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Medicine United States

NYT Investigates America's 'Lost Month' for Coronavirus Testing (msn.com) 412

The New York Times interviewed over 50 current and former U.S. health officials, senior scientists, company executives, and administration officials to investigate America's "lost month" without widespread coronavirus testing, "when the world's richest country — armed with some of the most highly trained scientists and infectious disease specialists — squandered its best chance of containing the virus's spread." With capacity so limited, the Center for Disease Control's criteria for who was tested remained extremely narrow for weeks to come: only people who had recently traveled to China or had been in contact with someone who had the virus. The lack of tests in the states also meant local public health officials could not use another essential epidemiological tool: surveillance testing. To see where the virus might be hiding, nasal swab samples from people screened for the common flu would also be checked for the coronavirus...

Even though researchers around the country quickly began creating tests that could diagnose Covid-19, many said they were hindered by the Food and Drug Administration's approval process. The new tests sat unused at labs around the country. Stanford was one of them. Researchers at the world-renowned university had a working test by February, based on protocols published by the World Health Organization.... By early March, after federal officials finally announced changes to expand testing, it was too late. With the early lapses, containment was no longer an option. The tool kit of epidemiology would shift — lockdowns, social disruption, intensive medical treatment — in hopes of mitigating the harm.

Now, the United States has more than 100,000 coronavirus cases, the most of any country in the world... And still, many Americans sickened by the virus cannot get tested... In tacit acknowledgment of the shortage, Mr. Trump asked South Korea's president on Monday to send as many test kits as possible from the 100,000 produced there daily, more than the country needs. Public health experts reacted positively to the increased capacity. But having the ability to diagnose the disease three months after it was first disclosed by China does little to address why the United States was unable to do so sooner, when it might have helped reduce the toll of the pandemic.

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NYT Investigates America's 'Lost Month' for Coronavirus Testing

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  • "Lost month"? (Score:5, Insightful)

    by Mr. Dollar Ton ( 5495648 ) on Sunday March 29, 2020 @12:45AM (#59883696)

    Isn't that more like lost three months? It was already clear in January that sars-cov-2 is going to be a 'uge problem, and yet it was talked down until it is so widespread that no other measure but the availability of a working mass vaccine and a cheap and easy to produce treatment will make a difference.

    We got ourselves into the current situation because of complacency, submission to myopic pressure from the "business" to do nothing and the desire of the political elite to not disturb the inflated stock market.

    And we ignored the basic truth that preparation and prevention is much cheaper than a panic search for a "cure".

    • Re: (Score:3, Interesting)

      Our military defenses may be second to none, but our healthcare defenses are on par with third world countries. (If you don't have healthcare coverage and are sick, coronavirus will mean almost certain death.)
      • Re:"Lost month"? (Score:5, Insightful)

        by Mr. Dollar Ton ( 5495648 ) on Sunday March 29, 2020 @12:57AM (#59883716)

        but our healthcare defenses are on par with third world countries.

        I don't know the US system well, so I cannot say much about that, but it isn't only the US that screwed up. The European Union got itself into the same mess as well.

        It is a political failure because of messed up priorities.

        If you don't have healthcare coverage and are sick, coronavirus will mean almost certain death.

        I sincerely hope US can do better than that in emergency.

        • Re: (Score:2, Informative)

          by whoever57 ( 658626 )

          I sincerely hope US can do better than that in emergency.

          https://nypost.com/2020/03/28/... [nypost.com]

          Thoughts and prayers only go so far.

          • It is horrible - but you should send that link to your leadership, not to me. I think universal coverage backed by the state is a necessity.
        • Re: (Score:3, Insightful)

          by DeBaas ( 470886 )

          I don't know the US system well, so I cannot say much about that, but it isn't only the US that screwed up. The European Union got itself into the same mess as well.

          I'll stay out of the US politics part of this, but if we should learn one thing is that Europe can no longer take it's cues from the US. The European leaders acted like teenagers looking at each other to see who will first dare to really act. In the past we could rely on the US to act first. Europe has to grow up.

          • Re:"Lost month"? (Score:5, Insightful)

            by Opportunist ( 166417 ) on Sunday March 29, 2020 @06:07AM (#59884152)

            Europe is, but it tries not to show it.

            The US is a bit like the schoolyard bully of international politics. Strong, but not the brightest bulb in the chandelier. Everyone knows it, but nobody really wants to say it because the bully isn't just strong and dumb but also quite sensitive about being told that he's not only dumb but actually universally hated. So the other kids suck up to him because every time he beats someone up for his lunch money, some of the pennies drop to the ground and whoever pretends to be his buddy gets to pick those up himself.

            And if you declare that you think he's a dimwit and and asshole, you might be the next being beaten up and out of your lunch money.

        • Re:"Lost month"? (Score:5, Informative)

          by AmiMoJo ( 196126 ) on Sunday March 29, 2020 @05:30AM (#59884084) Homepage Journal

          The EU is doing well at coordinating responses and running the joint procurement programme for ventilators.

          But you have to remember that the EU is not a government, it can't order member states to do things and has limited power.

          • Re:"Lost month"? (Score:5, Insightful)

            by makomk ( 752139 ) on Sunday March 29, 2020 @08:59AM (#59884484) Journal

            Key EU manufacturing states like Germany blocked export of vital protective equipment like masks to workers in other EU countries like Italy that desperately needed them, and basically had to be shamed into giving by the fact that China was selling Italy the equipment their fellow EU countries wouldn't. This frankly seems like it could be an existential threat to the EU - one of its most fundamental purposes is to end protectionism and ensure free trade amongst its members, and a bunch of countries just discovered that not only did this cause financial and economic problems, after hollowing out their local industries and leaving their governments unable to protect it, that free trade disappeared and left their healthcare workers without protection in the middle of the worst pandemic in a century.

        • Re:"Lost month"? (Score:5, Interesting)

          by thegarbz ( 1787294 ) on Sunday March 29, 2020 @06:35AM (#59884220)

          The European Union got itself into the same mess as well.

          Yes true, but for different reasons. In the free market you screw yourself through your own incompetence. In socialised medicine you screw yourself through government policy.

          The defense of both systems hasn't born out the positives. In the free market testing is supposed to be better because anyone can just go and get it done. In socialised healthcare it's supposed to be better because testing is free and not just reserved to those who can pay. In reality the free market had no test kits regardless if you had money or not, and the social system didn't care because of government policy not to care. /Disclosure: I ran a 38.5 fever, bad cough, headache, you know all the symptoms about a week after returning from a massive Spanish festival and the doctor said get some bed rest, I'll get tested for Covid-19 only if I develop pneumonia and end up in hospital. Did I have it? I'll never know.

      • I would say it's clearly much worse than 3rd world countries. Politicians are unwilling to order lockdowns and the people are unwilling to self-isolate because "muh freedom".
        • it's the GDP and Stocks. And taxes.

          In order to do long term lock downs we'd have to accept about 20-30% of the population going on a 3-6 month paid vacation. There's just no other way around it.

          No way in hell are Americans going to tolerate that. We've been hearing about welfare queens eating steak and lobster since the late 70s. That image resonates something fierce.

          Moreover, the ruling class do not want to let the cat out of the bag that we could, in fact, all work a hell of a lot less if we w
      • Comment removed based on user account deletion
        • Re:"Lost month"? (Score:5, Informative)

          by Mr. Dollar Ton ( 5495648 ) on Sunday March 29, 2020 @01:20AM (#59883772)

          The fact is, nobody prepares adequately for events...

          That is not a fact. Japan, Korea, Taiwan, Singapore showed preparedness. Also, a flu-like pandemic is hardly something that happens "once in a century", we've had 5 or 6 in this century alone.

          Iceland's sample of 12% of their population indicates that half of all carriers get no symptoms at all.

          Which means they are not "sick" - as in requiring hospital care, which is how I understood OP's comment. Now, I don't know if their conclusion is correct, I believe that in the face of a crisis US will manage her public and private resources adequately to provide for all who need help, but your counterpoint is not really valid.

          • but if anything that 50% is scary. If half of all carriers are asymptomatic they can and will be out there spreading it willy-nilly.

            If we all just go back to normal then it looks like 70% of the country gets it.

            That means 35% get sick. 115 million

            Of that 20% need hospitalization. 23 million.

            We don't have enough beds let alone ventilators. I wouldn't be surprised if we didn't see 15 million dead and 7 or 8 with severe permanent lung damage.
      • Re:"Lost month"? (Score:4, Insightful)

        by 93 Escort Wagon ( 326346 ) on Sunday March 29, 2020 @01:46AM (#59883830)

        If you don't have healthcare coverage and are sick, coronavirus will mean almost certain death.

        You realize this isn’t Ebola or Marburg... right?

      • by HiThere ( 15173 )

        That's gross exaggeration. Most COVID-19 cases are quite mild. The figures are wildly uncertain, but I think it's safe to assert that fewer than 10% of the cases are serious and require more than minimal treatment (i.e., can be treated by keeping warm and hydrated).

        Of course, there's a large fraction of the US population that *can't* keep themselves warm and hydrated.

    • You act as if people talking was the reason why things took so long to happen here in the States. The New York Times discovered otherwise.

    • Re:"Lost month"? (Score:5, Informative)

      by Idimmu Xul ( 204345 ) on Sunday March 29, 2020 @05:48AM (#59884114) Homepage Journal

      USA had it's first COVID case January 10th 2020 I think. This is stupidity from the top down.

    • Re:"Lost month"? (Score:4, Informative)

      by hey! ( 33014 ) on Sunday March 29, 2020 @09:14AM (#59884532) Homepage Journal

      Sure, there's been a pattern of doing things too late in the US, but we're talking specifically about testing. It makes sense to compare our response to South Korea; the first detected cases were reported there at almost the same time as the US.

      Based on that, I think you can argue that we're at least three weeks behind Korea in testing, more probably four. We were three weeks later in approving a working test. After that our complicated federal/state/local government system introduced at least two of weeks of delay as 50 independent state governments scrambled to find test kits and supplies.

      This showed up in the numbers states reported. By the middle of this month New York and Washington were the first states to hit 1000 tests/day, and were also the first states to report over a thousand cases. Texas, on the other hand, was struggling to process 250 test per day and was reporting 1/8 the number of cases that Washington State had.

      Even today Texas, with roughly half the population of South Korea, is still struggling to reach that 1000 tests per day *processed* benchmark, although it's *administering* more tests than that, generating a backlog. The state is turning to local public health agencies to do testing, and as those programs come on line we're seeing dramatic spikes in numbers. Houston went from 69 to 232 when it started testing, and would probably find more if there weren't a shortage of protective gear.

      If you lose three weeks it's no longer meaningful to compare the situation at four weeks. Korea was fast enough to *contain* the virus. In the US we're doing mitigation. We're both flattening the curve, but Korea is minimizing the area under that curve.

  • by rsilvergun ( 571051 ) on Sunday March 29, 2020 @01:02AM (#59883730)
    Our entire economy, including our healthcare system, is built on "Just in Time" business models pioneered by Walmart in the 90s.

    The idea is to have the bare minimum amount of capacity on hand to meet demand at any given time. This saves billions because you have fewer employees, few resources (in this case hospital beds, ventilators and testing gear) and less space devoted to them. All of that costs money, and the savings from not having them is real.

    It has been repeatedly shown the savings are greater than the lost sales due to occasionally not meeting demand.

    Problems arise here because "not meeting demand" for a hospital doesn't mean "has to settle for the store brand snack cake" it means death. Lots and lots of death.

    I'd like to say that, after the dust settles, that we'll fix out healthcare system. But I don't see that happening. The last serious attempt to fix the system, the Affordable Care Act, was thoroughly gutted thanks to a half trillion dollar ad campaign from the healthcare industry (and that just what we knew they spent, it doesn't include dark money).

    Again, the savings are real. So are the death panels.
    • Running your country like a business is the problem. The government by definition has to take care of the cases where the market fails, and healthcare is one obvious such case.
    • by bidule ( 173941 )

      I don't want to disagree with you, but it's impossible to "meet demand" for a once-every-10-years event. If it was possible, there'd be no flood.

      At best, we can build reserve space and fill it with elective cases. And have protocols to efficiently ramp up as needed.

      • by edis ( 266347 ) on Sunday March 29, 2020 @02:47AM (#59883898) Journal

        This one is much bigger, than once-in-10-years. It is about once per generation. Which makes it hard to memorize for the next one on the level of general knowledge or preparedness. Still, scholars do have these cases in their books, and get basic techniques of handling.

        Now, would building and maintaining reserve for a scale like this make sense at all? Perhaps not. Because the current state of urgent agile mobilization is what can focus all resource available on particular genome, particular response. Just in Time is proper once again.

        Quite many countries, nearly all, have internal doubts of "where have we been wrong before", "why now is too late", I would however attribute that to the overwhelming nature of the core issue. It is out of momentary control, can be addressed by restless practicing of the countermeasures:

        - control at the perimeter of spots
        - early lockdown, when entering issue
        - hardest lockdown possible, social distancing at its ultimate
        - protective gear
        - investigation of each case, contacts
        - tracking moves of the carrier, sick
        - quarantine for anybody suspect or entering perimeter
        - care for those in need of
        - isolation of the sick

        At the moment, there are still quite some developed countries, which do not flip the switch to complete workout, yours is not the last one, don't feel like that. It is dangerous flirting for the sake of not disrupting business-as-usual, while expected costs for such take can be extremely dear, too.

        • by AmiMoJo ( 196126 ) on Sunday March 29, 2020 @05:16AM (#59884056) Homepage Journal

          Here's an interesting research paper on the number of ICU beds available in various European countries: https://www.researchgate.net/p... [researchgate.net]

          Note that Germany is far and away the leader, which is how Germany is now able to offer ICU beds to patients from other European countries. I have to say, whenever there is a crisis in Europe Germany always steps up. Thanks Germany, I wish we could be more like you.

          Anyway, if you scroll down a bit the paper goes into detail as to why Germany has so many ICU beds. Compare with France. Germany actually spends a little less of its GDP on health than France does, and has a larger proportion of the population over the age of 65.

          Ultimately the paper concludes that it's not GDP or spending or the nature of the population that matters, it's the nature of the healthcare system. Germany's system delivers a lot of ICU beds.

    • And next time it might not be ventilators that we need, it might be CT scanners and gauze bandages.
    • "Just in Time" business models pioneered by Walmart in the 90s.

      No, that would be Toyota in the 1960s.

    • by hwihyw ( 4763935 )

      And one of the reasons for the spread of "Just in Time" business models is price gouging laws. If a supplier stockpiles bunch of N95 masks for a pandemic and the pandemic never comes, he has to throw out expired masks and lose money. If the pandemic does come, due to price gouging laws he can't raise the price of each mask to compensate him for the risk that he took to store them. So the supplier never stockpiles, and here we are.

      https://en.wikipedia.org/wiki/... [wikipedia.org]

  • by Anonymous Coward on Sunday March 29, 2020 @01:12AM (#59883750)

    But having the ability to diagnose the disease three months after it was first disclosed by China does little to address why the United States was unable to do so sooner, when it might have helped reduce the toll of the pandemic.

    Really? You don't know why? The rest of the planet already knows the answer: it's Trump's fault. That guy is a bad businessman at best, he should never have been elected and now you reap the rewards of electing an ignorant pompous asshole to lead your country.

    • Re: (Score:2, Informative)

      by Anonymous Coward

      Lest people forgets, emphasis mine.

      January 22: “We have it totally under control. It’s one person coming in from China. It’s going to be just fine.”

      February 2: “We pretty much shut it down coming in from China.”

      February 24: “The Coronavirus is very much under control in the USA Stock Market starting to look very good to me!”

      February 25: “CDC and my Administration are doing a GREAT job of handling Coronavirus.

      February 25: “I think that's a pr

  • Timeline (Score:5, Insightful)

    by phantomfive ( 622387 ) on Sunday March 29, 2020 @01:29AM (#59883792) Journal
    They got the gene sequence from the Chinese, so good job on that part, China. Quoting from the article:

    By Jan. 20, just two weeks after Chinese scientists shared the genetic sequence of the virus, the C.D.C. had developed its own test, as usual, and deployed it to detect the country’s first coronavirus case.

    But there were problems and they had to debug it.

    soon after the F.D.A. cleared the C.D.C. to share its test kits with state health department labs, some discovered a problem....While the C.D.C. explored the cause — contamination or a design issue — it told those state labs to stop testing.

    There was a test designed in Germany, but

    the German-designed W.H.O. test had not been through the American regulatory approval process, which would take time.

    They figured out a way to hack the 'broken' tests to work well enough

    [~Feb 26 the CDC] provided a workaround, telling state and local health department labs that they could finally begin testing.

    Stanford built their own test, based on the German design, but FDA rules didn't allow it to be used until they changed the rules:

    Researchers at the world-renowned university had a working test by February...but the Stanford clinical lab would not begin testing coronavirus samples until early March, when [the FDA] finally relaxed the rules.

    The article implies that Pence helped testing get done faster, but doesn't outright say it (I'll just quote it here so you can read it, because I'm not exactly sure what it's saying)

    until Mr. Pence took charge, the task force lacked a single White House official with the power to compel action. Since then, testing has ramped up quickly, with nearly 100 labs at hospitals and elsewhere performing it.

    In short, tests were available by the beginning of February, but didn't get put into use until March.

  • Mistakes were made and the Great Covid-19 coverup pandemic will ravage humanity until there is better way to prevent and treat. collaboration prority now. Strengthen immunity, improve PPE , safer distances. Invests in immunization , testifies tech.
    • In the entire history of the world there has never been a pandemic that spread this fast. It is literally unprecedented.

      It wouldn't be surprising if in the next century one spreads as quickly, but also is as deadly as smallpox.

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