Testing blunders crippled US response as coronavirus spread

A series of missteps at the nation's top public health agency caused a critical shortage of reliable laboratory tests for the coronavirus, hobbling the federal response as the pandemic spread across the US like wildfire, an Associated Press review found. President Donald Trump assured Americans early this month that the COVID-19 test developed by the Centers for Disease Control and Prevention is "perfect" and that "anyone who wants a test can get a test." But more than two months after the first US case of the new disease was confirmed, many people still cannot get tested.

In the critical month of February, as the virus began taking root in the US population, CDC data shows government labs processed 352 COVID-19 tests an average of only a dozen per day. "You cannot fight a fire blindfolded," Tedros Adhanom Ghebreyesus, head of the World Health Organization, said at a recent briefing. "We cannot stop this pandemic if we don't know who is infected," he said.

The Department of Health and Human Services, which includes the CDC, has begun an internal review to assess its own mistakes. But outside observers and federal health officials have pointed to four primary issues that together hampered the national response the early decision not to use the test adopted by the WHO, flaws with the more complex test developed by the CDC, government guidelines restricting who could be tested and delays in engaging the private sector to ramp up testing capacity. Combined with messaging from the White House minimizing the disease, that fuelled a lackluster response that missed chances to slow the spread of the virus, they said.

"There were many, many opportunities not to end up where we are," Dr. Ashish K. Jha, the director of the Global Health Institute at Harvard, told the AP. "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 as private labs have been cleared by government regulators to process tens of thousands of additional tests in the last two weeks, experts warn that the nation is still falling well short of enough testing capacity to keep ahead of the highly contagious virus. Trump last week rated his administration's response to the crisis as a perfect 10. However, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said the CDC's system wasn't designed to test for and track a widespread outbreak, which he characterized as "a failing." In interviews with the AP, two federal health officials with direct knowledge of the situation said CDC experts don't know why many of the agency's test kits failed to reliably detect the virus. The officials spoke on condition of anonymity because they were not authorized to speak publicly about what went wrong. J. Stephen Morrison, a health policy expert at the Center for Strategic and International Studies in Washington, called the testing issues a "debacle," contributing to what he described as a confused and delayed federal response to the crisis.

As a result, he said, the CDC has now been marginalized within the White House a worrisome development. "I don't think they anticipated the technical difficulty, or the speed with which the virus has been moving. The virus was racing out ahead of them," he said.

As they have done with some past outbreaks, officials at the CDC headquarters in Atlanta decided to develop their own test, focusing on three gene targets distinct from what the WHO used. The CDC published the technical details for its COVID-19 test on January 28, ten days after the WHO. By then, the virus had already been in the US for at least two weeks. The 35-year-old man who would become the first American to test positive had arrived in Seattle on January 15, following a trip to Wuhan. On January 30, the day WHO declared the outbreak a public health emergency, Trump again assured the American people that the virus was "very well under control." The following day, the US declared its own emergency. Still, US citizens returning from China who did not have a fever weren't tested for the virus but were encouraged to self-quarantine at home for 14 days.

At that point, the CDC had confirmed just eight cases of COVID-19 in the US. To help increase the number of people being screened, the Food and Drug Administration issued emergency authorization for CDC-certified labs run by state health departments to begin processing swabs, and they were provided with kits that could test 250 patients. As more sick people sought to be tested, many states were forced to limit access because of the flawed CDC test. Trump, for his part, continued to insist the virus would die out on its own. "One day, it's like a miracle. It will disappear," he predicted on February 27.

By then, experts say, the opportunity to halt the relentless spread of the virus within the US population had been lost. With the increased testing has come a skyrocketing number of confirmed cases, zooming from 43 at the beginning of March to 33,404 by Monday.

Jha estimates the US should be testing 100,000 to 150,000 people per day. "We certainly have the capacity. It's just we're not doing it," Jha said Thursday. "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."