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The Lost Month: How a Failure to Test Blinded the U.S. to Covid-19
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Aggressive screening might have helped contain the coronavirus in the United States. But technical flaws, regulatory hurdles and lapses in leadership let it spread undetected for weeks.
• Published March 28, 2020
https://www.nytimes.com/2020/03/28/us/testing-coronavirus-pandemic.html?action=click&module=Spotlight&pgtype=Homepage
as the deadly virus spread from China with ferocity across the United States between late January and early March, large-scale testing of people who might have been infected did not happen - because of technical flaws, regulatory hurdles, business-as-usual bureaucracies and lack of leadership at multiple levels, according to interviews with more than 50 current and former public health officials, administration officials, senior scientists and company executives.
The result was a lost month, when the world's richest country - armed with some of the most highly trained scientists and infectious disease specialists - squandered its best chance of containing the virus's spread. Instead, Americans were left largely blind to the scale of a looming public health catastrophe.
Since then, testing has ramped up quickly, with nearly 100 labs at hospitals and elsewhere performing it. On Friday, the health care giant Abbott said it had received emergency approval for a portable test that could detect the virus in five minutes.
Yet hospitals and clinics across the country still must deny tests to those with milder symptoms, trying to save them for the most serious cases, and they often wait a week for results. In tacit acknowledgment of the shortage, Mr. Trump asked South Korea's president on Monday to send as many test kits as possible from the 100,000 produced there daily, more than the country needs.
Public health experts reacted positively to the increased capacity. But having the ability to diagnose the disease three months after it was first disclosed by China does little to address why the United States was unable to do so sooner, when it might have helped reduce the toll of the pandemic.
"Testing is the crack that split apart the rest of the response, when it should have tied everything together," said Dr. Nahid Bhadelia, the medical director of the Special Pathogens Unit at Boston University School of Medicine.
"It seeps into every other aspect of our response, touches all of us," she said. "The delay of the testing has impacted the response across the board."
The absence of robust screening until it was "far too late" revealed failures across the government, said Dr. Thomas Frieden, the former C.D.C. 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 Food and Drug Administration, said the lapse enabled "exponential growth of cases."
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For all Mr. Azar's complaints, however, he continued to defer to the scientists at the two agencies, according to several administration officials. Mr. Azar's allies said he was told by Dr. Redfield and Dr. Fauci that the C.D.C. had the resources it needed, that there was no reason to believe the virus was spreading through the country from person to person and that it was important to test only people who met certain criteria.
But even in the face of a crescendo of complaints from doctors and health care researchers around the country, Mr. Azar failed to push those under him to do the one thing that could have helped: broader testing.
By Feb. 26, Dr. Fauci was concerned that the stalled testing had become an urgent issue that needed to be addressed. He called Brian Harrison, Mr. Azar's chief of staff, and asked him to gather the group of officials overseeing screening efforts.
Around noon on Feb. 27, Dr. Hahn, Dr. Redfield and top aides from the F.D.A. and H.H.S. dialed in to a conference call. Mr. Harrison began with an ultimatum: No one leaves until we resolve the lag in testing. We don't have answers and we need them, one senior administration official recalled him saying. Get it done.
By the end of the day, the group agreed that the F.D.A. should loosen regulations so that hospitals and independent labs could move forward quickly with their own tests.
But the evening before, Mr. Azar had been effectively removed as the leader of the task force when Mr. Trump abruptly put Mr. Pence in charge, a decision so last-minute that even the top health officials in the White House learned of it while watching the announcement.
But faced with the coronavirus, Mr. Trump chose not to have the White House lead the planning until nearly two months after it began. Mr. Obama's global health office had been disbanded a year earlier. And until Mr. Pence took charge, the task force lacked a single White House official with the power to compel action.
Since then, testing has ramped up quickly, with nearly 100 labs at hospitals and elsewhere performing it. On Friday, the health care giant Abbott said it had received emergency approval for a portable test that could detect the virus in five minutes.
Across the government, they said, three agencies responsible for detecting and combating threats like the coronavirus failed to prepare quickly enough. Even as scientists looked at China and sounded alarms, none of the agencies' directors conveyed the urgency required to spur a no-holds-barred defense.
Dr. Robert R. Redfield, 68, a former military doctor and prominent AIDS researcher who directs the C.D.C., trusted his veteran scientists to create the world's most precise test for the coronavirus and share it with state laboratories. When flaws in the test became apparent in February, he promised a quick fix, though it took weeks to settle on a solution.
The C.D.C. also tightly restricted who could get tested and was slow to conduct "community-based surveillance," a standard screening practice to detect the virus's reach. Had the United States been able to track its earliest movements and identify hidden hot spots, local quarantines might have confined the disease.
Dr. Stephen Hahn, 60, the commissioner of the Food and Drug Administration, enforced regulations that paradoxically made it tougher for hospitals, private clinics and companies to deploy diagnostic tests in an emergency. Other countries that had mobilized businesses were performing tens of thousands of tests daily, compared with fewer than 100 on average in the United States, frustrating local health officials, lawmakers and desperate Americans.
Alex M. Azar II, who led the Department of Health and Human Services, oversaw the two other agencies and coordinated the government's public health response to the pandemic. While he grew frustrated as public criticism over the testing issues intensified, he was unable to push either agency to speed up or change course.
At the start of that crucial lost month, when his government could have rallied, the president was distracted by impeachment and dismissive of the threat to the public's health or the nation's economy. By the end of the month, Mr. Trump claimed the virus was about to dissipate in the United States, saying: "It's going to disappear. One day - it's like a miracle - it will disappear."
Department of Health and Human Services Secretary Alex Azar said the government is committed to "radical transparency" in keeping the public informed about its response and preparedness planning. Messonnier, he said, was "just previewing for the American people" the strategies that health officials have in their toolbox as additional cases appear.
"Transparency is being candid with people about what the continuum of potential steps are, so they can ... start thinking about, in their own lives, what that might involve. Might. Might involve," Azar said.
"We cannot make predictions with any degree of certainty about how a virus will spread or what will happen," he added.
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