The Daily - Why the U.S. Wasn’t Ready for the Coronavirus

Episode Date: March 11, 2020

Developing a strategy for testing was supposed to be a relatively simple part of preparing for the coronavirus in the United States. So what went wrong? Guests: Sheri Fink, a correspondent for The Times reporting on global public health, and Dr. Helen Y. Chu, an infectious disease expert in Seattle. Dr. Chu was part of a research project that tried to conduct early tests for the coronavirus but failed to obtain state and federal support.For more information on today’s episode, visit nytimes.com/thedaily. Background reading: During the early days of the outbreak, when containment would have been easier, the federal government missed a series of chances to ensure more widespread testing.After weeks of playing down the potential effects of the coronavirus, President Trump proposed an emergency relief package to bolster the economy — one that has been met by bipartisan opposition.The number of known U.S. cases of coronavirus infection has passed 1,000, with the virus found in every region of the country. Universities continue to close classrooms. Here are the latest updates on the outbreak.

From The New York Times, I'm Michael Barbaro. This is The Daily. Today. It was supposed to be a relatively simple part of preparing for the coronavirus in the United States. Testing for it. My colleague Sherry Fink on what went wrong. It's Wednesday, March 11th. So in 2018, it was the 100th anniversary of the terrible 1918 flu pandemic. This was called the Spanish

flu, and it just killed millions and millions of people around the world. So on that 100th year anniversary, many gatherings were held to discuss the lessons of that flu pandemic for today. And there was this one gathering of high-level people in Atlanta, Georgia, where the Centers for Disease Control and Prevention is based. And among the officials there was a group from the National Security Council. It had actually been created a special unit on global health security that was created after that terrible Ebola outbreak in West Africa. So let's begin with you, Dr. Borgum. So one of the officials with that group, with that unit. Well, it's a pleasure to be here with so many of my colleagues, and we've been working together for more than a decade on these issues.

She steps up to the podium, and she says. The threat of pandemic flu is our number one health security concern. So this is a pretty senior health official on the National Security Council warning her colleagues that there is a very predictable threat here, a pandemic flu. And are we ready to respond to a pandemic? I fear the answer is no. In her words, the country's just not really ready for it. So we should do something about it. Exactly.

And as it happens, the very next day, that global health security unit where she worked was shut down by a senior member of the Trump administration. So fast forward two years and it's early January, January 3rd. It's a Friday, and the Secretary of Health and Human Services, Alex Azar, is at home in Washington. And he gets this phone call from Robert Redfield, this doctor who's the head of the CDC. about these reports coming out of China that there are these clusters of pneumonia cases and that the likely culprit is a new coronavirus. And Alex Azar, the Health and Human Services Secretary, says this is a very big deal. And what does Azar do with this information and this understanding that whatever this is, it's going to be a big deal.

The Trump administration officials start meeting every day in the basement of the West Wing. And so at first they say, OK, let's let's screen the flights that are coming from China. But there's an even more serious question that comes up, which is, should we ban flights altogether? And should we deny entry to anybody who has come from China in the last 14 days to anybody who isn't a citizen or a permanent resident here? So then that debate got shifted right to the Oval Office. And the top health officials of the nation at that point were agreed. A ban from traveling from the center of this epidemic could buy us some time, could help us to prepare ourselves before this came.

It could slow that down. The president asked, what could the consequences be on the economy? All logical things that you would probably ask. In the end, he sided with the aides who supported the idea that this could actually help protect our nation's health. The problem was we weren't completely prepared.

Our government wasn't completely prepared to use that time. What do you mean? The biggest issue that the government had to face was testing, being able to diagnose somebody who has this illness. was testing, being able to diagnose somebody who has this illness. And what is the problem with testing at this point? Well, it didn't seem like there would be a problem. Even though it was a new virus, the Chinese quickly made the sequence of it available, and labs were really quickly able to create a test for that,

including the World Health Organization had already approved a test that was developed by some German scientists. But the U.S., which considers the CDC the world's premier public health agency, they decided to make their own test. But it didn't actually get FDA approved until the first week of February. And at that point, it could be distributed to public health laboratories across the country. But, you know, now we're already over a month into this scary new outbreak by that point. So this is already off to a pretty slow start at a moment where every single day counts. That's right. So now we're like a month into this thing, and they're finally able to mail out the kits to public health laboratories around the country, state health laboratories, some big city health laboratories, this network of labs that our public health system has. that test. They have to, what's called validate it, make sure it's working. And right that next day, the CDC starts getting reports from some of these public health labs saying, we're not able to validate this test. We're having problems. We're getting some inconclusive results. And

that's the first sign that something may have gone wrong. This test is not working. Well, the CDC says it's definitely working in their lab. So they told all the labs across the country, if it's not working for you, of course, don't use it. Just send samples to us. Of course, that adds time. You have to collect a sample in your local area and then send it to Atlanta and then wait for that result to come back. So what impact does this testing snafu have at this point on our understanding of the epidemic? It just means that we don't know.

We actually don't know. We say we have a low number of cases in this country at that point. But if you don't test, how can you know? Okay. And for these weeks where it seemed like we had cases in the low double digits in the United States, and there was a sense that things were quite stable and the danger was pretty low, the virus very well could have been spreading and spreading widely. And we wouldn't have known because we weren't have known because we weren't doing the testing that would have told us that. Exactly. And here's why. Because only a small proportion of people who get the virus get really, really sick, fortunately. But by the time

that they get into a critical care bed at a hospital and the doctors there are scratching their heads and they've tested for all the known things that cause pneumonia and severe, severe respiratory distress, weeks have gone by since that person was infected. So you're actually looking at history. If you finally get a positive test at that point, then yes, it has been spreading in the community. And that's all that time that you lose. Right. So this time that the Trump administration had bought the American people with that dramatic step with shutting its border to Chinese travelers is kind of being squandered. Yeah. There were so many people who are starting to feel at this point like this time was being squandered and we needed to get eyes on this. There were travelers coming from parts of the world where we didn't have a travel ban that now had a large number of cases and they weren't being screened at the airports. They were

going out into the communities and there was just this urgency of being able to test more. And that's when this one group of doctors and researchers took matters into their own hands. We'll be right back. Sherry, who is this doctor? So her name is Helen Chu. Hello, this is Helen. Hi, Helen. How are you doing? I'm doing well. How are you?

I'm well, thanks. She's a physician and a researcher in Washington state, which is where the first case of coronavirus was detected in the U.S. back in January. And she and her colleagues see a potential solution to this testing problem in their own work. We had a study in place that was set up for detection of respiratory viral illnesses in the community. She specializes in studying how viruses pass from person to person within that same community. And she and her colleagues have this big study where they're collecting all these samples from people who are sick and then testing them in the lab for flu and other respiratory

viruses. And through collecting hundreds and hundreds of samples every week, they're trying to track the spread of viruses. And she was in the middle of collecting samples when the coronavirus arrives in Washington. That is right. So we had this infrastructure in place already, essentially, in the Seattle area to be able to detect early entry of a virus into the city and then to understand how it spread. And that sounds like it would make her very well positioned to do the same thing for the coronavirus. Exactly. She thought of that. The state health officials knew about their project, and they immediately thought about the potential of this project to help with this issue of testing.

And so what happens? They make their own coronavirus test really fast, and they're ready to go to help the state by the first week of February. But there's one hitch. We had to go through regulatory clearance, essentially. We had to talk to CDC. We had to talk to FDA. They don't have the approval to test and then give those results out for two reasons. One is they're not a clinical lab, so they don't have the regulatory approval for that. And number two is they've just created this new coronavirus test, which isn't yet FDA approved. So we were at a point where we could test thousands and thousands of samples at very

high throughput, but we didn't know what to do when we found a positive. So there's good reason to have some of those regulations in place, but they figure this is a public health emergency and they feel like there's got to be some way around this bureaucratic red tape where they could at least screen these samples and get that information out to the public health authorities to confirm that test, whatever it is. But everybody felt very hesitant about us being able to provide results or to do the testing at all. The CDC doesn't seem to find a way around it. Weeks go by and they're getting more and more frustrated and they're seeing the outbreak is growing in China and it's spreading to other countries.

So we know, you know, there's a potential for it to be an outbreak, not just in China. We had the information, we had the data there sitting in our lab where we could actually answer the question. And that was frustrating that we could answer it. We had the capacity to answer it, but we couldn't move forward because we didn't know what to do. They feel like they're sitting on a gold mine and they feel like the virus very well could be out there. After all, there had been this case in Washington state more than a month earlier and nobody's had eyes on it. Nobody's been doing surveillance in the community, testing samples. So they're getting more and more nervous.

Is there something we're not seeing? Because we're not really testing very widely. So what do they end up doing? Just kind of keeping those samples on ice and doing nothing? Well, at first, that's what they did because they thought they could speak with these officials and find out some official workaround so that they wouldn't be violating regulations and get in trouble? Everyone wanted to be able to do this the proper way, to go through CDC and state labs and have them have the high capacity to do the testing of all of these patients who really needed a diagnosis, but it just couldn't be done. And then it gets to February 25th. I mean, the month is almost gone.

It's more than a month since that first case. And they finally just said, what we would do is move forward with research testing only. We're going to start using this unapproved coronavirus test that we have and that we believe is very reliable and start testing these samples. Wow. So they're just going for it. Well, they're just going for it. And like, technically, they can test, right? But the issue is they can't report the results. So what we would do would just be to go ahead and test the samples for coronavirus, but not to associate that with the information from the sample, so the clinical information. So they have a plan to test for the coronavirus.

And if they find it, that would mean that they're sitting on information that they're not supposed to have. They're sitting on information that they're not supposed to communicate because of these regulatory issues. It's all going to be fine as long as they don't find a case. OK, so once they decide to do that, what happened? What happened was one of the very first days that they started testing. It was February 27th that we got the first positive.

They found a case. What I thought was, oh no, if it came up that early in our testing, that meant that it had probably been here for a while and that we just didn't know that it was there. And so the questions racing through my head at that point were, what is the right thing to do right now? And so what happened at that point was that we rapidly convened a meeting of the investigators. The group just convenes. They all get on the phone and they talk about ethics at this point. We talked through the ethics of the different options. Keep it to ourselves, tell public health,

or tell the participants. And what we were allowed to do was to keep it to ourselves. But what we felt like we needed to do was to tell public health. So that's what we did. They decide that the most ethical thing is to report the result to the local health authority. They confirm the result, and it's this local teenager in the very same county as that first positive case, but no known link to that person and no travel history. And that next morning, the public health lab went out, and they found this teenager who was feeling better by that person, and no travel history. And that next morning, the public health lab went out and they found this teenager who was feeling better by that point because he had a mild form of this illness, which is most common, especially in young people. And they get to him just after he walks into his

school because he's, yeah, and they end up shutting the school down to make sure that nobody else will catch the virus. I mean, that was a good moment for our team, I thought. We did something that didn't follow the rules, but we were able to prevent spread in a high school. And that seemed really important. So because of the doctor's actions, they catch him basically in the nick of time. They do. And they also realize that they may have a big problem on their hands. do. And they also realize that they may have a big problem on their hands because if this case descended from that first case, if that person potentially had infected somebody without knowing

it and then, you know, there was mild illness going on and nobody caught it, there could be hundreds of cases in the area. And so that gave them the information that they needed to start acting, to start looking more seriously for the virus in the community. I wonder, had Dr. Chu not broken the rules in this case, how that would have changed how we understand the coronavirus in the Seattle region? Well, we wouldn't have known until the people started dying that there was a problem. And unfortunately, the really sad thing is that that happened really soon after that. And so if Dr. Chu and her colleagues had been able to test sooner, they would have been able to alert the authorities earlier.

And that's the real tragedy here. the authorities earlier. And that's the real tragedy here. You know, Sherry, on the one hand, the story that you have just told, it's a pretty heroic story of a doctor willing to go against the rules, the instructions, because she felt that it was needed in the moment, in the midst of a public health crisis. On the other hand, it feels risky for the lesson here to be that medical professionals should go rogue in the middle of a crisis. I mean, what in your mind is the lesson here? I mean, I'm somebody who's reported on disasters for many years and used to do some disaster response myself. And I've always seen in crises that thinking outside the box can really solve problems and it can save lives.

And I think we generally accept that already, that the rules do have to bend, that people need to think creatively. And one of the reasons they have to do it, and it was so evident here, was that the larger system, the official responders, the official system in place, couldn't do everything and was faltering. But I wonder how much would things potentially have been different, Sherry, if, thinking back to the start of our conversation, those government programs, the National Security Council's health program, for example, hadn't been cut?

National Security Council's health program, for example, hadn't been cut. I mean, how much does that reflect an overall approach to this epidemic from the people currently in charge, from the Trump administration? I think you can trace it back further than that. It is a pattern that these programs, when there's a crisis, they get really well funded. And as soon as Ebola recedes into history, we start cutting those parts of government. You can look back after the anthrax attacks and 9-11, and there was all this money that went into bioterrorism preparedness and hospital preparedness. And then you look at the numbers and they go down over time. This is a reaction of humanity and society and government is to sort of like when it's in the news and it's fresh in our minds, we invest in it and then we turn away. So I feel like this is a pattern. And when this happens and we have these gaps in our preparedness that the government always seems to have, what I have found over and over again as a reporter is regular people step in and fill some of those holes. And I'm thinking right now, I have this image of Hurricane Katrina and government officials not being able to rescue everybody who needed help all at once. People waving towels off of rooftops and people stuck in hospitals. And

then it was like these regular people who had airboats who were fishermen from western Louisiana and they show up and they just take people to dry ground. You know, I've seen examples like that over and over. In this case, we saw Dr. Chu and her colleagues doing something like that. But what I found out today on the phone with Dr. Chu was that yesterday the Washington state regulators called their lab and asked us to shut down. The project got shut down again. So the regulators, the state regulators told them they can't keep doing this. So it looks like the government isn't going to allow this to

continue to fill that hole. And so that hole remains. The question is whether this will be one of those lessons that comes out of this particular outbreak. And of course, there will be a tomorrow. There will be a day where we're not in the midst of something so frightening that we're in right now. And the question is, will this fit that same cycle where we say we've learned the lesson, we need to kind of innovate, come up with new systems that will ensure that we're in a better footing, that we can have some backup systems so that we can roll out testing as a country much more quickly? Or will this fit that same cycle where once the immediate danger goes away, we stop investing or we just forget? Sherry, thank you.

Thank you. A few days ago, my colleague Peter Baker asked President Trump whether he regrets eliminating the global health unit of the National Security Council in light of the coronavirus epidemic. I just think this is something, Peter, that you can never really think is going to happen. You know, who I've heard all about. This could be, you know, this could be a big deal from before it happened. You know, this something like this could happen. The president claimed, despite past warnings from federal health officials, that such an epidemic was

previously unimaginable. But who would have thought, look, how long ago is it? Six, seven, eight weeks ago. Who would have thought we'd even be having this subject? We were going to hit 30,000 on the Dow like it was clockwork, right? We'll be right back. Here's what else you need to know today. On Tuesday, public and private institutions across the United States took their strongest measures yet to limit the spread of the coronavirus.

Dozens of colleges and universities, from the University of California, Berkeley to Harvard, are closing their doors or asking students to attend classes remotely. Major airlines, including Delta and American Airlines, said they would drastically cut back on international flights. And the nursing home industry issued a recommendation to bar visits from family and friends after deadly outbreaks inside of five nursing homes around Seattle. In New York, officials have created a containment zone around the source of a major outbreak in the city of New Rochelle, north of New York City, ordering schools, community centers, and houses of worship within the zone to close for the next

two weeks, and deploying the National Guard inside the containment area. And in California, a cruise ship with at least 21 infected passengers docked in Oakland, where it was met by workers in protective gear who took those on board to a nearby military base in the largest quarantine operation so far on American soil. For the results of Tuesday night's Democratic primaries, which were held in six states, listen to this morning's episode of The Latest.

You can find it on The Daily Feed or by searching for The Latest wherever you listen. That's it for The Daily. I'm Michael Barbaro. See you tomorrow.