The moral of this gruesome story when it’s finally written will be “We waited too long.” Waiting too long is understandable with mass social distancing: Even though distancing works better the earlier it’s applied, it’s no small thing to shut down the world’s biggest economy. You want to know for absolute certain that that train is headed right at you and can’t be stopped before you make a move like that.
But other early preparations we could have taken weren’t so costly. The feds could have erred on the side of caution in January by scrambling to procure millions of masks and protective equipment in the event that an epidemic arrived. An order could have been placed for more ventilators. Military hospital ships could have been readied in the expectation that they’d soon be deployed.
A panicked surgeon in New York has an op-ed in the Times today titled “The Sky Is Falling.” She writes, “We need more equipment and we need it now. Specifically gloves, masks, eye protection and more ventilators. We need our technology friends to be making and testing prototypes to rig the ventilators that we do have to support more than one patient at a time. We need our labs channeling all of their efforts into combating this bug — that means vaccine research and antiviral treatment research, quickly.” We waited too long:
The USNS Mercy is likely to deploy sooner, though the Pentagon has not said where it will be sent.
“The Comfort, which is on the East Coast, should be ready in a couple weeks — plus, the Mercy, which is on the West Coast, should be ready in a week and a half, two weeks, definitely before the end of this month the Mercy will deploy,” Esper told CNN’s Jake Tapper Wednesday.
The Pentagon is donating what few masks and ventilators it currently has to hospitals, but that’s not nearly enough to meet the surge.
Ironically, just as the long, excruciating delay in widespread testing is finally beginning to ease, some doctors are reporting that they’ve hit a new snag: They can’t safely test patients with symptoms because they don’t have masks to protect themselves. There were reports a few days ago that front-line doctors and nurses across the world have been hit especially hard by the disease, probably because they’re getting more of a viral load via contact with so many patients than the average infected person does — and here we are without the means to shield them. The CDC website actually now has a page up advising medical personnel to use bandanas or headscarves as a last resort because they *might* provide some extra protection. We’re staring at an epidemic within the medical profession on top of an epidemic within the larger population.
It’s not just masks, either. There’s currently a shortage of something as basic as the swabs needed to conduct virus tests, with one San Francisco hospital warning that it’ll need to stop testing people altogether if it isn’t resupplied within five days. The U.S. military had to fly 500,000 swabs in from Italy earlier this week just to try to keep hospitals supplied for now.
This is a massive managerial failure. Even inside the White House, at this late hour, people appear not to know exactly how the chain of command is operating. Jared Kushner’s taken it upon himself to form a “shadow task force” alongside Mike Pence’s official task force and no one seems quite sure who’s in charge. “Two senior officials said some government officials have become increasingly confused as they have received emails from private industry employees on Kushner’s team and have been on conference calls with them, unsure what their exact role is in the government response.”
The core failure, though, remains the CDC’s breakdown in developing a workable diagnostic test early and the FDA’s delay in turning to commercial testing instead. The WSJ has a piece about that today that’s worth your time. It was a perfect storm of incompetence, it seems:
CDC officials botched an initial test kit developed in an agency lab, retracting many tests. They resisted calls from state officials and medical providers to broaden testing, and health officials failed to coordinate with outside companies to ensure needed test-kit supplies, such as nasal swabs and chemical reagents, would be available, according to suppliers and health officials.
When the U.S. Food and Drug Administration, also involved in the response, finally opened testing to more outside labs, a run on limited stocks of some supplies needed for the CDC-developed test quickly depleted stores, lab operators and suppliers said. Hospital and commercial lab operators said the government didn’t reach out to enlist their help until it was too late.
“This was kind of a perfect storm of three separate failures,” said Tom Frieden, who directed the CDC from 2009 to 2017, citing the botched test, overstrict FDA rules and sidelined private labs. He cautioned he didn’t have direct knowledge of details.
If you want to see what good management looks like, read Reuters on South Korea’s response to the crisis. The comparison between their country and ours is irresistible because each of us recorded our first official coronavirus cases on the same day. It’s not completely fair: Korea had to act sooner because of its proximity to China; it’s also more used to worrying about regional epidemics after the SARS and MERS outbreaks. But their bureaucracy appears to be far more nimble than ours and their early, effective initiative to test widely has largely contained new infections there.
The administration of President Donald Trump was tripped up by government rules and conventions, former officials and public health experts say. Instead of drafting the private sector early on to develop tests, as South Korea did, U.S. health officials relied, as is customary, on test kits prepared by the U.S. Centers for Disease Control and Prevention, some of which proved faulty. Then, sticking to its time-consuming vetting procedures, the U.S. Food and Drug Administration didn’t approve tests other than the CDC’s until Feb. 29, more than five weeks after discussions with outside labs had begun.
Meanwhile, in the absence of enough kits, the CDC insisted for weeks on narrow criteria for testing, recommending it only when a person had recently been to China or other hot spots or had contact with someone known to be infected. As a result, the federal government failed to screen an untold number of Americans and missed opportunities to contain the spread, clinicians and public health experts say.
South Korea prioritized getting test kits out the door ASAP, gambling that they’d be reasonably accurate and not littered with false positives. Said one cardiologist at the University of Pittsburgh of America’s comparative screw-ups, “It makes me feel like I’m living in a farce.” It’d go too far to say the feds have handled this the way a third-world government would but they obviously haven’t handled it the way a first-world government like Korea has. Maybe that’s what decadence looks like — we can still respond to crises, it just takes us much longer and costs much more in blood and treasure than it does for some of our international peers.
Speaking of third-world governments, listen to this short NPR report on secret audio of Senator Richard Burr, head of the Senate Intelligence Committee, telling businessmen at a private meeting three weeks ago that this could be a 1918-style pandemic and that they might soon have to alter their travel for safety’s sake. NPR did not find records of Burr saying stuff like this publicly at the time. Why not? Why did special interests get a heads up on this from him when the rest of us didn’t? Did he think it was better to leave us all in the dark than to risk angering Trump by contradicting his then-rosy outlook on the virus publicly?