Failing the Coronavirus Test
Even with good intentions and strong institutions, it is possible to be caught flat-footed in a pandemic. To be sure, the Trump administration ignored numerous early warnings from inside and outside government, dismantled the administration’s pandemic response team, literally threw away the pandemic playbook left them by their predecessors, and defunded the position of the CDC expert who had been embedded in China specifically to look out for coronavirus outbreaks.
Still, even in the aftermath of such bad decisions, cutting some slack is warranted. Because public health is invisible when it works well, it is always on the fiscal chopping block when the memory of the most recent scare subsides. South Korea was out front during this crisis largely because the country was burned badly during the last SARS outbreak. And Australia’s conservative prime minister acted fast in large part because of his poor response to the nation’s recent wildfires.
Since there is a lag time between the onset of an infectious disease and uncontrolled community spread, especially when a disease is new and not well understood, leaders must act decisively when there is little to see. Responding this way demands the support of a public that believes in science, trusts authorities, and feels close to their fellow citizens. Americans aren’t known for their obedience to authority and social trust even in sunnier times.
However, President Trump and his team’s failings rest on what he did, and principally did not do, after receiving numerous intelligence assessments and stark warnings from epidemiologists once COVID-19 had arrived and already begun to spread. You can read the details here, here, here, here, and here. He blamed the messengers in the CDC, downplayed the potential scope of the crisis, repeatedly applauded his decision to shut down entry to the U.S. from China (even though at least forty thousand Chinese entered the U.S. after the policy was adopted), ignored the shortage of N-95 protective masks, and worried primarily about the impact of the virus on the stock market. As one White House source told The Financial Times, Trump’s son-in-law “had been arguing that testing too many people, or ordering too many ventilators, would spook the markets and so we just shouldn’t do it. That advice worked far more powerfully on him than what the scientists were saying.”
Trump downplayed the coronavirus threat in the face of mounting and alarming public evidence, let alone repeated presidential intelligence briefings. On January 21st he said “We have it totally under control. It’s one person coming in from China…It’s going to be just fine.” On February 26th Trump noted that the U.S. had fifteen cases, “and the 15 within a couple of days is going to be down to close to zero, that’s a pretty good job we’ve done.” On March 10th he observed “It will go away. Just stay calm…It’s really working out.”
After a half-hearted week or so of acknowledging the threat in mid-March, he returned to dismissing epidemiology, blaming China, touting unproven and potentially dangerous treatments, representing himself as the primary victim of the crisis, and taking victory laps as the death toll climbed, even as the death toll from the disease exceeded 100,000 Americans and the disease was not contained.
The critical issue of testing is a microcosm of President Trump’s failed approach to the coronavirus crisis. Virtually every country that has contained or crushed COVID-19—an increasingly large and diverse group of countries that includes Germany, New Zealand, South Korea, Taiwan, Slovenia, Greece, Vietnam, and Iceland—combined early diagnostic testing with contact tracing to keep down infections and to assess the extent of community spread.
The need for massive early testing, followed by contact tracing and isolating infected Americans, was recommended from the start by virtually every public health expert, regardless of his or her political leanings. The prevalence of asymptomatic and pre-symptomatic transfer in COVID-19 raised the early testing stakes significantly, since if those whom the first infected carrier contacts are not identified, it meant that anyone could be a potential carrier when the disease spread. Failing to do sufficient testing early in an outbreak thus hinders containment and forces lifesaving follow-up measures to be more drastic--in this case the shelter-in-place rules adopted by most American states.
As Senator and 2012 GOP presidential candidate Mitt Romney put it, addressing coronavirus testing czar Admiral Brett Giroir, “I understand that politicians are going to frame data in a way that is most positive politically. Of course, I don’t expect that from admirals. …You ignored the fact that South Korea accomplished their [tests] at the beginning of the outbreak, while we treaded water during February and March. I find our testing record nothing to celebrate whatsoever.”
The CDC’s initial test for COVID-19 was flawed in practice. HHS decided not to pursue the possibility of using a serviceable test developed by the World Health Organization, and it was slow to authorize the use of tests developed by state labs. Regulations were also kept in place that stopped private and university labs from stepping into the breach.
Speaking at the CDC in Atlanta on March 6th, Trump remarked that “Anybody right now and yesterday, anybody that needs a test, they’re there. And the tests are beautiful.” This was untrue, then and for many weeks to come. And even after enough test kits were procured, the federal government did not secure enough swabs and reagents needed to make them work.
Later, Trump from time to time would boast that the U.S. had done the most testing of any country in the world (this was eventually true in absolute terms, though still not even close to the top on a per capita basis). For the most part, however, his skepticism of testing for COVID-19 verged on medical nihilism. On May 14th, at a medical supply distributor in Allentown, Pennsylvania, he opined that “It could be that testing is, frankly, overrated. … When you test, you have a case. When you test, you find something is wrong with people. If we didn’t do any testing, we would have very few cases.”
In a March 13th Rose Garden press conference with technology leaders present, Trump offered a vision of nationwide, even international screening and testing:
“Google is helping to develop a website. It is going to be very quickly done, unlike websites of the past, to determine whether a test is warranted and to facilitate testing at a nearby convenient location.
“We have many, many locations behind us, by the way. We cover the — this country and a large part of the world. By the way, we’re not talking about the world right now. But we cover very — very strongly our country, stores in virtually every location. Google has 1,700 engineers working on this right now.”
Despite indignant White House denials, this scenario largely was made up out of whole cloth, from the scope of the website to the reach of the project even to the actual company involved (it was Verily, Google’s parent, and with just a handful of engineers). The process resulted in an unremarkable website, one that was not even up and running when the President was extolling it, that steered practitioners (not patients) to potential testing sites only in the Bay Area. It has since expanded its footprint but has no resemblance to the testing juggernaut that Trump envisioned.
When asked at the same press conference whether he took responsibility for not having better COVID-19 testing capabilities in place, Trump said “I take no responsibility at all.”
The U.S. leads the world in coronavirus deaths and overall cases, both by a large margin. As of this writing in mid-June, the death toll from COVID-19 is at least 117,000, and roughly 20,000 new cases are being diagnosed daily, though the positive rate of tests is falling in most states.
Any credit for slowing the spread of the coronavirus pandemic, relatively speaking, should properly go to health care responders, essential workers, Governors, a Congress that acted with relative speed, and the professionals in the administration and in the states who continue to do their jobs in the face of misinformation, ideological hostility, and personal threats. And especially the solidarity of those who sheltered in place once the virus was spreading uncontained, which is ordinarily a public health strategy of last resort.