2020-03-24 13:26:511 Oct 2018 01:53 AM EST
By Laura Tucker, Staff writer; Image: Donald Trump Visits the CDC (Image source: Public domain)
Anyone looking for answers on what happened with coronavirus COVID-19 that caused us to get to this point only needs to look at two factors: the Centers for Disease Control and Prevention and Donald Trump. One denied there was a problem for far too long, and the other made a series of missteps that overlooked certain factors and was not able to meet the testing demand.
Early in March, the president assured the public that the test that the CDC developed for COVID-19 was "perfect" and promised that "anyone who wants a test can get a test." However, weeks later, and two months after the first case was confirmed in the U.S., there are still many people who can't get tested
With just a handful a positive cases in January, the next month, CDC data shows that the government's labs only processed 352 tests total, an average of just 12 tests per day, according to the Associated Press.
"You cannot fight a fire blindfolded," said World Health Organization head Tedros Adhanom Ghebreyesus. "We cannot stop this pandemic if we don't know who is infected."
The Department of Health and Human Services, of which the CDC is a division, has started an internal review to assess what happened. Outsiders and federal health officials point fingers at the early decision not to use a World Health Organization test, flaws with the CDC test, government guidelines of who could be tested, and delays in allowing the private sector to participate in testing. Another component was the messaging that Trump was responsible for that was behind some decisions.
The WHO was alerted on New Year's Eve by Chinese scientists who informed them of a cluster of pneumonia cases that had no known causes in Wuhan. These 27 cases were linked to the wholesale fish market. Within two weeks, the Chinese determined the genetic makeup of the virus and shared it publicly.
Just a few days later, German scientists developed a test that could identify a unique part of the DNA in the virus. The WHO adopted this test and published the guidelines for it on January 17. They worked with private companies to produce testing kits. But the CDC decided to develop its own test based on three gene targets that were not the same as what the WHO used.
The CDC published the COVID-19 test details on January 28, but the virus had already been in the United States for at least two weeks after a 35-year-old man had frown from Wuhan to Seattle on January 15. Federal officials announced he was positive on January 21.
Trump was asked about the risk to the U.S. the following day and said it was under control and limited to just the one sick man. The CDC, because of limited capacity at its lab, decided testees needed to have fevers, coughing, or difficulty breathing and had to have visited Wuhan two weeks prior or close contact with someone who already had the virus or was thought to possibly have it.
By January 30, the WHO declared a public health emergency, but Trump told the American public that it was under control. He followed this by running off to his Mar-a-Lago resort in Florida, tweeting a photo of himself golfing.
The next day the U.S. declared an emergency. U.S. citizens returning from China who didn't have a fever weren't tested but were told they should self-quarantine for two weeks. The CDC had confirmed just eight cases of COVID-19 at this point but amended the testing group to those who had fevers and who had traveled from China, not just Wuhan.
Only 178 patients had been tested four days later, and 82 others were waiting for their results. The Food and Drug Administration issued emergency authorization for CDC-certified labs that were run by the state to start processing swabs and provided them with kits to test 250 patients.
Technicians were reporting inconclusive results with the first tests that were processed. The CDC said that could be due to the test looking for signs of generic coronaviruses instead of COVID-19 specifically. Only around a half-dozen state and local public health labs had reliable tests by mid-February.
CDC Director Dr. Robert Redfield insisted still that the agency had developed "a very accurate test" and didn't consider it to be their fault that the test didn't initially work. "I consider that doing quality control. I consider that success," he said.
The CDC widened it's testing criteria to now include people who were "severely ill" with COVID-19 symptoms "even if a known source of exposure has not been identified." But this was just when the test problems began. With more people qualifying to be tested, states were being forced to limit access because of the CDC test that was flawed.
Association of Public Health Laboratories officials sent a letter fo the FDA on February 24 that basically requested permission for state labs to develop tests, leading to the organization reversing a previous position and allowing public and private labs to conduct testing.
Trump was still downplaying the virus. He insisted three days later, "One day, it's like a miracle. It will disappear." Experts claim by that point opportunity to stop the spread of COVID-19 in the U.Sl had already been lost.
Two days later, there were only 22 confirmed cases out of 472 patients who had been tested. Nine of those confirmed cases weren't related to travel and had spread person to person in the country.
Comparatively. South Korea had its first confirmed case on January 20. They used a test that was similar to the WHO's and allowed private labs to run the sample. Despite being smaller than the U.S., with only one-sixth the number of people, South Korea had tested more than 20,000 in one day. They also used drive-thru centers, which allowed those who were infected and not showing symptoms to be IDed more quickly, which made the number of infections increase rapidly.
The FDA announced it would allow private labs to produce new tests without requiring preauthorization from regulators. Trump and HHS Secretary Alex Azar went to a CDC lab and promised 4 million test kits would be available by the end of the next week. Labs didn't process tests that quickly, however, only doing 25,200 in the next seven days.
Trump also wanted a cruise ship that possibly had infected crew members and passengers to remain off the West coast instead of docking in California so that he could keep the number of coronavirus cases low. "I don't need to have the numbers double because of one ship that wasn't our fault," he said, heading off to another golfing weekend.
He refused to accept blame for anything and blamed the administration trouble on the Obama administration. However, in 2018 Trump had dismissed a group whose job it was to prepare for and respond to global pandemics.
He and other officials also heaped blame on the WHO, saying its test wasn't reliable. However, the agency had no trouble with testing in any other country
With private companies being allowed to join in, testing in the U.S. has experienced a surge. This led the number of confirmed U.S. cases to raise dramatically from 43 at the beginning of the month to more than 33,000 by Monday. Only in the past few days has testing exceeded what was done in South Korea.
"There were many, many opportunities not to end up where we are," said Jha. "Basically, they took this as business as usual. ... And that's because the messaging from the White House was 'this is not a big deal, this is no worse than the flu.' So that message basically created no sense of urgency within the FDA or the CDC to fix it."
Even now that the problems have been discovered and private labs are being allowed to participate, testing capacity is still falling short and not able to keep up with the demand. It can take a week to get test results.
Yet, Trump rated his administration's response to be a perfect ten last week. The director of the National Institute of Allergy and Infection Diseases, Dr. Anthony Fauci, said the CDC's system wasn't designed to test for and track a pandemic.
Dr. Ashish K. Jha, the director of the Global Health Institute at Harvard, says the U.S. should be testing 100,000 to 150,000 people per day. "We certainly have the capacity. It's just we're not doing it," he said. "We are up to about 40,000 tests per day now — and so we are moving in the right direction. Still far from where we need to be, but moving."
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