David Santiago/Miami Herald via AP
Health care workers prepare a COVID-19 test sample at a testing center in Miami, July 23, 2020.
A few weeks ago, I needed to have a routine medical procedure. Before Boston’s Beth Israel Hospital would admit me, I was required to take a COVID test. I was directed to a drive-in tent in the hospital parking lot, where I stayed in the car, lowered the window, a garbed technician put a swab in my nose for a few seconds, and soon I was on my way. Eight hours later, they had the test results and I was cleared for the procedure the next day.
Last week, as I was reviewing the July 31 testimony of Brett Giroir, who is in charge of COVID testing for the Trump administration, something didn’t compute. Giroir told the House Select Subcommittee on the Coronavirus Crisis that the best that most of the country could do was to get results back in five days for about three-quarters of people tested, with some test results taking ten days or more.
A light bulb went off. How could my local hospital get tests back in a few hours while test results in much of the country take a week?
Interviews with several senior people suggest that the testing debacle is probably the most serious and underappreciated aspect of the administration’s serial failures to contain the pandemic. Trump’s pressure on states and school systems to open prematurely and his disdain for masks and other basic public-health measures are a big part of the story, of course. But testing has not gotten sufficient attention.
Only with rigorous and timely testing of much of the population can contact tracing proceed and quarantines be appropriately targeted. If tests take several days to come back, then infected people go on to infect multiple others and contact tracing is next to useless. Increased testing, ironically, is also needed to assure the economic reopening that Trump obsesses about, so that businesses, offices, schools, retail stores, restaurants, and bars can safely open without spreading infection.
Disentangling the multiple strands of what went wrong is like tracing the epidemic itself. One dimension is Trump’s distinct lack of enthusiasm for testing. His strategy in the crucial first months of the pandemic was to downplay its seriousness. If more people were tested and found positive for the virus, that would make a liar of him.
Meanwhile, Trump placed great hopes in the early discovery of a vaccine. Thus, what Trump dubbed Operation Warp Speed threw billions of dollars at commercial vaccine producers, some of which had no record of ever successfully bringing a vaccine to market.
But there is no Operation Warp Speed for testing. Trump has repeatedly disparaged testing, and in the negotiations over the latest relief bill, the Trump administration explicitly rejected any new funding for more testing.
“They’ve been able to incentivize the vaccine industry,” says Dr. Dennis Carroll. “They haven’t done that with diagnostics.” Carroll, a much-lauded scientist, was the government’s top official responsible for tracking new pandemic threats until Trump shut down his unit last year.
Seven months into the pandemic, we are all paying for these serial failures, with five million cases of COVID, expanding areas of increased infection, and over 150,000 deaths—triple the number of Americans killed in Vietnam.
As Carroll observes, a successful vaccine program and massive testing to track its success are two sides of the same coin. “Even when we have a vaccine, we will still need extensive testing,” he says.
Trump’s personal failure as president to support large-scale testing is only part of the story of his broader responsibility for this catastrophe. Another part is Trump’s long-term damage to the Centers for Disease Control and Prevention, once the crown jewel of public-health agencies.
Trump’s war on science, his appointment of CDC leaders who were either incompetent or corrupt or both, his firing of people perceived as disloyal, and his cuts in CDC funds all served to devastate a once-great public institution. “The whole scientific enterprise has been hollowed out,” says one former CDC official.
In the meantime, Trump named and then replaced a succession of officials to be the government-wide COVID coordinator—HHS Secretary Alex Azar, Vice President Pence, Tony Fauci off and on, and even first son-in-law Jared Kushner, whose testing plan simply evaporated.
How could my local hospital get tests back in a few hours while test results in much of the country take a week?
These three vectors of denial and incompetence came together last January, when the CDC, despite Trump’s nonsupport of testing, decided to create and distribute its own COVID test. The plan was for the CDC to supply tests to public-health labs all over the country, while HHS would contract with commercial lab companies, like Quest and LabCorp, to take production to scale. Because of lack of overall leadership and interagency rivalry, none of this came to pass. It would have required the full mobilization of nonprofit and commercial labs, with government coordination—something that never happened.
The CDC rushed to develop a test, which soon proved to be unreliable as well as contaminated. It shipped test kits to cities all over America, totaling only a few thousand at a time when the demand for testing was rising into the millions.
Interestingly, given Trump’s China-bashing, the CDC and other labs were able to move forward on developing a test because Chinese scientists succeeded in identifying the pathogen’s genetic sequence, and the Chinese government on January 10 shared the information worldwide.
Its prestige on the line, the CDC blocked other test development while it tried to get its own test to work. It rejected offers from European countries that had developed proven tests and taken production to scale. Because the CDC decided that it would produce all the tests, other labs in the U.S. that were developing reliable tests were denied FDA approval for their use.
Not until February 29, after the palpable failure of the CDC, did the FDA reverse course and begin granting emergency approvals to COVID tests developed at universities, hospitals, local public-health facilities, and in commercial testing companies. By then, nearly two precious months had been lost, while cases soared.
In the cities like New York where the pandemic raged out of control in March and April, the lack of sufficient testing prolonged the agony, as it does today in much of the South and Southwest.
Had the administration taken testing seriously, it would have recognized the need to expand national capacity, with nonprofits, for-profits, and public-health labs all mobilized in common purpose. But that did not happen.
In Boston, both Beth Israel Hospital, where I was treated, and Massachusetts General Hospital quickly developed high-quality COVID tests in their own labs. Both also have the capability of processing tests in-house.
Mass General Brigham (formerly Partners HealthCare), according to Dr. Anand Dighe, director of the Mass General Core testing lab, does about 75 percent of testing in-house—a total of 2,500 to 4,000 tests a day. It works around supply chain problems, according to Dighe, by devising testing platforms not reliant on materials in short supply. It also works closely with another large Boston-area nonprofit, the Broad Institute, for peak testing demands.
Beth Israel does all of its own virus testing for such diseases as HIV, hepatitis C, and ordinary flu—and now COVID. “We’ve gone from about 1,500 virus tests a year to 1,500 a day,” says Dr. Jeffrey Saffitz, the chair of pathology. “We had two technologists operating our robotic testing machines. Now we have 23 operating round the clock.”
But while a few academic medical centers like Boston are able to meet testing needs from their own labs, personnel, and ingenuity, most cities are not so fortunate. Most localities and hospitals have to outsource their testing to outfits like Quest and LabCorp (a duopoly that controls 54 percent of the $27 billion testing market in the U.S.), and these companies lack the capacity to meet peak demand. Their dominance and control of supply chains also retards innovation and collaboration elsewhere. They use only a couple of testing platforms, which increases bottlenecks.
For a national testing system to function, all of the supply chain issues need to be addressed. There has been no coordinated government strategy on this front either. Trump recently issued an executive order requiring vital pharmaceutical products to be made in the U.S. It quickly became apparent that this was nothing but a cheap anti-China gesture with no administrative plan or follow-up, and effectively meaningless.
Its prestige on the line, the CDC blocked other test development while it tried to get its own test to work.
While COVID cases are increasing in most of the country, the crucial measures for bringing the pandemic back under control—rapid-response testing, contact tracing, and appropriate quarantines—are simply not available because of the serial policy failures. According to a comprehensive July 15 McKinsey report, total U.S. testing capacity is around 3 million to 3.5 million a week—and not all of it where testing is most urgently needed—while the requirement is up to 20 million tests a day. Other experts have put the required number at 25 million a week.
During this entire period, Trump was scoffing at the extent of the pandemic, and literally declaring in tweets that he did not want more testing. “With smaller testing we would show fewer cases!” he tweeted on June 23.
In an effort to disclaim responsibility, he was also making a national crisis the responsibility of the states, which plainly lacked the resources and the capacity to fashion a national policy.
Along with a deficit of adequate testing and contact tracing is a deficit of good information. The result is a set of policies on quarantines that are either too weak or too draconian, says Dennis Carroll. “With good metrics, you don’t need to shut down the whole city. You’re taking a hammer when you need a scalpel. You can be a lot more surgical in your approach. It’s also better for the economy.”
When the CDC was thrown back on its own devices, the consequences of Trump’s war on science were palpable. “The CDC has been consistently undermined,” says Dr. Tom Frieden, who headed the CDC under President Obama. “In every previous health emergency, the CDC has been front and center.”
Consider Trump’s senior appointees. The longtime expert who was initially in charge of the CDC’s response, Nancy Messonnier, was distrusted by the Trump administration. The sister of former Deputy Attorney General Rod Rosenstein, Messonnier went ahead of the party line by warning in February to prepare for a pandemic. She was undercut and sidelined from daily briefings.
The current head of the CDC, Dr. Robert Redfield, has a sketchy history. He has worked with far-right fundamentalist organizations advocating abstinence as the best strategy for combating HIV, and promoted a palpably failed HIV vaccine. While at Walter Reed Army Medical Center, he shamelessly promoted a vaccine called VaxSyn, made by a Connecticut company, MicroGeneSys, despite its proven failure. An Army investigation let Redfield off the hook, concluding that his mistakes were innocent. But as investigative reporter Laurie Garrett found, “Redfield continued to strongly support VaxSyn, pushing Congress to fund a $20 million clinical trial on HIV-positive men.”
Redfield succeeded Trump’s first CDC director, Dr. Brenda Fitzgerald, who was forced out in January 2018 over her investment in tobacco stocks. As Georgia health commissioner, she had accepted a million-dollar gift from Coca-Cola to help fund her initiative on childhood obesity.
While COVID cases are increasing in most of the country, the crucial measures for bringing the pandemic back under control are simply not available.
This is the pattern. As serious people are disinclined to put up with Trump’s fantasies and personal corruption, he mainly finds ones with badly blemished records. They in turn make boneheaded decisions.
Because of Trump’s own disdain for testing, even competent senior officials, such as Tony Fauci and Deborah Birx, have other tightropes to walk and other battles to fight, and have largely not involved themselves in testing policy.
As the election draws closer, Trump’s hope is to keep changing the subject—to blame the Democrats for the failed negotiations on a relief bill and take credit for executive actions to fill the gap; to foment violent protests against his own incipient fascist tactics and then claim credit for being a law-and-order president; to escalate the conflict with China and play his usual card of economic nationalism.
But the one area where Trump cannot evade responsibility is the needless catastrophe of COVID, where Trump’s narcissism, his cruel lack of compassion, his science denial, his contempt for government, and appointment of incompetent officials all came together in a brew that cost America its tenuous prosperity and hundreds of thousands of lives. This stain is indelible.
