America: The Ideal Petri Dish
Preface: I’m not a doctor, scientist, or elected official. I urge you to follow the facts, some of which are spelled out within the following essay. I also urge you to only listen to the pros — the governors, mayors, nurses, doctors. In a nation, particularly, filled with misinformation and “research” stemming from the fathoms of fiction, it is critical to disregard any advice that isn’t sourced or that doesn’t come from the aforementioned pros.
As the sun was falling on the end of a decade, doctors in China were treating patients with pneumonia of an unknown cause. A few days later, the cause was identified as a new virus. The now infamous COVID-19 has infected over 1.5 million worldwide and has claimed the lives of more than 90,000 people. The deadly disease devastated Italy and Spain, and although America knew it was coming, its early response is the very reason the country might see the world's highest number of deaths. This response, or lack of it, is a combination of misinformation, miscommunication, and misfortune that warrants questions of responsibility within the higher echelons of this nation’s institutions. The mightiest country on Earth is facing an epic tragedy, a test that will put its iron spine under a certain pressure that perhaps comes only once every century.
This perfect storm was only possible due to the recent political climate and conditions that have revealed utter negligence; when the U.S. should have been spearheading the effort to eradicate the virus, the country was entangled with political drama and regulatory hurdles. This novel coronavirus was on the radar since early January. The Centers for Disease Control and Prevention (CDC) created the “Incident Management System” in response to COVID-19 on January 7. Meanwhile, the country was distracted by the President’s impeachment. It was only a day before when John Bolton, the former national security adviser, expressed a willingness to testify before the Senate. On January 11, China reported its first death related to the new virus. Four days later, the House of Representatives voted to send the articles of impeachment to the Senate.
By late January, the virus began to spread beyond China. Japan and Thailand reported cases. South Korea and the U.S. reported cases on the same day. The manner in which these two latter countries reacted really shows a sharp contrast between the efficiency of South Korea and the relaxed style of the United States. By early February, South Korea had its first test approved. The country tackled the problem aggressively. Medical staff and government officials made it possible to test 20,000 people a day at over 600 locations. They have tested hundreds of thousands of people, and the testing continues. This early testing made detection possible, meaning the virus could be traced. With this data, South Korea implemented accurate mapping of the spreading virus, which included digital monitoring of lower-risk patients and keeping close tabs on visiting travelers. The travelers were required to submit symptoms through an app. Commuting areas, like subway platforms, were turned into PSA venues where announcements were delivered in multiple languages, including English and Chinese. According to NBC News, bottles of hand sanitizer were placed “in front of nearly every entrance and elevator for public use.” The South Korean people took the threat of this virus seriously, willing to temporarily suspend privacy rights and increase surveillance to track the spread with more accuracy. In February, Seoul National University’s Graduate School of Public Health conducted a survey that revealed that 78.5% of respondents “would sacrifice the protection of their privacy rights to help prevent a national epidemic.” All of these measures have helped with easing the burden on overwhelmed hospitals in South Korea. On February 29, new cases peaked with 909 cases. Since March 11, the country has seen a steady decline in new cases. Meanwhile, things looked different in the United States.
Around New Year’s Day, Dr. Robert Redfield — Director of the CDC — was on vacation with his family, constantly on the phone. He was being briefed on the severity of an emerging virus out of China. In one dire conversation, George F. Gao, Director of the Chinese CDC, broke down into tears. By January 20, the CDC developed a test, just two weeks after collecting the genetic sequence from Chinese scientists. On January 22, President Trump said in an interview, in regards to the coronavirus, “We have it totally under control.”
Alex M. Azar II is the current Secretary of Health and Human Services (HHS). He was leading the Trump administration’s task force against COVID-19 until late February. On January 31, he declared a public health emergency for the United States. Although the announcement gave urgency to the subject, it ironically created a barrier for hospitals and labs that wanted to make their own tests. They were subject to an FDA (Food and Drug Administration) process called “emergency use authorization.” This wouldn’t be the only time the FDA got in the way. Therefore, the U.S. had to look to the CDC for testing.
On February 3, forty-nine members of Congress addressed a letter to Dr. Redfield about the need for testing in states. Around the same time, Dr. Bruce Aylward — a senior adviser at the World Health Organization (WHO) — led a two-week trip to China to conduct research on the virus. On this occasion, the WHO had more luck than America’s agencies; China rejected an early attempt by Mr. Azar and Dr. Redfield to send CDC experts to learn more about COVID-19. China would later ask for the CDC’s help in investigating the global health crisis.
The CDC-manufactured test kits were distributed to labs on February 6 and 7. The testing criteria was too narrow in early February. This was mostly due to the fact that the CDC was practically the only healthcare system administering tests (due to the FDA regulations). America began its battle against the virus with a rationed screening process. The CDC was only allowing those who had recently visited China or those who had been in contact with someone infected get tested. Meanwhile, the WHO had been distributing its own test kits across the globe. The CDC and WHO tests were slightly different. The CDC test used three genetic sequences to match with portions of a virus’s genome extracted from a swab. The German-developed WHO test used just two, potentially making it less accurate. Shortly after the FDA cleared the CDC to share its test kits with state health labs, a problem arose: The third sequence, or probe, gave inconclusive results. The CDC explored the cause of the problem, and while searching for the cause they told state labs that received the kits to stop testing. This proved to be a major mistake. Few were getting tested as the virus spread with freedom. This is a period the New York Times has dubbed “The Lost Month.”
No testing meant no surveillance testing. In attempts to track the virus, the CDC announced a plan on February 14 to check for coronavirus in people who had been swabbed in a screening for the common flu. This plan was to take place in five high-risk cities: New York, Chicago, Los Angeles, San Francisco, and Seattle. However, most of the cities could not carry it out.
The Mid-February numbers were dismal. According to the CDC, test sample numbers were only at 100 per day. By February 16, the CDC and state public health labs had gathered and tested 1,600 specimens. The standard procedure is that two specimens are required per person, meaning that the total sum of people that had been tested stood at 800. Per the Washington Post: “That’s roughly 2.4 tests per million people in the United States. In contrast, South Korea, which found its first case on the same day as the United States, had tested nearly 8,000 people, or 154.7 tests per million.”
If this wasn’t bad enough, it should come as no surprise that the CDC didn’t really consider adopting the test being used by the WHO. Dr. Anne Schuchat, the CDC’s Principal Deputy Director, did not think “we needed somebody else’s test.” Furthermore, the German-developed WHO test had not been approved by the FDA. The approval process notoriously takes a while. However, it’s worth noting that the CDC’s decision to develop its own test is quite routine. Jeremy Konyndyk, a senior policy fellow at the Center for Global Development, explains: “The CDC will develop their own test that is suited to an American health-care context and the regulations that exist here. That’s how we normally would do things. A lot of countries don’t have the capabilities that we have here. And so they need to rely on the WHO to provide tests to them. We don’t have to do that in the United States.”
Dr. Redfield responded to the Congressional letter on February 24, a whopping three weeks after the legislators sent it. Days later, in the wake of the stubborn virus spreading, the CDC told state and local health department labs to finally begin testing. Permission was granted to use the CDC kits that were originally sent out. But the agency told these facilities to leave out the faulty third probe. Out of sight, out of mind.
“You may ask about the coronavirus, which is very well under control in our country.” — President Trump, February 25
On February 26, Mr. Azar had been removed as the leader of the task force. He was replaced with Mike Pence, which should have given Americans little solace. Pence’s record on health is appalling. The Vice President was the Governor of Indiana from 2013–2017. During his term, he oversaw and mismanaged the biggest HIV outbreak in the state’s history. Southeastern Indiana was recognized as a major hotspot of the nation’s opioid epidemic in 2015, following a spread of HIV associated with intravenous drug use. At one point, the crisis was so severe that in rural Scott County — population less than 24,000 — new HIV cases had exceeded the number of people infected with HIV (via injection drug use) in NYC the previous year.
In February 2015, the city of Austin, Indiana, reported 30 cases of HIV. By March, the number of reported cases was 55. A year later, cases were at 190. Pence initially banned a clean-needle exchange program, an initiative that health officials advocated to reduce the spread of HIV. The CDC pushed for Pence to lift the ban, but he was obstinate. By late March of 2015, Pence declared a public health emergency — a measure that allowed for clean-needle exchange. He continued to show reluctance by saying, “I do not enter into this lightly. I don’t believe effective anti-drug policy involves handing out drug paraphernalia.” About 235 cases of HIV were eventually tied to the outbreak.
This complete failure exposed a weak health infrastructure in the state of Indiana. Indiana ranked among the states with the fewest drug treatment providers. United Health Foundation’s America’s Health Rankings Annual Report ranked Indiana 41 of 50 from 2013–2015. A 2016 study published in the New England Journal of Medicine concluded that the crisis could have been prevented. The same study also noted that free HIV testing had not been available in the community since a Planned Parenthood clinic closed in 2013. The closing was due to federal and state funding cuts. Five rural clinics were closed in Indiana, one of which was providing HIV tests in Scott County. A 2018 study by Yale School of Public Health found that the number of HIV infections could have been dramatically reduced if the state had acted faster. Despite all of the Indiana blunders, on February 27 of this year, Trump said, “Anybody that knows anything about healthcare, they look at the Indiana model.”
This was the same day a conference call took place between Dr. Hahn (the FDA Commissioner), Dr. Redfield, top aides from the FDA and HHS, and Mr. Azar’s Chief of Staff. Recall, Azar had been replaced the day before. Azar’s Chief of Staff, Brian Harrison, started with an ultimatum: No one leaves until we resolve the lag in testing.
The group urged the FDA to loosen regulations so that hospitals and independent labs could move onward with their own tests — many of which sat unused in labs nationwide. Standford University’s Virology Laboratory developed kits in February but wouldn’t start testing until the FDA eased regulations. Test kits were deployed in the first week of March.
A French diagnostics company — BioMérieux — tried to get their testing system, BioFire, up and running in February after communication with the FDA in January. They finally received emergency approval for the BioFire test on March 24. By the time restrictions were lifted and testing was expanded, containment of the virus was completely out of the question. America was fighting from behind. On March 11, the WHO formally announced a pandemic.
The testing debacle was a major factor in the crisis we are facing. The shortage of ventilators was another part of the equation. America is home to less than a dozen companies that manufacture the life-saving machines. And although America was slow in developing a national strategy for accelerating the production of ventilators, the shortages were global.
Andreas Wieland, the chief executive of Hamilton Medical in Switzerland, one of the world’s largest makers of ventilators, has said, “The reality is there is absolutely not enough. We see that in Italy, we saw that in China, we see it in France and other countries.” Hamilton Medical moved as quickly as they could, transferring employees to the factory and increasing the hiring. Still, they couldn’t keep up with the huge demand. Mr. Weiland explained, “Italy wanted to order 4,000, but there’s not a chance. We sent them something like 400.” These intricate, computerized machines can cost up to $50,000 each.
The U.S. has about 160,000 ventilators in hospitals nationwide. According to the now-famous Dr. Fauci of the National Institute of Allergy and Infectious Diseases, the U.S. has 12,700 in the nation’s stockpile. Although that seems like a substantial amount, worst-case scenarios offered grim predictions — America running out of hospital beds and ventilators. So, orders had to be filled. Per NYT: “The United States is toward the back of the queue, according to [ventilator] manufacturers.” Again, America was fighting from behind. On a March 16 conference call with governors, President Trump told them, “Try getting it yourselves,” in regards to ventilators.
“It’s going to disappear. One day — it’s like a miracle — it will disappear.” These were Trump’s words on February 27, as America had 60 confirmed cases. The country recorded its first death caused by the coronavirus two days later. Since then, this country has tragically lost more than 16,000 people. The number will only grow; there’s no saving the dead. But perhaps America can honor them in the future. The next time a deadly virus emerges, we will hopefully know what to do. More importantly, we’ll know what not to do.
President Trump appointed both the CDC Director and the FDA Commissioner to their posts. Dr. Redfield, of the CDC, had never run a government agency before his appointment to lead the CDC in 2018. Dr. Hahn, of the FDA, was appointed only seven weeks before the HHS Secretary — Alex M. Azar II — declared a public health emergency. Before his replacement at the helm, Mr. Azar did not include Dr. Hahn on the virus task force. Azar had been at odds with the White House for a while. So a liaison to the President was necessary. This role was filled by Acting White House Chief of Staff Mick Mulvaney, who was being forced out by Trump and has since been replaced.
Without a doubt, we were caught off guard with the arrival of this virus. Yet, there were better ways to handle the arrival. There were better ways to respond to its early stages. Surely, there must have been people with more experience to head the institutions we look up to and follow. Lives would have been saved had America acted quickly and properly. In all, this reminds me of an old lie that says “grown-ups know what they’re doing.”
At the very least, this weapon manufactured by Earth has allowed her to breathe again. The Himalayas are visible from India. The Venice canals are running with more clarity. Seismic activity around the world has gone down. The overdue gift to Earth, however, has come with a cost that knows no number and only climbs with each passing day.