Where Are the Tests?

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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.

Read More

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

NBC, Mismanagement, missed opportunities: How the White House bungled the coronavirus response

14 thoughts on “Where Are the Tests?”

  1. There's an scene from Aliens, the second episode of the movie series where the company an who has been covering up the implications of a colony on the planet where the monsters of the first episode were discovered. In both movies, the company saw the rather durable and aggressive creatures as weapons with commercial value. 

    In this case, Trump saw no value in the virus, so he wrote it out of the script of the reality show "Trump's Second Term." For no scientific reason, Trump thought the PR threat could be managed if the US did not have a big outbreak and there is no serious outbreak if the numbers are low. Slow walk the testing, keep the numbers down and it will all go away. 

    Here's the similarity between "Aliens" and Trump's production – the moment the company man is trapped alone with one of the beasts. Big oops. That's where Trump is – the virus isn't following the script. Only in the last three days has Trump realized this is going to be a major player in the re-election chapters of the show. 

    The medical consequences of the political decisions are only starting to show. IF this monster has been breeding and doubling in the background, largely undetected because of lack of testing, the impact is potentially huge. Spain saw a jump of 1500 cases in 24 hours – they have a population 15% of the US so if that curve repeats here, we will see days where the count of infected people jumps by 10,000 in a day. We've tested about 2000 people total in 3 months.  No one knows where Spain is on the infection curve (or Italy and no one trusts numbers from China.) 

    Trump is no longer suggesting this will just "go away." That's proof to me that the Experts have convinced Trump this will get MUCH worse. If we had hard data, we might know how much worse.

     

      • Which I missed upon first scan but was unable to edit when I more tightly read the post. Sorry, accidents happen, but no option exists to clean up the mess before the spill causes a stain.

  3. The Chinese (Jack Ma) will save us. I remember a USA where we saved other countries.

    From Stephanie Ruhle's twitter feed:

    • "I don't take responsibility at all" – Donald Trump
    • Filed for bankruptcy protection over five times.

    See the pattern?

    • "I don't take responsibility at all" – Donald Trump

      Exactly. That's the story of his life.

  4. One of the most boring things on teevee news and commentary is all the sad emoting over Trump needing to act more presidential. It ain't gonna happen. Not now, not ever. Newsreaders should take a cue from those of my boyhood Chicago. Every morning newscast started with a list of assaults and murders read in a bored, matter-of-fact tone. Current newscasts should start with a listing of Trump's most recent lies read in a similar style. No further comment is needed.

    I probably just got over Covid-19 infection. It took about 40 days. I don't remember ever being sick more than about a week before in my life. At first it didn't seem likely because, while the fever and head and body aches were there, the dry cough was missing. It was a wet cough. As it turns out, though, there's not so clear a line between the two. It quickly invaded my lungs. Luckily, I had an albuterol inhaler around for seasonal allergies.

    Being something of a macho dumbass, I didn't see my doctor until almost a month went by. A mask was put on me shortly after arriving in her office. She wouldn't speculate about what I had, but asked a lot of questions and carefully noted the symptoms. There was, of course, no test available. She prescribed 5 20mg steroid tablets, 20 horse-sized antibiotic pills for fear of a bacterial infection caused by all the lung irritation, and a new albuterol inhaler. I was told some people have to go through the pill regime 3 times before it helps. Please take care and follow all the recommendations. You do not want to get this thing. Keep in mind that it's possible to shed the virus even when you think you're over the symptoms.

    I currently live in West Lafayette, Indiana, about three miles from the Purdue University campus. Until a few days ago there were always students and faculty traveling to and from all points on the globe. If you live in a similar place, it might be worth driving to a less densely populated area when you have to shop. It's very annoying that it's impossible to be 100% sure it was Covid-19. I'll have to go out for groceries in 5 or 6 days.

     

    • My wife, who's a little older than me, also showed some symptoms. She had a slight cough for a few days and that was it. We don't know who had it first. We really didn't do anything different than the other. Assuming I actually had it, it is possible to get the virus without having serious symptoms.

       

      • The most common symptom is fever, we're being told, so if there was no fever it was probably some common respiratory infection. Or allergies. My sinuses have been haywire lately, but otherwise I feel fine. I'm sure it's allergies.

        • If you don't have fever and aches it's probably not the virus. I just heard a doctor on MSNBC say it's not known that having the virus gives immunity to another dose.

          It is possible my wife didn't catch it. We were very careful.

           

        • I apologize for being a little flustered here. TV actually seems to be a better source than anything I can find on the web right now, and I've been watching compulsively.

          After seeing several doctors describe symptoms, particularly one who has tested positive and is doing a vlog, I'm convinced I did have the virus. The vlogger's symptoms were exactly like mine.

          I read a few days ago that some parts of the country have higher than normal tree pollen counts. If you have a problem with that type of pollen it could explain your symptoms. My allergies are to weeds, especially during fall.

          After thinking it over more, I don't think I can draw any conclusions about my wife's symptoms. She was with two large groups of women in the days before I got sick and could have picked up a cold. She doesn't have allergies that would apply.

          It's encouraging that the treatment I described above worked. We should know more once testing picks up.

           

  5. Being a lifelong imbecile, tRUMPleTHINSKIN has always hated the word "test."

    At the very mention of the word, his pea-sized balls recede so far inside him, they're probably up by his ears!  Lord knows there's plenty of space  between them!!!

    I would compare this maladministratiom to the Keystone Kops, but on top of the tRUMPniks not being at all funny, the major difference is that the Keystone Kops jumped to the job when they heard they were needed.  The result is the same though, complete ineptitude – minus the laughs.

    Maybe when tRUMP talked at his inauguration about "American carnage" we should have known that he was warning us about our future after a few years of his presiDUNCING!

    Can you imagine the devastation if he's reelected?

    If there was a Jesus, he'd be weeping.  Copiously.

    But he'd also say, as you reaped, so you are now sowing.

    If he's  reelected, America will fully deserve what it gets.

  6. "The Trump presidency is over".  I am saying my prayers.  For me, it would be poetic justice is something as tiny (microscopic) as covid-19 would bring him down.  Considering that Trump tested negative, perhaps the virus is hiding in his "pea-sized balls" that have traveled up to his brain which is also pea-sized. 

    Although I don't like the idea that most people will get the virus, if that is  true, it would give humans what they call herd immunity and perhaps the virus will just go into hiding.  I  don't know, I just know that viruses are weird and I still think it may be an invasion of the aliens who want to mess around with humans. 

    Please don't send the guys with the white coats after me, any institution is not ready to deal with me.  Besides, I am self-isolating and no danger to anyone.

     

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