Michael Caputo’s moves to more closely control public health agencies under HHS’ umbrella prompted the loudest objections | Mark Wilson/Getty Images.

After it became clear in mid-April that his administration’s response to Covid-19 was threatening his re-election, President Donald Trump considered a leadership shake-up within a health department whose rivalries and battles with the White House had hampered efforts to contain the virus.

Instead, Trump made a different move: He personally intervened to place his campaign aide Michael Caputo — a confidant of disgraced operative Roger Stone who had himself come under scrutiny for his ties to top Russian officials — as assistant Health and Human Services secretary for public affairs.

Trump — not HHS Secretary Alex Azar — approached Caputo about the job, and Caputo has repeatedly emphasized that he works for the president, health officials told POLITICO.

Trump’s calculation seemed clear: If he couldn’t easily move aside the health professionals who led the agencies, he could dramatically alter what the public learned about their work on the coronavirus.

Caputo immediately began supplanting career public affairs staff with his own loyalists and Trump veterans – political appointees who often knew little or nothing about health care.

They included an old Army buddy to oversee messaging for the Food and Drug Administration, and a former contractor for Medicaid chief Seema Verma to staff the director of the Centers for Disease Control – the two most trusted agencies in a health world that had traditionally been insulated from political pressure.

On Wednesday, after POLITICO detailed Caputo’s efforts to interfere with the weekly scientific reports coming out of the CDC and a disastrous rant in which he accused health officials of plotting against Trump, the 58-year-old spokesman announced he was taking a 60-day medical leave.

Interviews with more than 30 current and former health officials painted a picture of a health department laid low by its own press spokesman in the midst of the worst pandemic in a century.

Multiple HHS officials said Caputo’s impact on the substance of health policy was limited, but he entirely transformed what the public learned about the government’s response to the virus.

For months, Azar had clashed with a range of administration officials at the White House and within his own agencies -- battles that often spilled into public view.

The rising frustration with Azar prompted the White House to try to reassert control, installing Caputo atop HHS's communications office in a bid to exert greater influence over the department and a secretary with few remaining allies in the West Wing.

After reporters at The Wall Street Journal privately interviewed Azar and wrote a critical piece on the health secretary, Caputo provided a copy of the recorded interview to a publication that swiftly lambasted the WSJ.

When a group of White House officials discussed firing the health secretary in late April, Caputo raced to shore up Trump's support for Azar.

"Azar had one foot on a banana peel and another on a sheet of ice" before Caputo joined HHS, said one former senior Trump administration official, who credited Caputo with taking much of the heat off him.

Caputo in May hired Gordon Hensley, who served as his spokesperson when he came under scrutiny through Robert Mueller’s probe into Russian interference in the 2016 election, as a health department adviser, and in June added GOP communications consultant Natalie Baldassarre as one of his aides at HHS, after she worked at his old communications firm.

But Caputo’s moves to more closely control public health agencies under HHS’ umbrella prompted the loudest objections.

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Amid the firestorm, Caputo weighed a potential departure from HHS, consulting with Azar and other senior officials on Tuesday about the logistics of a medical leave, said four individuals close to the situation

Some White House officials began to conclude as well that Caputo had become a distraction and needed to depart — whether medical leave or otherwise

By Wednesday afternoon, the situation had become untenable, and HHS announced that Caputo was taking a 60-day medical absence