In his capacity as Virus Czar, VP Mike Pence on several recent occasions has promised us “millions” of coronavirus tests. For example:
TUESDAY, March 10, 2020 (HealthDay News) — Millions of much-needed testing kits for COVID-19 are on the way to clinics and labs nationwide, Vice President Mike Pence told reporters during a White House briefing Monday evening.
Pence heads the Trump Administration’s coronavirus task force. He said the group reached out to governors from 47 states on Monday, and was “able to confirm with them that testing is now available in all state labs in every state in the country.”
“Over a million tests have been distributed,” Pence said, and “before the end of this week, another 4 million tests will be distributed.” Pence said. He added that, “with the deployment of the commercial labs we literally are going to see a dramatic increase in the availability of testing.”
Furthermore, major medical testing companies such as LabCorp and Quest have also “brought a test forward and are taking that to market effective today,” Pence said.
If you look at the number of tests actually conducted, however, one suspects the promised tests are lost in shipping. According to the CDC, from March 10 (the date on the news story above) to March 12, the last day for which there is data, only 23‡ people were tested using the CDC test.
Since private lab tests have become available, somewhat more testing has been done, as you can see on this graph from the CDC website:
The blue bars are CDC tests conducted; the orange bars are private lab tests conducted. On the best day, March 9, we see there were ‡2,000 tests. This is still frustratingly slow, however, especially compared to several other, mostly smaller, countries. (For more updated data on the U.S., see the Covid Tracking Project.)
Before going any further, let us review the first and primary reason why the U.S. fell so far behind.
On Saturday Jan. 11 — a month and a half before the first Covid-19 case not linked to travel was diagnosed in the United States — Chinese scientists posted the genome of the mysterious new virus, and within a week virologists in Berlin had produced the first diagnostic test for the disease.
Soon after, researchers in other nations rolled out their own tests, too, sometimes with different genetic targets. By the end of February, the World Health Organization had shipped tests to nearly 60 countries.
The United States was not among them.
Why the United States declined to use the WHO test, even temporarily as a bridge until the Centers for Disease Control and Prevention could produce its own test, remains a perplexing question and the key to the Trump administration’s failure to provide enough tests to identify the coronavirus infections before they could be passed on, according to POLITICO interviews with dozens of viral-disease experts, former officials and some officials within the administration’s health agencies.
There has yet to be an explanation as to why the U.S. refused the WHO tests, but I’m betting it’s a combination of wingnut ideology — the United Nations is evil, you know — and belief that if there’s a crisis going on, someone ought to be making some money from it. Even so, the administration caused long and pointless delays in producing the private lab tests, which I’ll explain in a bit.
The Atlantic has been doing some outstanding reporting and commentary about Trump’s blumbling response to the pandemic. We’ve gotten better information on how many Americans are (not) being tested from Atlantic than anywhere else, for example. See especially What You Need to Know About the Coronavirus and The Dangerous Delays in U.S. Coronavirus Testing Haven’t Stopped.
It may be premature to declare, as one Atlantic writer did, that The Trump Presidency Is Over. But there is useful information in The 4 Key Reasons the U.S. Is So Behind on Coronavirus Testing.
The first of the Atlantic’s four reasons for testing delays is red tape. But it seems the red tape has gotten worse under Trump than it was for previous presidents. In past epidemics, the Food and Drug Administration moved quickly to give many labs around the country the authorization to begin testing for the contagion. Trump’s FDA didn’t do that. Even labs that had independently developed working tests were not given clearance by the FDA to go ahead and begin testing. So they sat on their working tests and did nothing. And the logjam didn’t budge until a group of top scientists petitioned Congress, and the next day the FDA allowed testing to begin. But weeks had been lost.
My understanding is that fairly early during the crisis the CDC had contracted with just a couple of companies, LabCorp and Quest, to produce tests. But I’m not getting a clear picture from news stories what went on with LabCorp and Quest. The more recent tests seem to be coming from a lot of places.
The second reason test development has been delayed is that it has been difficult for labs around the country to get samples of the new virus. And, of course, the government couldn’t be bothered to expedite that.
The third reason is an issue with equipment, which ties into our lack of a national health care system. The tests that have been developed so far are called “lab-developed” tests. Apparently this is a specific thing that requires specific equipment that most medical labs don’t have. Most labs are equipped to run something called a “sample-to-answer” test.
As late as this week, several lab directors told me that no sample-to-answer versions of the coronavirus test had been approved in the U.S. “That means that the vast majority of clinical labs in this country will not be able to do in-house testing at this time,” says Susan Butler Wu, an associate professor of clinical pathology at the University of Southern California.
The U.S. health-care system is broken up into state and county public-health laboratories, which have different equipment than academic research institutions, which have different equipment than hospitals that diagnose patients. So the same test won’t necessarily work in different places. “We don’t have a nationalized health-care system where you put the same equipment in all the hospitals,” Wu says. “We have all these independent hospital systems with their own equipment in their own labs.”
And the fourth reason is “leadership and coordination problems.” Ya think?
Going back to the inactive FDA that wouldn’t allow labs to procede with testing until prodded, one gets the impression that everyone in the Trump administration, top down, is afraid to breathe without permission from Dear Leader. They don’t even exercise their own authority. And with no leadership coming from Trump, the various department heads have to work on their own initiative to coordinate their activities. But they don’t. Instead, the Atlantic says, there’s nothing but in-fighting and back stabbing.
Containing a new infectious disease requires a lot of close collaboration between the president, the CDC, the FDA, and other parts of the Department of Health and Human Services, several Obama-era health officials told me. “One reason we were able to move quickly [during the Ebola outbreak] was that there was a great deal of coordination and issue spotting and troubleshooting that went on,” Hamburg, the former FDA commissioner, told me.
Trump’s people don’t do coordination. They don’t issue-spot or troubleshoot. They just blame each other for the screwups.
At WaPo, Paul Waldman lists Nine reasons Trump is uniquely incapable of managing crises — including this one. It’s a legitimate list, but I think it leaves out the one, over-arching reason, which is that Trump has no experience whatsoever working within a complex, hierarchical organization. That’s one of the reasons he has no appreciation for coordination. Time and time again, for example, he’ll kick off some major change in policy without notifying key allies or stakeholders or the agencies that will have to carry it out. He did it this week with the Europe travel restrictions; neither airlines nor European allies were notified before the announcement was made.
In the kind of close family business he’s always run you can get away with that. In any large and complex organization with many interacting parts, you can’t. This is what I’ve seen in Trump over and over again — a guy who has never had a real job and has no clue how organizations function. And he is utterly disinterested in learning.
Reporting has also hinted that even people who tried to alert Trump that the coronavirus could be a serious issue didn’t give him the whole picture of how bad it could get.
In the case of Alex Azar, he did go to the president in January. He did push past resistance from the president’s political aides to warn the president the new coronavirus could be a major problem. There were aides around Trump – Kellyanne Conway had some skepticism at times that this was something that needed to be a presidential priority.
But at the same time, Secretary Azar has not always given the president the worst-case scenario of what could happen. My understanding is he did not push to do aggressive additional testing in recent weeks, and that’s partly because more testing might have led to more cases being discovered of coronavirus outbreak, and the president had made clear – the lower the numbers on coronavirus, the better for the president, the better for his potential reelection this fall.
I am betting no one in the administration has the courage to bring Trump really bad news that he doesn’t want to hear and face his famous temper.
Combine that with Waldman’s nine factors of Trump’s incompetence — such as his inability to plan ahead — and you’ve got a government that can barely organize a picnic, never mind respond to a complex crisis.
German Lopez, Vox, The Trump administration’s botched coronavirus response, explained
Derek Thompson, The Atlantic, America Is Acting Like a Failed State
Maria Cardona, The Hill, Coronavirus exposes Trump’s greatest weaknesses
Carolyn Y. Johnson and William Wan, Washington Post, Trump is breaking every rule in the CDC’s 450-page playbook for health crisis