America Failed On Many Fronts In Corona Crisis

This article is from the archive of The New York Sun before the launch of its new website in 2022. The Sun has neither altered nor updated such articles but will seek to correct any errors, mis-categorizations or other problems introduced during transfer.

The New York Sun

One of the things that is coming into focus in the crisis over the coronavirus is that the United States has failed on so many fronts. There was the lack of U.S.intelligence during the early days of the epidemic in China and the lack of attention to the intelligence on the seriousness of the infection during January.

There was also a lack of preparedness for testing that directly led to our current situation of sheltering in place. We have a national stockpile of equipment and vaccines and drugs that exists just for events like covid-19. But it is woefully undersupplied and, clearly, our plans for re-supply are completely inadequate. We continue to underfund state and local public health facilities and workers.

Today, though, I want to briefly review the history of our approach to pandemic preparedness and the current testing debacle.

Inspired, mainly, I think, by Josh Lederberg’s report from the American Academy of Medicine in 1992 on the threat of emerging infections, experts began to seriously consider the possibility of a worldwide health crisis caused by a new (or even old) infectious agent. I was fortunate to have been asked to join Dr. Lederberg’s Forum on Emerging Infections of the National Academy in the late 1990s.

We reviewed public health capabilities in the United States, in other developed countries, and in the developing world. We found that all were seriously underprepared to deal with anything like the kind of infectious disease we were considering.

In all cases, including that of the United States, we identified gaps in current infrastructure making observations on how these could be addressed. (As a “Forum” we could not write reports or make specific “recommendations.”)

After the attacks of 9/11 and the following anthrax attacks, we reviewed preparedness for biological and chemical attacks against the United States on a larger scale. These deliberations shared considerable overlap with our previous reviews of public health capacity. We constructed models and projections of the effects of such attacks.

Later, in 2016, after having dealt with SARS, MERS, Ebola and Zika, the Academy released a report on pandemic planning where improvements in global public health infrastructure and preparedness were emphasized. All this as well as experience with an H1N1 pandemic and the emergence of avian flu led to the development of a pandemic playbook during the Obama administration. Please note that this history spanned the administrations of Presidents Clinton, Bush, Obama and now Trump — Republican and Democratic.

One of the key components of preparedness is the availability of detection systems that provide early information on emerging infections that might become pandemic. In 2010 and again in 2016, reports examined progress in timeliness of identifying outbreaks and in communicating their existence.

The authors found that, overall, the world community had improved between 2000 and 2010, but very little since then. Lagging regions included the Americas, Europe, and South-East Asia. (Hmmmmm). In the 2016 Academy of Medicine report, it was recommended that the World Health Organization take responsibility for detection and coordination of a global response.

This brings us to covid-19 and its beginnings in China. We now know that the outbreak began in November 2019 in the Hubei region of China among customers of wild animal markets. Local authorities were aware of clusters of pneumonia in the region but apparently were reluctant to report this. China did not acknowledge the outbreak until late December.

The WHO announced the outbreak on January 5. According to the Washington Post, American intelligence agencies had been warning about the potential of this infection since early January. (One might ask where U.S. intelligence was during December). On January 18, Secretary Azar of Health and Human Services was trying to convince President Trump about the potential seriousness of this outbreak.

By the third week in January, we were repatriating diplomats and others from Wuhan and the Hubei Province. On January 31 travel from China to the United States was restricted to American citizens and permanent residents and their families. Somebody in the administration recognized the danger posed by this virus.

Business Insider has published an informative timeline on testing. By January 10, the sequence of the virus was published. With the nucleic acid sequence in hand, diagnostic testing became possible. One week later, the first diagnostic testing kits were available. By February 6, the WHO had shipped 250,000 test kits to 159 countries.

South Korea, as soon as the news of the virus from China was available, invested heavily in the manufacture of kits so that when the sequence was available, they could deploy testing to the population on a large scale. As used in South Korea, the test took about 10 minutes to complete and individuals had their results within one day.

The US, for reasons that escape me, decided that they would develop their own test and that it would be run at first at the CDC and later at state public health labs. Once the CDC had their test approved by the FDA, they shipped it out to the state labs – but it was faulty in spite of having passed an FDA approval process.

Then, instead of immediately approving other tests for use in this emergency situation, the FDA continued to rely on its usual stodgy protocols for approving diagnostic tests. While I agree that we need the FDA to assure us that the tests are going to be accurate and useful, we also need them to have a way of accelerating their process in response to a public health emergency. They can do this but chose not to for another month. Then again, their initial approval of the CDC test was not such a good precedent either.

The problem with this American response is that it flies in the face of basic epidemiologic principles. The ideal way to deal with an outbreak is to identify cases and then their contacts and quarantine them for the incubation period.

The first U.S. case was reported January 22. Without widespread testing, we were unable to identify cases and therefore unable to quarantine contacts. This allowed the disease to spread throughout the United States.

South Korea instituted very wide testing of the population, testing 3,500 people per million population. Even today, we are testing a measly 240 or so per million. South Korea’s test results were available often within minutes and in any event up to 24 hours. Our test results still come in about 5 days later.

South Korea also used cell phone localization data to track movement of identified cases and to warn those whose phones had been in the vicinity of the confirmed case. They used police to supplement health care workers in testing and searching for contacts.

The result is that South Korea was able shut down the epidemic without having to shut down the country. Of course, their epidemic started and was centered around a specific church in a specific geographic area of the country so perhaps their task was a little easier than it has proven to be in our vast country.

Like South Korea, Hong Kong, Taiwan, and Singapore were all able to test widely and keep the epidemic controlled without shutting down their economies.

One of the major problems with the covid-19 virus is that about 30% of all transmissions are from asymptomatic or minimally symptomatic people. This means that widespread testing would be required to identify all the cases. But other countries have succeeded anyway.

This delay in widespread testing, case -finding and contact isolation has left us with only one solution — social distancing. Our only way out of this current state of affairs involves widespread testing, case identification, and contact isolation. We are nowhere near where we need to be.


Dr. Shlaes, a retired infectious diseases physician and expert on antibiotics, maintains a blog called “Antibiotics: The Perfect Storm,” from which this column is adapted.

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