governors, frustrating health officials inside and outside the administration who worry it could create a false sense of security.

There is little scientific evidence for the theory, heightening concerns that if cases suddenly start to accelerate, that single tweet will undo months of work to assure Americans they're handling the crisis.

“We can’t say that it’s been contained. We lost containment a long time ago,” said Osterholm. “We’re in uncharted territory right now.”