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WASHINGTON — In late February, Vice President Mike Pence was appointed to lead the White House coronavirus task force by President Trump. He became immediately alarmed by the shortfalls in testing availability.
Trump had been unhappy with how the pandemic response was being handled by his Health and Human Service secretary, the former pharmaceutical executive and conservative attorney Alex Azar, and wanted Pence to galvanize — and organize — the faltering effort. Pence asked Stephen Hahn, who heads the Food and Drug Administration (and who had clashed with Azar) to join the effort.
Hahn’s charge was to “increase capacity, and do so rapidly,” according to an official on the White House coronavirus task force familiar with the episode, but would only speak on the condition of anonymity. The premium, that official acknowledged, was on speed, not necessarily coordination. To get test kits and related equipment to states as quickly as possible, Pence and Hahn simply had to make sacrifices.
There were other challenges. Governors received confusing messages about what they could expect from Washington and what they were supposed to do for themselves. Meanwhile, top White House figures like Jared Kushner, the president’s son-in-law and adviser, were enlisted to resolve the supply chain problems that created the testing shortfalls. But no single person was placed in charge of the supply chain effort.
That helps explain why, two months later, virtually all of the problems Pence identified remain as vexing as they were when he took charge. And it explains why top public health figures talk about testing much as they did when the pathogen first made landfall in the United States in early January: that is, as a conundrum that would be resolved at some unknown future date.
In seeming recognition of just how much work remains on the testing front, the White House released on Monday a new testing guidance that “calls for coordination with governors ‘to support testing plans and rapid response programs,’” according to Bloomberg, which obtained a copy of that plan in advance of its public release.
Despite the concerns shared by many on his own coronavirus task force, President Trump has routinely misrepresented the nation’s capacity to test people for the coronavirus.
Speaking at last Tuesday’s coronavirus task force briefing at the White House, Trump made a seemingly impressive claim, asserting that the U.S. had tested more people for the disease than every other nation in the world combined.
“We’ve done very well, our testing,” the president said. “If you add them all up, we’ve tested more.”
That assertion came in response to a question from a reporter who reminded the president of a promise Pence made on March 9: “Before the end of this week, another 4 million tests will be distributed.” Yet those tests would not be distributed that week, or the week after, or the weeks after that. In fact, only in late April, more than a month after Pence made his claim, did the U.S. pass the mark of 4 million people tested.
So why, four months into an epidemic, is a nation ranked as the world’s most prepared for a pandemic still waiting for a testing breakthrough?
The story of the administration’s testing failure is one marked by incompetence, arrogance and short-sightedness. The chaos that has marked the Trump presidency from the start has been particularly damaging in the midst of a pandemic, as administration officials struggle to master supply chain logistics and grasp how to meld bureaucratic jurisdictions. The president, meanwhile, has feuded with governors instead of working with them, frustrating any attempt at a coordinated national response.
According to a Harvard study, the United States needs to be conducting 20 million tests per day to reopen the country completely. Right now, the country is conducting about 250,000 tests a day, after several weeks during which testing remained at a frustratingly steady 150,000 per day. That means testing has to be increased by 80 times in order to meet the standard determined by the Harvard researchers.
For all the president’s optimistic talk, members of his coronavirus task force realize such a dramatic ramp-up is simply not possible with the tools currently available. “We have to realize that we have to have a breakthrough innovation in testing,” task force response coordinator Dr. Deborah Birx said in a recent “Meet the Press” appearance.
Now the Trump administration is moving to reopen the country, even though it has not tested enough Americans to fully grasp the scope of the disease, let alone begin declaring victory over what Trump likes to call “the invisible enemy.” That enemy has remained invisible in good part because most people have no means of finding out if they are, or have recently been, infected with the coronavirus.
“They still haven’t woken up to the fact that they need a massive testing program,” says a former top U.S. public health official close to the Democratic Party establishment. “I think that’s the fundamental missing element.”
The former official believes that the current situation could have been easily avoided. “They have the entire industrial complex of this country at their beck and call,” he says. He wonders about why he hasn’t seen “images of factories in this country” churning out hospital equipment.
“He’s not a manager,” the former official says of Trump, who ran for president on his managerial experience, vowing he “alone” could “fix” what ailed the United States.
Frustrations with these delays have been felt by ordinary Americans simply seeking a coronavirus test and prominent figures dismayed at a superpower struggling to deploy relatively simple medical equipment. In a Reddit question-and-answer session, Microsoft founder and philanthropist Bill Gates lamented that the “testing in the U.S. is not organized yet. In the next few weeks, I hope the government fixes this by having a website you can go to to find out about home testing and kiosks. Things are a bit confused on this right now.”
That was on March 18. More than a month later, widespread confusion about testing persists, even as Trump continues to make his bombastic claims. As for a testing clearinghouse website, which Trump said Google would build, it never materialized at the scope the president promised. To this day, there is no federal website that allows a person to find out the closest legitimate testing site to their address. Instead, the CDC page on testing points to local and state health departments. (Searching on Google does lead to a Google Maps site showing nearby testing locations.)
Aggressive testing is a critical component of the president’s Opening Up America Again program, but many states say they still do not have enough tests to even begin contemplating the process. That means they won’t know just how severe the outbreak is within their borders, especially since many people who carry and transmit the disease will be asymptomatic, meaning that they could be spreading the coronavirus without knowing it.
“Testing asymptomatics will be key” to reopening the country, Dr. Birx said last week. Finding those silent carriers will be critical to keep them from spreading the disease to people who are bound to have a much more severe response. Those asymptomatic carriers will be the most difficult links to break in the chain of transmission.
The testing shortfalls are rooted in the administration’s decision to let states handle the testing issue on their own. At the same time, many states wanted the federal government to give them license to pursue their own plans, even as they pressed Washington to give them the resources to bring those plans to fruition.
That created a tug-and-pull situation in which states competed with each other and the federal government for resources, inevitably leading to those resources sometimes going to places they didn’t need to be. Trump has praised states shipping critical equipment like ventilators to other states, but a centrally organized coronavirus response effort may not have required such interstate generosity.
Trump has said it is his duty to act as the nation’s cheerleader, which likely explains his vast overstatement of the nation’s testing capacity. But optimism hardly disguises the fact that delays, shortages and misallocations persist. In explaining why there were, by his count, 40 million tests available but only 4 million Americans tested, Adm. Brett Giroir of the National Health Service said there were shortages of equipment needed to conduct and convey the tests. Dr. Giroir, who has been placed in charge of testing on the White House coronavirus task force, called it “an end-to-end issue” related to cotton swabs needed to collect samples from nasal passages and chemical compounds in which those samples are stored. Without that secondary equipment, the tests themselves are as good as useless.
“We’ve been told over the course of this response that the supply chain will open up, and it has not been opening up,” said American Public Health Laboratories chief program officer Eric Blank in a call with reporters last week. He called on the federal government to “play a bigger role” in building a “consistent supply chain.”
In an emailed response to questions from Yahoo News, Giroir said that “testing production capacity keeps getting better and better,” and that laboratories and hospitals across the nation could test between 120,000 and 150,000 people per day. Giroir additionally said that the White House task force was “encouraging diagnostic test developers and manufacturers to rapidly develop new technologies and scale up testing inventory.” The assertion seemed to acknowledge that, four months into the pandemic, that long-promised scaling up remains elusive.
Trump has routinely blamed the Obama administration with leaving him a diagnostic testing infrastructure he claims was not prepared for the coronavirus. “I inherited broken junk,” Trump said earlier this month, in what has generally been described as an inaccurate assertion.
It is true that one of the most consequential decisions regarding the coronavirus took place long before most Americans had ever heard the phrase “social distancing.” But that step was taken by the Trump administration. Two years ago, in April 2018, incoming national security adviser John Bolton fired the president’s homeland security adviser Thomas Bossert. He subsequently downgraded the position, too, effectively removing the homeland adviser’s access to the Oval Office.
The famously territorial Bolton got rid not only of Bossert, but the entire global health division within the National Security Council. Among those dismissed was Dr. Luciana Borio, who several years before had worked on developing “medical countermeasures” to fight a pandemic. Testifying before Congress in 2014 about the Obama administration’s handling of the Ebola outbreak, Borio described to lawmakers in detail how public health officials were “identifying and isolating infected individuals” by using tools such as diagnostic tests.
Only two people died in the United States from Ebola.
A former national security official who has been affiliated with Democratic administrations told Yahoo News that the “homeland security adviser wouldn’t be the one to individually coordinate the testing and supply chain issues, but would be the one to make sure the agencies are working together to get it done,” the former official explained. Were a homeland security adviser sufficiently empowered, he or she could “run a process that makes sure the decisions are getting made quickly” and “bureaucratic hurdles are identified and overcome.”
Bossert, for his part, was reluctant to criticize Trump. He told Yahoo News that the “challenge isn’t deciding who is in charge or who to blame. There is plenty of work and blame to share. The challenge is establishing a common objective and unity of effort.”
In any case, the homeland security adviser’s role is now a deputy position currently held by Julia Nesheiwat, a former Army intelligence officer who had previously been Florida’s chief resilience official. She assumed the role in late February, just before the pandemic hit the U.S. and has been virtually invisible since.
Borio and Bossert both issued coronavirus warnings as the epidemic was poised to strike the U.S., but those warnings appear to have not been heard within the White House. At first, the Trump administration approached the epidemic with bravado, with economic adviser Larry Kudlow declaring the disease “contained” in late February, weeks before the worst of the viral onslaught.
As he was speaking, the CDC was still struggling with the coronavirus test it had been trying to develop since January. The World Health Organization had offered to send the same European tests it was using in China, where the outbreak began, but virologists at the Centers for Disease Control and Prevention wanted to rely on their own. The test they created, however, was badly contaminated, and the problem was not fixed until early March.
Trump was also slow to recognize the scope of the looming threat, and his administration’s lack of preparation. In early March, he toured CDC headquarters in Atlanta and was asked by a journalist about the apparent difficulty of obtaining a coronavirus test. Trump disputed that any such difficulty existed. “Anybody that wants a test can get a test,” the president said. “That’s what the bottom line is.”
But this was not true, and Vice President Pence conceded as much only a few minutes later in a White House briefing. “We have a ways to go yet” on testing, Pence said, promising that coronavirus tests would be “broadly available” within a “matter of weeks.”
Some had already concluded by then that waiting for the White House was fruitless. “We can do that test, we have the sophistication,” New York Gov. Andrew Cuomo said he told Pence in late February.
Governors were bound to discover, just like the White House, that global supply chains are exceedingly difficult to navigate, especially in a time of crisis. On March 12, for example, Florida Gov. Ron DeSantis announced the successful purchase of 2,500 coronavirus test kits. But, as one local news outlet reported, he acknowledged that “right now the state doesn’t have access to enough sample collection and swab material due to a nationwide shortage.”
DeSantis was, in other words, describing the exact same supply chain problem that Admiral Giroir would still be struggling with more than a month later.
The day after DeSantis made those comments, Girior was appointed as the coronavirus task force “testing czar.” A respected pediatrician who held a high-ranking position in the Department of Health and Human Services, Giroir nevertheless lacked the kind of logistics experience that the position appeared to clearly demand.
“He’s a very reasonable guy and well intentioned,” the former high-ranking public health official with Democratic Party ties told Yahoo News. “But I don’t think he knows how to do it. He can run an intensive care unit. But he can’t move the government. You need to know how to make things happen.”
Giroir disputed that criticism. “I work closely with and lead a team of logistics people working to marry the strategy with science,” he told Yahoo News.
The White House has appointed a bevy of other officials to help resolve supply chain problems. They included Rear Adm. John Polowczyk, who oversees supply chain efforts for the Federal Emergency Management Agency, along with presidential son-in-law and counselor Jared Kushner, who is reportedly assisting Polowczyk. Economic adviser Peter Navarro, a China hawk, also joined the effort, promising to use the Defense Production Act to compel private companies to produce medical equipment on what Navarro was fond of calling “Trump time.”
Time was indeed a problem. “It takes a little while for markets to adapt when there are changes,” says Daniel Stanton, an expert in supply chain logistics. “And this has been a very sudden change.” Still, Stanton believes that even the pressures of a global pandemic could have been overcome. “The way you manage a supply chain during a disruption is through collaboration and communication,” he tells Yahoo News, making clear that he believes that the Trump administration has fallen short on both counts.
Much as he has with previous crises, the president personalized the pandemic. If he received praise from New York Gov. Andrew Cuomo, Trump would invariably praise Cuomo back. At the same time, he engaged in feuds with other Democratic governors, including Gretchen Whitmer of Michigan and J.B. Pritzker of Illinois.
“If they don’t treat you right, I don’t call,” Trump said in the midst of his spat with Whitmer. This gave off the indelible impression that the states were better off trying their luck on the open market as opposed to courting a volatile president who could turn on them at the slightest perception of insult. Only that open market invariably held perils of its own, including competition, price gouging and lack of coordination.
White House officials insist that leaving the states to procure their own tests and testing supplies was not an abdication of responsibility. “The response effort has always been locally executed, state managed and federally supported,” the task force official said. The federal government, he argued, “can only do so much to get resources to the states,” and it was ultimately the governors’ responsibility to make sure tests were being administered to their citizens.
“They know their states better, they know their situations,” the task force official argued, adding that “the federal government just doesn’t have the insight” into how each state operates.
Public health officials do agree that the size of the United States would have made a centralized federal testing regime difficult to implement. “The states know what's best for their states," said Dr. Scott Becker, director of the American Public Health Laboratories, in a call with members of the media last week.
At the same time, getting the right resources to the right states — the swabs, re-agents and test kits themselves — remains a federal duty, Becker and his colleagues argued during the press call. “This is a federal government responsibility,” Becker said of the kind of supply chain “end-to-end” issues that Admiral Giroir described.
“The states will be responsible for how the strategy will work in their state. But that is dependent upon an expanded supply chain and a consistent supply chain. And that’s where the federal government really comes in,” Becker said. He acknowledged a “true ramp-up” of testing had not yet taken place. He hoped that one would soon.
Governors don’t have the luxury of waiting. Last week, the National Governors Association wrote a letter to congressional leaders pleading for a “a federal centralized structure” to address shortfalls in testing and medical supplies. In response, the White House sent the governors a memorandum that listed coronavirus testing sites in each state. The implication was that there were no shortfalls, only resources underused by inattentive governors.
The guidance particularly annoyed Larry Hogan, the Republican governor of Maryland who heads the National Governors Association. The list of Maryland sites included prominent federal facilities — the National Institutes of Health in suburban Washington and Fort Detrick, a military facility — that are not accessible to ordinary Americans.
Hogan had asked some weeks before for a federally run testing site in Maryland. The Trump administration told him “it was on the states,” according to Hogan spokesman Mike Ricci.
Hogan’s wife, Yumi, the first gubernatorial spouse in the United States of Korean descent, helped him contact South Korean suppliers of testing kits. The negotiations lasted many hours each night, for three weeks straight. But they concluded with the Hogans on the tarmac of Baltimore/Washington International Thurgood Marshall Airport, watching a jet disgorge crates that contained 500,000 coronavirus tests.
Even though the White House had told the governors that testing was their responsibility, it was plainly annoyed at Hogan’s dealmaking, especially since the South Korea deal was accompanied by the kind of flattering coverage that has generally eluded Trump. “I don’t know what the governor of Maryland is doing in South Korea,” Giroir said at that evening’s coronavirus task force briefing.
But the governor was doing what he had been asked to do, work the federal government either could not or would not undertake.
With reporting by Rebecca Corey
Cover thumbnail photo: John Moore/Getty Images.
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