[ED NOTE: Some months ago, bewildered by the amount of oncoming data and information - and its misapplications - I started putting together a coronavirus database. That can be found here. Much of the information in this piece is taken from there.]
POSTMORTEM: Too Early?
Part III
by Domingo Soto
Testing
Testing is the basic first baby step of diagnosis and treatment. As the head of the WHO warned "You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don't know who is infected...We have a simple message for all countries: test, test, test. Test every suspected case." In the US testing got off to a bad start and continues to limp along.
The manufacturing errors caused delay, and, the CDC initially restricted tests to those with respiratory symptoms, those who had traveled to China, or persons who had close contact with an infected person. By Valentine’s Day, the CDC and state labs had only tested just under 2,200 samples. South Korea - a much smaller country that had also marked its first case as beginning on January 21 - was testing around 20,000 people per day by early March and would eventually test nearly 500,000 people.
The CDC announced that it would begin screening in what it perceived to by the five high-risk cities of New York, Chicago, Los Angeles, San Francisco and Seattle. An agency official said it could provide “an early warning signal to trigger a change in our response strategy.” The plan failed, however, as most of the cities lacked the resources to carry it out.
This failure is seen by the health professionals as a critical reason for the disease’s spread. “Had we had done more testing from the very beginning and caught cases earlier, we would be in a far different place,” Dr. Jennifer Nuzzo, of Johns Hopkins, would tell the New York Times. The administration, she said, had an “incredibly limited” view of the disease’s potentiality.
The absence of robust screening until it was “far too late” revealed failures across the government, said Dr. Thomas Frieden, the former CDC director. Jennifer Nuzzo, an epidemiologist at Johns Hopkins, said the Trump administration had “incredibly limited” views of the pathogen’s potential impact. Dr. Margaret Hamburg, the former commissioner of the FDA, said the lapse enabled “exponential growth of cases.”
But no one was at the helm. Or, rather, not only was the person who was theoretically in charge not paying any real attention, he was betting against the house. Despite the repeated warnings and health alerts from the WHO, the warnings from our intelligence agencies and daily briefings, including the January 28 briefing and the President’s own February 7 taped interview with Woodward regarding the perniciousness of the disease, the administration began playing a shell game with the public. Testing, or rather, the data it would reveal, somehow perceived as a negative, was the key component of this guile.
At a campaign rally during the second week of February, Trump suggested that the virus would be gone by April, a claim he would frequently repeat. On Valentine’s Day, he would boast that "We have a very small number of people in the country, right now, with it. It’s like around 12. Many of them are getting better. Some are fully recovered already. So we’re in very good shape."
His cavalier attitude continued throughout the month. “We pretty much shut it down coming in from China,” he would say. By the end of the month, with the stock market bringing on the bears and his administration asking for emergency aid, he would tweet that the virus "is very much under control" and the stock market "starting to look very good to me!".
By February 25, Mardi Gras Day, a holiday that will become a significant spreader event, testing was still foundering and the task force was, like the blind man in the cave, trying to figure out what animal they had before them.
But the band played on. Azar would hold a press conference, maintaining that “Thanks to the president and this team’s aggressive containment efforts, the novel coronavirus is contained.” Abetting him was director of the US National Economic Council, Larry Kudlow, who would hit the news shows to assure the country that the Coronavirus would not be an economic tragedy. “I won't say airtight but pretty close to airtight."
Contemporaneously, the WHO would announce its findings; new data from China confirmed that the coronavirus had a high fatality rate and the CDC our first community transmission of the virus. Trump, however, would boast that aggressive public health containment measures and travel entry restrictions had successfully limited the spread. He touted the efforts of his team. “CDC and my Administration are doing a GREAT job of handling Coronavirus....I think that's a problem that’s going to go away… They have studied it. They know very much. In fact, we’re very close to a vaccine....The 15 (cases in the US) within a couple of days is going to be down to close to zero....We're going very substantially down, not up.” Claiming that the country was "really prepared", he places Pence in charge of the White House task force. Despite all of these details from this momentous day (and what he has admitted to Woodward), the President would continue to claim that “This is a flu. This is like a flu....It’s going to disappear. One day — it’s like a miracle — it will disappear.”
The health professionals, however, were not quite so sanguine. Dr. Nancy Messonnier, Director of the CDC’s National Center for Immunization and Respiratory Diseases, followed up on Trump’s February 25 remarks. “It’s not so much of a question of if this will happen anymore, but rather more of a question of exactly when this will happen.” She said that hospitals and schools should begin preparing for an outbreak, and that she had even spoken with her own family about “significant disruption of our lives.”
During this time, a cruise ship, some of whose passengers had become infected with the virus, were shunted around the globe. Like the passengers of Leon Uris’ novel, they were seen as a pariah. Denied entry elsewhere, the ship returned home and waited in a bureaucratic limbo off the California coast. Although he would eventually relent, the President’s considerations were not about the 2,000 trapped souls. He preferred, he said, that the passengers stay on board the ship. “I like the numbers being where they are. I don’t need to have the numbers double because of one ship."
By early March, the system finally started paying attention to testing, if with somewhat mixed results. FDA Commissioner Hahn would claim that the nation would have the capacity to test a million people by the end of the week, an assertion immediately challenged by the labs. The CDC lifted the restrictions on coronavirus testing, allowing coronavirus testing, “subject to doctor’s orders.” A short time later, the FDA authorized state-developed tests.
Trump claims that “Anybody right now, and yesterday, anybody that needs a test gets a test. They’re there. And the tests are beautiful....the tests are all perfect like the letter was perfect. The transcription was perfect. Right? This was not as perfect as that but pretty good.” He would be forced to walk that claim back.
Even with the the government’s fourth quarter rally, the crucial issue of testing continued to limp along, impeded by the President’s hostility to it. As late as April 9, his position on a widespread COVID-19 testing program to assess whether workers can safely return to their workplaces was that it was "never going to happen" even though the following day the US would mark its deadliest day and become the first country to hit 2,000 deaths in 24 hours.
Although Dr. Fauci maintains that the US should increase its testing even more, by early May, the country had reached some modicum of success with the issue of testing. He estimated that the US is conducting approximately 1.5 to 2 million Covid-19 tests per week, but noted that "testing is an important part, but it's not the only part."
As reported by the New York Post, the CDC’s Anne Schuchat’s mea culpa places the blame on a lack of testing and a delay in travel alerts for contributing to the spread of the disease. The government, she notes, was slow to react to the looming coronavirus pandemic as it spread from Europe, which led to the rocketing rates of infection and death here.
“We clearly didn’t recognize the full importations that were happening....The extensive travel from Europe, once Europe was having outbreaks, really accelerated our importations and the rapid spread...I think the timing of our travel alerts should have been earlier.”
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