Trump has assembled a fabulous team to test and fight the spread of the virus. The President and his team composed of government and private sector leaders, have done a wonderful job in reassuring the American people that the leadership is and will be in control to minimize the impact of the coronavirus pandemic.
8
@lieberma I assume this was sarcasm. When asked when testing would be available Trump said next question
38
@lieberma
This comment is sarcastic, right? I had to ask, because SOMEONE voted for Trump and still supports him.
35
@lieberma
Just curious, what date did Trump assemble this “fabulous “ team if his? Was it before or after his statements about a hoax or just the flu or calm down it’ll go away soon?
32
No matter what Trump blithers, he is lying. This vapid little man absolutely cannot lead a cub scout troop let alone a company or a nation. With rabid narcissism clouding what little vision he has, we are now at least 2-3 weeks behind where we should be in dealing with this plague.
Ignorant Partisan politics (do you hear that, you lackey Republicans?) does not solve problems - it creates and exacerbates them. So does obstruction to try to keep the truth from the people of this Republic. A REAL President in his official capacity should be a uniter and a master manager. Trump is a grifter and an ignoramus - a divider, hate-monger, liar and denier. That makes him an enemy of the State in REALITY and his followers traitors.
I hate to be so graphic but truth is truth - and the facts are unquestionable here. Trump has been too stupid and narcissistic, among other notably negative traits, to admit that he is grossly unqualified to hold office. A decent, intelligent, honest and smart person would have ceded power over three years ago - or, better yet, never applied for a job for which he is incapable of performing. IMPEACHED Donald John Trump is a national disgrace and must be sidelined as soon as possible. We can't count on his Cabinet (ostensibly OUR "Board of Directors) to correct this horrible mistake.
15
sounds like you should be doing it
2
Has Typhoid Trump (aka Codonaldvirus) been tested yet?
3
Pres. Trump just said that he has memorized the Stafford Act. Here is a link to all 192 pages. Just saying.
https://www.fema.gov/media-library-data/1582133514823-be4368438bd042e3b60f5cec6b377d17/Stafford_June_2019_508.pdf
1
Unfortunately I doubt trump reads the times (I could have dropped “the times” from that sentence). Please ask hannity to read this article on fox tv and then tweet a video
4
Editor:
Why did the U.S. decline to use the WHO test for Covid-19?
Was that decision made by politicians or healthcare professionals?
10
Sounds great. Where is the profit for Amazon coming from? Are the Socialist liberals going to put a profit limit on each delivery?
Good luck keeping Trump and his toadies out of the way!
3
Good Lord. Why is Trump still in the White House. We don't need an incompetent lunatic who ran a casino into the ground in charge of this.
7
My Q: You said you don’t take responsibility for slow response to coronavirus but [your ]administration disbanded the White House office on pandemics? (NPR reporter Yamich Alcindor)
TRUMP: No, I don't know. It's the -- it's [the] administration, perhaps they do that. You know, people let people go. You know, you used to be with a different newspaper than you are now. You know, things like that happen.
And when you say me, I didn't do it. We have a group of people.
ALCINDOR: It's your administration.
TRUMP: I could ask, perhaps -- my administration, but I could perhaps ask Tony about that, because [I don't know anything about it.] I mean, you say we did that. I don't know anything about it.
The only hope is for this man to fly to Mar-a-lago and Self-Isolate until November.
11
Trump Boomers, don't you care about your grandkids?
8
Trump . . . do that? You're dreaming David, a good and intelligent dream which would, of course, be a nightmare for Steve - Trump's "Brain" of the month who favors chaos taught to him by Santa Monica lefties.
Having a NY Opinion piece writing telling people how to fix things in seven days and pretending some easy solution was missed weeks ago is ridiculous. Not only does the whole newspaper pretty much consist of opinions rather than actual news reporting, but the writer is not in any way qualified to give the written advice. Disappointing - probably the same guy that called President Trump nothing but a racist when he restricted travelers from China of a month ago. Hindsight is 20/20 but counting on the NY Times to solve the problem is not solution.
3
We have been at the mercy of Pinocchio's limited intelligence and out-sized ego.
No White House statements can be trusted now.
2
There are too, too many articles/op-eds on the NYT about coronvirus. The politicization and sensationalism of the virus by politicians and the media have caused the sheep to be extremely fearful and panic-driven. Well, Americans are not noted for their high IQ's. The yearly flu season results in thousands of deaths -- no articles on that. The coronavirus so far cannot compare with the Spanish flu of 1918. The blame belongs with the Chinese with their disgusting wildlife/meat markets. They are barbaric, cruel, ignorant, at least those who eat/murder/use those innocent animals.
3
Mr. Trump has put Jared Kushner in charge. Jared is seeking advice from the father of Karlie Kloss, his sister in law. The father of Karlie is a doctor and asked on Facebook for suggestions about how to respond to the pandemic.
Dear friends, this is all true.
It's all here:
https://www.politico.com/news/2020/03/13/jared-kushner-combat-coronavirus-facebook-127941
9
Dr Kessler we need smart and decisive folks like yourself in charge of this rapidly changing situation . The fact that testing is so scarce in the USA is a disgrace compared to countries like S Korea and Australia !!
5
Nah, the orange stable genius decided to let Roche and Walmart handle this. Unbelievable, but hey, this is a guy who hasn't looked at the photo of him standing next to someone who tested positive (or have anyone show him the photo...where is Fox when you need them). He must think that his shenanigans at Studio 54 may him immune to any virus.
1
If this approach can be combined w/ a workable test, theoretically we /might/ be able to manage the projected need for tests (cases doubling every 6 days, 1 million cases by the end of April).
But who will lead that effort? An assistant secretary of health seems more like a scapegoat-to-be. This needs someone more like Bill Gates, someone at an entirely different level.
References:
* https://www.statnews.com/2020/03/10/simple-math-alarming-answers-covid-19/
* https://www.bloomberg.com/news/articles/2020-03-13/roche-gets-clearance-for-coronavirus-test-that-s-10-times-faster to
I don't mean to be disloyal to the Times, but I saw this in the Washington Post today, by Beth Cameron, the person who ran the unit in the National Security Council responsible for the tracking etc. of pandemics. Trump eliminated the office. Explains a lot. HIs obsession to cancel anything Obama did is sick.
https://www.washingtonpost.com/outlook/nsc-pandemic-office-trump-closed/2020/03/13/a70de09c-6491-11ea-acca-80c22bbee96f_story.html?utm_campaign=wp_post_most&utm_medium=email&utm_source=newsletter&wpisrc=nl_most
3
Trump needs to stop talking, stop shaking hands, quarantine himself, and let adults handle this.
4
Let's remember that the President's appointment of Mr. Redfield to head up the CDC was extremely controversial at the time. In his early work with HIV interventions he was stridently opposed to the distribution of free needles or condoms. He similarly opposed the distribution of free condoms in Africa to combat the spread of AIDS there, preferring an abstinence only policy. At the time, he was affiliated with a fringe "Christian" group that espoused the position that AIDS was "God's judgement on homosexuality".
Most Americans would regard such a background as simply repugnant. For Mr Trump they are the very qualities he was looking for in the head of the CDC
1
A British company, Randox Laboratories, apparently has a Covid-19 test that gives results within 5 hours. Perhaps the US should partner with this company to expand production and distribute kits around the US:https://www.randox.com/coronavirus-randox/
Another British company, Mologic, is developing a rapid diagnostic test: https://mologic.co.uk/news/
Perhaps the NYT should investigate what sort of tests are being used elsewhere and how/when can the US get a suitable supply of appropriate rapid tests so that we can try to understand and control the spread of the virus.
2
If only the Administration would read the NYT then they would know what to do...
2
Trump has been an unmitigated failure and an utter embarrassment as a leader.
Incessant lies and disinformation abounds.
Constant clean up on aisle 45.
Maybe these clowns will get their act together.
The problem is Trump still cannot stop himself from lying to the public. He's on tv right now saying that "we don't want everyone getting tests". What an idiot.
Who is he to decide who should be tested?
And he's also still shaking hands with people.
If you pitched this story to a movie studio 3.5 years ago you'd get thrown out of the room.
1
Remember this! his Trump administration spurned the WHO distribution of test kits (which were ready to use) in order to develop and distribute test kits that would be made in U.S.A. (what!?) ... and we know that the decision came from none other than Donald John Trump.
2
From your pen to the ears of those that can make this happen!
I’ll believe it when I see it. My husband was tested today because he has some symptoms, we travelled recently, etc. But the facility where he was took a swab, said they would send it to the state health lab where they would decide whether it should be sent to the CDC, then when the CDC gets it they again will decide whether to test it. You see our state has only been allocated only 700 tests. Never mind that my husband and I are quarantined (I believe in that, it’s ok), but he is a doctor that is not working at a time when doctors are needed. The fastest, if all those levels say ok to test, that he can get results is 5 days.
Somebody fix this!!!
158
@Office manager A British company, Randox, have developed a rapid Covid-19 test and is looking for partners to distribute it. (I have no connection with the company; only read about it in the UK newspaper last week).https://www.randox.com/coronavirus-randox/
2
@Office manager: Wow, just wow. Your state doesn't have any approved labs yet, huh? Hang in there, please.
(But VP Pence said, "Every American can be tested"!)
4
Nonsense.
You think lab facilities can generate the estimated 50 million test kids needed within 7 days?
What kind of dream world is the author living in?
21
Remember when we actually had competent leadership?
2
Once again America was vcuaght out flat-footed.. Shucks, ain't nothin gunna happen, man. This is what happens when a culture idolizes nincompoops and disdains educated and knowledgeable people as nerds, geeks and wimps; and has it's head in the sand most of the time about most of its pressing needs as a society and national community!! Ah, the joys of individualism and my rights, my rights!! I hope this will be a lasting lesson, but I doubt it.
1
Japan is reporting reinfections after people recover. So maybe, not so fast.
1
Awesome idea! Let's put Jarvanka in charge of implementing this.
1
Just read this elsewhere: https://www.businessinsider.com/jack-ma-pledges-to-ship-coronavirus-tests-masks-to-us-2020-3
Jack Mar of Alibaba is providing the US with 500K test kits and 1M face masks. If that's the case, it's hopeful that people all over the world can work together on this one.
Right. This should have been done in January, when the Corona virus was known to be in China and there was a great likelihood of it spreading worldwide. Of course, Trump's not responsible for that. It was Obama's fault.
4
The virus has been present in the US since December. Trump made it his mission to undermine the CDC, state public health departments, and individual doctors.
Hopefully he and his family get the virus and in his case i pray it is fatal. He is a liar, a cheat, a monster, a rapist, a greedy cowardly evil stain on our democracy. His adult family members and all his enablers.
Let’s hope the Trump Virus does what the impeachment trial didnt - rid us of him. Amen
4
Trump calls the valid question: "Why did you close the Office of Pandemic Preparation?" a nasty one. However, he forgot to answer the question. Why? Because his big brain told him to close it.
5
Reading all these comments on the USA Co I’d-19 testing fiasco is like reading a report on a mega-gigantic dam bursting, in the middle of the night, and the communities downstream asking for information on what flood relief measures might be put in place next month.
Too little TOO LATE. The damage is done! It was done as Trump had already severed friendly relationships with countries that were creating and disbursing the tests, and as he ignorantly bragged about the US's invincibility while the virus was already proliferating, and killing, in the US. IS proliferating, but who the heck knows if they have the virus!????? You have to have had contact with someone who is known to have it, or to be traveling from a hotspot country.... but we're way past that! His insatiable ego and utter foolishness is the bottom line for this catastrophe.
I hope the strategy outlined by Dr. Kessler actually happens and is a miraculous success. I will give Trump zero credit for any success. I will pray for his base to see his actions for what they really are.
2
I can't help but suspect that the continuing delay in testing is a deliberate policy of Trump himself. He cares more about " the numbers are where I like them" than about the lives of the American people. Of course this is entirely in character, as Trump cares only about Trump, period.He is a traitor to his oath of office and to the people of the United States.
You can lie all you want, Mr. Trump, and do your best to hide the true number of cases, but the Virus doesn't care, and it's coming, sooner than you think, and your lies are a worthless defense against it.
2
Are there enough test kits?
THE TESTING MESS IS DUE TO The most dangerous, criminal sort of neglect by Trump: Outright denial of any danger. Here you have the incompetent, ignorant Trump spouting idiocies he must have gleaned from that font of sewage, Fox News. He announced that the COVID-19 was like the flu. In fact in the Cabinet room he said that the flu vaccine could be used to treat the COVID-19 virus. That's the most dangerous sort of lie anyone could utter! Anthony Fauci, the doctor who's the expert leading the medical end of things didn't say that! No informed person would say that! Only someone who cares NOTHING about the lives of people in the USA would say such a destructive thing! But we're stuck with Donald Trump. Many thanks to the destructive Susan Collins, Lisa Murkowski and Lamar Alexander for letting the greatest criminal in human history off the hook! Remember that when you go to vote in November. If you make it through the COVID-19 that is!
5
There are five people in this country who could quickly end this country’s prolonged suffering, shame and embarrassment under Trump.
They are Melania, Ivanka, Jared, Hope Hicks and Stormy Daniels.
Four of them are women.
All they would need to do is get together and hold a press conference.
1
If an effort such as this could be up and running a week, it could act as screening tool. The trick is to make the screen one that can detect a large number accurately.
Then anyone who tested postive on the screening test could be referred on for the more accurate/formalized test now available.
Think original, earlier, flu swab screens. If you swabbed positive, you were then sent for more accurate PCR testing. (Of course our current flu swabs have advanced to PCR, but COVID-19 will eventually get there, too).
There never would have been a "testing mess" if Trump had admitted he was out of his depth, acknowledged the shortage of test kits and allocated funds to buy them from countries where they are readily available, such as Australia and South Korea. He also could have risen above himself and announced that he was diverting funds from wall construction to combat the spread of coronavirus.
3
The state of public health in this country has declined every year of this century, a shocking fact considering the significant infections — e.g. SARS, MERS, Ebola, and now COVID-19 — we have seen during the period. I’d encourage people to look at the report by the non-partisan Trust for America’s Health, https://www.tfah.org/wp-content/uploads/2019/04/TFAH-2019-PublicHealthFunding-06.pdf. In particular, The Prevention and Public Health Fund has suffered over this period by having the fund pay for other legislative programs that have nothing to do with its mandate, a well-known tactic in the era of tax cuts to place a bandaid over a gaping wound.
Public health is more than just a response to emergencies such as COVID-19. Part of the public health mandate is to improve the overall health of the nation’s citizens by reducing obesity, encouraging smoking cessation, improving diet, promoting vaccinations, and other ongoing programs. As we have been reminded during the current crisis, those who contract the corona virus disease and have the worst reactions are those whose health is already compromised. In the US, those aren’t just the very young or old; those with compromised lung function because of smoking, or those who are significantly overweight, those who haven’t corrected blood pressure are more likely to die when infected by this virus. Cutting public health is as they say penny-wise but dollar-foolish.
2
The article at the link below explains in really good detail what the response in different countries of the world has been and how those measures have affected the spread of the virus. Social distancing now, everywhere, not just in outbreak areas, is the only thing that will help. I have been sharing it everywhere, sending it to my elected representative, family and friends. Please, read and share. Turn the pressure on people who are in a position to act.
https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca
Where were you at the end of January? Way too little, way too late.
Posted this before unsure whether it’s true but China apparently offered payments on sliding scale from 2000 to 50 dollars to be tested.Two grand if u got it or 50 if u ain’t.
Dr. David Ho, one of the most eminent physicians who worked during the AIDS crisis, was on Rachael Maddow on Friday night. He is currently working on developing treatments for COVID-19. Speaking about the lack of tests he said, “without the tests, we are blind.” That statement was chilling.
Anyone paying attention knew Trump was unfit in a myriad of ways. He is certainly unfit to effectively lead in our current crisis, as is his minion Pence. How many people will die because of Trump’s stupidity and hubris? How much will the economy suffer? How long will it take to recover from the mishandling of this pandemic?
Even Friday in The Rose Garden Trump stood there and repeatedly lied. Then he shook hands with a number of the businessmen behind him. If there had been an eclipse, he would have stared at it with no protective glasses. His idiocy never ceases to amaze. How shameful for our country that this is our President. He must be removed in November. Our people are in mortal danger with Trump at the helm.
God help The United States of America.
6
Yes, I heard Dr. Ho last night and the same chill went through me. And I must say that with the exception of Dr. Anthony Fauci at Trump’s press conference, the rest of the group gave the impression of being robots with an on and off button in back controlled by Trump. And Trump, himself, was such an outstanding example of an incompetetent, lying, marauding criminal that it is a wonder the press folks weren’t all vomiting.
2
I was watching a YouTube video the other day of how in 1940 the US government working with Ford Motor Company ser up a factory to make Liberator 4 engine bombers. The factory employed 42,000 workers and produce a bomber ever hour. Surely US can overcome this virus. Just needs some competent leaders
Trump is realistic about what can and can't be done. stop comparing US to other countries: what they do mostly won't fly here. I see a smooth approach to containment. if he did too much and the virus did not materialize into a widespread problem, he would be criticized for overreacting. sut back and continue to enjoy the ride, while stocking up on mostly useless masks and hand sanitizers. this epidemic is not revealing anything about Trump, other than his continued steady lead, but it is showing humans, once again, to be the silliest species on the planet. run, forest, run.
3
@Steve Borsher So the issue then is that he was not willing to take the criticism for doing the right thing. Because, responding earlier would have the right thing to do. And that's not coming from Hindsight. I've been watching this spread via that John Hopkins site since early January.
25
@Steve Borsher
When a hurricane and nor'easter storm are combining and heading to the northeast coast, we expect the leadership to react and overreact to the danger. If by luck the damage is bad but not catastrophic, then the public fully understands. The leadership is thus admired for doing the right thing, and further admired for having the guts to do the right thing. Do we ever see Trump doing the right thing and acting in behalf of the public welfare?
29
Trump is being realistic? The US should not be compared to other countries? I wish I could agree with you, but I have to believe the evidence in front of me. As an American citizen living outside the US, I can tell you that it would do the United States a world of good to compare itself with other developed representative democracies realistically. The narrative that the US is the greatest is a delusion that prevents Americans from demanding that their government make necessary and appropriate changes.
27
Seven days!
What happened to the WHO protocol that was offered worldwide in well over a month ago? Why does Canada and Australia have this “under control?” Why is the Pres. so proud that the U.S. test kits were finally patented by some big drug company? Why was this NOT in the public domain? If an academic researcher in Seattle could develop a testing procedure in her lab what were all those labs at CDC, NIEHS and NIH doing? Are we waiting one more week because this administration wanted to insure that some could profit from this health emergency?
Oh, I forgot. This is a MAGA administration!
3
Remember the families separated and caged at the border? Remember the pictures of neglect? Remember the administration’s response?
It is like a “summer camp?”
So, why should we be surprised when we witness incompetence, lack of empathy and lies?
We are all in cages now. Luckily, we can vote, and this is an election year. Luckily, we still have truthful media sources like The New York Times, The Wall Street Journal, The Washington Post, MSNBC, ETC. Luckily, even chastened voices from the right are embracing the truth, once in a while.
As we all confront new conditions like “social distancing”and “self quarantine,” like the wholesale cancellation of “normal,” like the rising ratios of cases and deaths, we would do well to remember those on the border while we face our own summer camps.
3
Our healthcare system is ripping off our government .
The W.H.O. had cheap test kits available months ago but big pharma told our government, that's right they told our government to wait until they could come up with one to exclusively sell here in the US. They are charging $1300 dollars apiece for them. Then Washington says that they will give the test for free. They are not free . We are paying for them with our taxes.
3
Time to take healthcare out of the hands of the Marketers that run the private sector and have Public healthcare officials make decisions about what and when drugs and diagnostics are produced. Fifteen years have past since Corona viruses killed thousands and during that time these viruses have popped up again and again in various countries on a smaller scale. Why don't we have accurate, rapid diagnostics or vaccines for that matter? Once the headlines are gone or if the annual market is less than $500 million, Big Pharma, Merck, Pfizer, Galaxo and others lose interest. Let the private sector produce what is or might be needed, but the decision to go forward with development, initial investment and efficacy be controlled by qualified, highly trained scientists, epidemiologists, nurses and doctors. Remove market forces from these decisions, your and my health should not be monetized.
3
My person who was lucky to get a test must wait 4 DAYS for result in New York City. FOUR DAYS. This person was also in Italy during the outbreak where none of the passengers were tested coming in to JFK. From that plane one is in hospital, my person, and her friend sick at home self quarantined waiting for results. I am self quarantined as I visited my person and have symptoms and awaiting results from test. We should have an immediate spit test, this is certainly ridiculous.
Frankly New York City be prepared because now it’s going to hit.
3
To my doctor yesterday-
I am caring for a house bound 94 year old friend. While taking what precautions I can I fear exposing her and endangering her life. It's important to the safety of my friend that I am free from the virus.
From my doctor-
I understand the gravity of the risk to your friend if you were to get infected.
While things are changing rapidly on a daily basis, currently testing for COVID–19 remains extremely limited. At the moment, it is only being performed in symptomatic patients under specific circumstances with the approval of our infectious disease department. Sorry that I am unable to help you with this.
1
The whole world is suffering from Corona virus except Russia.
1
Trump appointed mousy Pence despite having world experts around the country - one who was advising in China and he is negative. This is about cover up - Mar a Lago was a stopping point for a Brazilian official who now tests positive - home in Brazil! Makes the US look stupid and weak. And yes hysteria - Y2K all over!
1
I live in SW Missouri near a town of 53,200 plus several towns around of sizeable populations and as of today, we have a "handful" of test kits for the virus. Disgraceful.
I called Sen. Blunt and our do nothing governor and contacted the CDC.
I guess we will have to have thousands get sick and die before we get even adequate testing.
I am so angry that Trump allowed this travesty to just roll over our nation because he is an idiot.
2
I see we’re again trying to blame Obama for the testing holdup.
That is a flat-out lie.
https://www.factcheck.org/2020/03/trumps-misplaced-blame-on-obama-for-coronavirus-tests/
6
Some relevant reading
https://www.poemuseum.org/the-masque-of-the-red-death
“A day late and a dollar short” is unfortunately the reality of incompetence of the Trump administration.
1
He put the Dollar in his pocket long before he was late
1
In Trump we trust. But just to be safe, owners of MAGA hats should not display them for while.
4
Let's assume that every single person in the country was just handed a Covid-19 test kit with 100% sensitivity and 100% specificity. Exactly what would my fellow NY Times readers do with a positive or negative result?
Does a negative result change avoidance behaviors that you should be doing anyway? I would hope that a negative result does not make you feel immune to the threat of infection. You should be isolating. That is the point of "bending the curve" of new infection, limiting crowds, and protecting your own families.
Does a positive result mean you frantically travel to the nearest emergency room? This is what all hospital staff fears, that the millions and millions of Americans will flood the ERs over a simple test. If you have symptoms, stay at home, please! Positive test in hand, the hospital does not have anything to offer you - except if you already need ICU level care, which you don't if you are reading this. Hospital ERs are usually flooded with millions of non-sensical visitors, they do not need more because of this hysteria.
True enough. But adequate testing will provide critical information about the disease and its spread through the population, information that will save lives.
2
In large part, the test results are not for you, the individual, they are for society as a whole. Health care professionals, administrators and mangers need this information to monitor the progress of the pandemic, to understand the efficacy of responses and to plan for the future. If we can learn as much as we can about COVID-19 this spring, then we will have a better chance when it returns next fall.
1
Here’s the deal panicked Americans......testing alone doesn’t save your life. Nor does testing negative mean you won’t get the virus.
More likely than not most reactions will be mild and, presently, there doesn’t seem to be a known medical treatment. This panic about testing is similar to the people panicking about toilet paper; ridiculous.
Not true. The testing data is not for the individual. One datum, your result, is meaningless. What is important is to develop an accurate data set so that we, society as a whole, can learn as much as we can about this virus. The panic is that public health and medical professionals know very little about COVID-19. Your responsibility is to not think “me”, but to think “we.”
2
Take a moment to expand your thoughts beyond yourself. The data captured through testing helps identify hot spots for targeted action. Last I checked hoarding toilet paper doesn’t offer the same benefits.
2
Unfortunately, yesterday’s response from the White House was another empty self congratulatory exercise by the President, as the reality is that testing remains a challenge and the Google website he touted is not Google, is not up and running, is preparing to go active at one location in the “Bay Area” and go from there. (“Has this man no self awareness of how immature it is to continually be praising himself?) I am so sick of watching this charade of Trump, Pence, and the “experts” all of which first have to nauseatingly go thru the drill of telling Trump how wonderful he is, before disseminating the newest empty promises regarding this very serious threat. It is criminal that weeks into this we are not able to test for this virus in this Country. This medical crisis certainly brings home the shortcomings of our supposedly “wonderful medical system”. We were offered tests by the WHO from the beginning and could have been up and testing from day one, but we refused them. I strongly suspect Trump felt if he didn’t test, you could deny the extent of the spread, and he could then protect the Market while we died quietly at home in our beds. Well, this is what happens when you elect a totally incompetent Arrogant Sociopath, and then refuse to hold him accountable. We as a Country have paid a very high price!
4
Maybe this health disaster will encourage folks to vote Trump and his Cronies out of office. When you have Miller and Kushner as Senior Advisers you know we’re in trouble.
Ok then there’s Pence whose nose couldn’t be browner!
4
Couldn't we fix the testing mess in 7 hours (not days) by simply buying existing tests from the WHO?
The WHO has apparently offered the tests to the U.S. South Korea has offered tests as well.
I am not sure why the U.S. has to reinvent a wheel that has already been used successfully by the WHO and South Korea.
Can anyone explain this?
50
This is an essential question that must be answered and someone held accountable.
5
@Teri
A homemade testing system could pick more money from American pockets by high-balling the cost of the test kit.
1
@Teri
Because accepting help from the WHO would appear to be demeaning to some politicians?
1
Do not forget that Donald J Trump the person who was supposed to be in charge originally referred to this Covid-19 Pandemic as a "HOAX" and later worried that the Democrats and News Media were making it look worse than it really would be to make Trump look bad. How can anyone expect competence when the CEO is a paranoid narcissist who thinks everything happens to his benefit or detriment. What about all those who are sickening or dying or losing take-home pay because of this epidemic? How can we continue to move forward with such a flawed human being in charge?
2
I am currently experiencing the initial symptoms of covid-19. I asked my doctor for a test and she said no. I don't fit the strict guidelines for getting tested.
I live in the Bay Area and teach middle and high school students privately. And I think I know which of my students might have been the source of the virus. He will not get tested, either, because he is young and he is getting better fast.
I am not young and I am scared. Reading Dr. Kessler's column I felt a jolt of hope, a smart voice sounding like a true American innovating on the spot. And I cried, I guess because all we read is bad news. We need some hopeful good news.
I hope that the "test czar" will read this and take ideas from it.
123
@InTheKnow Believe it or not, you are a lucky one. You will receive care before the hospitals implode. Just gotta wait a few more days for the tests to put you there. Good luck.
5
@InTheKnow
So sorry to hear your situation!
May you find the care you need quickly!
I can't believe we are the citizens of the sole super power on the planet and can't get basic healthcare that's an assumed right everywhere else.
In South Korea, where they're testing 10,000 people every day, they don't ask you if you have insurance and take a copay.
Because basic healthcare is free for all citizens!
10
@Intheknow Same here with symptoms except where I live there are NO TESTS available. I don’t know what worse knowing you could be tested or not being able to have one.
4
Sounds like Trump may have listened to you. Great minds think alike.
Sorry but today's press conference seemed to me a bunch of sharks swimming around the dough that was thrown in the water. Anyone Trump brings in is in it for the money -- he's the number one grifter
Young friend went today to doctor with classics symptoms including fever and infected lungs, could not get tested due to shortage. Wow. Our government has failed us!
21
@Frederick
I am hearing the same from friends , and family.
U.S. cases surpass 2,000 while death toll is now 42. I am staying home. This administration is useless in this crisis. But Trump is all around useless. Get rid of him. Although Pence believes he can pray away the crisis and is just as useless. Heaven help us all.
Dr Giroir directly reports to VP Pence. VP Pence does not believe in evolution, so is unable to understand how reverse transcription polymerase chain reaction testing for a novel RNA virus works.
1
Biden isn't president and he asks experts to help him. Trump asks Steven Miller and Jared. Therein lies the problem. It is the equivalent of being diagnosed with cancer and asking the check out person at the grocery store what you should do. And then when you do finally call the doctor, refusing to listen to their advice. I am sure most people who support Trump deal with problems in their lives the exact same way. Just imagine a friend with cancer saying the doctor is a 'snake in the grass' or it's a hoax I have cancer and waiting until the symptoms become a big problem before doing what the doctor says. The result will be exactly the same. "You waited too long. I am sorry. There's not much I can do for you."
3
Who authorized the turning down of 60,000 ready to go test kits from the W.H.O. In early January? I have yet to hear an answer on this. Don't tell me its not relevant at this point because I think it is.People are going to die here because of this decision.Of all the heinously bad things this administration has done over the years I think this is the most egregious thing ever. I want the democrats to drill down on this.
83
@RBO - It was reported that the administration told the WHO we would develop our OWN test. The test was flawed. CDC got their funds cut by Donald J. Trump.
Trump also closed the White House office on pandemics, as reported by the head of that effort who was fired and her office closed (Bolton was NSC at the time).
Trump isn't taking any responsibility for anything, but credit for everything good or made up in his schpeal.
16
@RBO Because Big Pharma is making new expensive kits to sell to our government. 1300 bucks a piece.
10
This is THE question that must be answered. Which office or which individual was offered the WHO tests and why was the decision made to refuse them? We have been flying blind for a month-and-a-half or two. Why?
16
All these private industries are going to own databases filled with our medical information? How could that go wrong? This smorgasbord of scrambled privatized services may be necessary at this late, late point, but it exposes the toxic neglect that Washington has allowed to occur to its health agencies and to the public trust.
31
@Jaden Good comment but at this time of panic I don't think most people would care too much about secrecy of their medical data. Get cured and avoid death is on most peoples' minds.
2
@Jaden 50 yeras of gross neglect...!!!
@Jaden
Allowing private companies to have access to your health data is very risky.
Nerd alert -- if you really want to know how the DNA sequencing works in detail, the Wikipedia article isn't bad:
https://en.wikipedia.org/wiki/DNA_sequencer
Tip: you can go through the list of manufacturers, identify a particular machine, and try to find the machine's operating manual, which is often on the internet.
One of America's strengths is that there are many loci of power. Thus, in spite of Trump's non and counter-productive "leadership", governors, mayors, business people, religious leaders, school boards, and others are getting it together to do the right thing, to do what is necessary. Of course such cannot replace a well-developed national plan and Presidential leadership, but it will serve our people well, reminding us in the process that we are not alone.
A proper response can only come with coordinated planning, whicht should have been done years ago. And that is the fault of all of us, not only a succession of Republican and Democratic Administrations that failed to do so. Evolution has largely created us as beings more concerned with present and near-future threats and needs than with those that are long-term and abstract. Putting it simply, we never demanded that our leaders prepare for such a threat, even though, sooner or later, it was inevitable that the threat would materialize.
Though Trump has done everything in his power to screw things up in most ways, nonetheless he would not get away with it if the American people, Republicans and Democrats alike, had not encouraged the transfer of power to the President and the Executive Branch, powers previously held by Congress and the States. Whenever their man was President, increased power was fine for Democrats and Republicans, ignoring that the power would remain there when someone they didn't like held the office.
With regard to our government, we seem to be living in some strange futuristic hell. I fear that the administration did not want tests so that "the numbers" could be manipulated to their political advantage.
If the government has been cut to the point of such total ineffectuality, we are indeed in dire shape and should vote them all out!
1
They've been talking - for ages - about the next pandemic. Year after year went by without one, so complacency finally set in. 'Cry wolf.' Many more examples of this syndrome: lack of prep for the next 1906-type earthquake; for the next Fukishima; for the next Tunguska; and, of course, climate change. Among others.
1
I’m not a Biden fan...and even I admit, WE HAVE TO HAVE SOMEONE, ANYONE able to deploy appropriate organizational leadership to save us.
3
My country was poorly prepared for this long overdue situation. What else are we ill prepared to meet? Climate change? Don't worry, it'll go away as soon as it warms. Ha I made myself laugh with that one.
2
Suggestions, comments here, some good, some bad. Here's the thing. They all blow right past the primary fact in this article.
Dr Robert Redfield, director of the Centers for Disease Control and Preventiont told Congress he DID NOT KNOW who was in charge of making sure that people can be tested for Covid-19, especially health care workers. He is reported as saying his responsibility was only to ensure that state publicise health laboratories have access to the test. Pressed further, he said he would look into who was in charge.
Where is the outrage? Absent from comments here, for sure! If this reporting is accurate, this guy is asleep at the switch.
2
Redfield should not have been hired in the first place (but Senate Republicans pushed hin through). He should now be fired and someone with actual public health expertise put in place now.
2
2 more things:
1 - Temperature checks. Good solid evidence analysis of Chinese cases show high temperature was the earliest and most consistently reliable indicator of infection. People infected don't show signs except temperature increase. That's why the Chinese are checking everyone's temp. all the time. Those famous Korean drive-thru test facilities actually do the first pass as a temp. check.
Thermometers aren't high tech. States need to distribute them widely, and have people check a lot. Stores can remain open by checking all customers' temperatures.
2 - Invent better mask. Masks are useless if they're not dense enough to catch viral particles, and dangerous if they are. Dangerous because they become a storage bank of virus that's inches from your nose and mouth. Virus doesn't die in the mask, which is moist by your own breath. Solution: a layer in the mask that either desiccates microbes, or otherwise kills them. Without harming the wearer.
A final note: the WHO reported 3 days ago that careful household surveys in Wuhan found children weren't vectors, but caught the disease from adults. This isn't the flu.
There’s something strange happening with the whole test kit “shortage” and the media keep turning to the Trump administration for answers when in fact they may be the problem. Perhaps they should be looking into the supply chain for an answer to the bottle neck.
1
Sorry even if Trump had the authority to mandate all of this it couldn't be done in 7 days.
This afternoon during his interminable press conference of self congratulation Trump most openly and excessively shook hands with all the CEOs of America's leading corporations that he himself identified as being essential to the fight against Covid-19. Good Job, Trumpy!
3
Trump does not want people tested because he wants the numbers to be low - meaning if we knew how many people actually had the virus it would be bad for his re-election.
The World health Organization had a working test in early February and shipped it to 60 countries but not the US because Trump never requested it.
This has been a colossal failure of leadership as well as a disgusting unimaginable assault on our health by the narcissist in chief.
2
In home testing is missing in this discussion
I believe the test is being considered in Canada and helps deal with social distancing and the urgent for open access to testing
Sorry. Any new test has to be validated. Don't see that happening in 7 days.
5
@PD
retired AMA attorney F/71
The blocking of well-validated tests getting into use here has been a two-fold failure of leadership: 1) FDA's Office of in vitro diagnostics (OIVD) leaders have been applying non-emergency review and clearance standards to ex-U.S. mfrs tests, e.g., Roche's COVID-19 test as part of the company's automated platforms in our largest hospitals and commercial labs for years. At 5:17AM yesterday, Roche got its EUA cleared to ramp up its test system's use in this country.
Those of us who know about OIVD's fear of the boss' retaliation have worked tirelessly to get Roche's testing cleared for use here.
2) FDA leaders fear of their boss is warranted. The man in TWH has one priority and unwavering message: this new virus is just like a cold--no big deal. He refuses to own potential bad outcomes should his administration fail to get ready for pandemic-level mayhem with this virus.
By law, when a President's signs a declaration of a major disaster, hurricanes to infectious diseases, all state and federal legal barriers to getting essential goods and service where they are needed go away.
OIVD no longer fears retaliation and knows that Roche's test system runs 10 times the volume, getting Y/N results to clinicians and patients within four hours.
Ditto for NY State's Wadsworth Lab. Its Director, Dr. Jill Taylor, is a world reknowned virologist who led her team's test method validation and got FDA's first EUA, albeit too late.
4
I'm watching this debacle of a "news conference". One long commercial of free advertising for the very companies that have greatly contibuted to the destruction of the wages in America. This is a disgrace.
45
Stop making apologies for our President who has the mentality of a 12 year old.
71
@Milque Toast Most 12 year olds have more empathy than this president.
1
@Milque Toast
You are being generous.
You are insulting all 12 year olds....
1
We need to be doing random tests of everybody! Not of people who think they “need” tests... Research is showing that COVID-19 carriers are most contagious before they experience symptoms. Catching pre-symptom carriers and isolating them prevents the healthcare system being overwhelmed later on, and has proven to be the difference between the 4+% mortality rate in Italy and the <1% rate in S. Korea.
67
What I see in my own state - Michigan - is terrifying. Only our Dept. of Health can test, and they have been extremely rigid about who can be testing - until two days ago, the patient had to have traveled internationally. Anyone who believes that the number is the 12 being reported today should understand that fewer than 200 people have been tested in Michigan. I know of one person with pneumonia who has been in a Grand Rapides ICU for almost two weeks. His doctor requested testing early on and the MiDH declined. If this patient has COVID-19, a vast number of health care workers have been exposed. I'm sure this is repeated throughout the state and throughout the country. If we don't test widely, we will cripple our health care system.
156
@Anne Same thing in Illinios. Woman in La Grange hospitalized w/Pneumonia plus has Athsma and Immune system issue. No Test. She finally reaches out to local news from hospital room. Finally 1 day after she is discharged, hospital calls to say she could come back for test....but would need to under go 2 day quarantine.
3
This is a start, but it's still not nearly enough. The author writes: "First priority for testing should be given to hospitals, nursing homes and health care workers."
Indeed, it should. But the only way to contain this is to get an accurate read on who is positive, and then trace and test their contacts.
We need far, far more than testing of people who are hospitalized, working in hospitals, and living in nursing homes.
The only other alternative seems to be to shut down the country indefinitely.
We can resume normalcy much more quickly when everyone who has potentially been exposed or has any symptoms has been tested.
We can close schools temporarily and then let the kids back in all the kids who test negative.
Every day we waste is not only losing ground against this pandemic but also losing money for businesses, losing critical education and social time for our kids, and losing wages for the parents who need to stay home with kids while the schools are closed.
18
@Rose And what happens when the kids go home, go to sports practice etc? One negative test only captures a moment in time.
How about a certification program for service industry workers such as flight attendants, restaurant servers, hotel staff, store clerks, or anyone who deals directly with the travelling public? They could wear a badge; it would ease the mind of someone, such as myself, who has to travel within the next couple of weeks. Hospital workers should be tested first, of course, then the service industry. They help us get from here to there, make up our beds, serve our food, clean up after us, and I salute them. They deserve some peace of mind, as well.
26
@John Someone who tests negative today, might be infected the next day. Given the irresponsible scarcity of testing kits, it is not possible to keep testing the same people over and over to ensure the sort of badges you suggest have any validity after the first day of issue.
It would be best for you to find ways to do whatever you do from a distance rather than fly at this time. It is not worth the risk both to you yourself as well as to others.
9
@John
Some folks had a similar idea for various other disease situations, but the problem is that someone who tested negative yesterday may have been exposed immediately after. It would create a more dangerous situation because it would instill a false sense of security.
Wash your hands people!!
4
I worked a drive -through flu vaccine clinic in 2010. It was in conjunction with the local navy base who had medics involved with the local community health department. The entire idea of the exercise was to be prepared for an emergency response in the event of a pandemic. So the know how is there, the drill has been practiced and where is the current administration on implementation?
49
This article says that the goal is that “every person in America who needs a test can be tested.” However, testing all persons, not just those “who need a test,” seems to be what’s needed. South Korea, Singapore and Hong Kong, are testing every person since victims are most contagious before they exhibit symptoms. These countries either avoided rapid spread or are seeing new infections leveling off. If the U.S. wants to stave off contagion more effectively, it needs far more testing than appears to be planned.
66
@fishergal I live in Hong Kong. We are definitely NOT testing every person. Please do not spread false information.
7
This is the fourth person to be put "in charge" and yet I heard Trump was waiting for Jared Kushner's opinion before doing anything. Meanwhile, my friend, a doctor in a hospital, is a bit sick and trying to get tested before seeing anymore patients and has been unable to get a test. The incompetence is astounding.
129
@Kristine
The Trump Plague is upon us.
2
@Kristine it gets worse. I just read how Kushner is conducting his research- via Facebook: https://www.politico.com/news/2020/03/13/jared-kushner-combat-coronavirus-facebook-127941
3
This piece would be more comforting if we could believe that the Trump administration will finally recognize the need for this kind of action.
515
@RKD:
What I find MOST troubling is the trump administration was TOLD about this exact threat years ago. Don't believe? Public records show how... and this article describes it (in a reputable journal of U.S. Foreign Policy):
https://www.foreignaffairs.com/articles/2020-03-03/pandemic-disease-threat-national-security
This article excerpt describes a meeting years ago, with trump administration officials:
"On January 13, 2017, national security officials assembled in the White House to chart a response to a global pandemic. A new virus was spreading with alarming speed, causing global transportation stoppages, supply-chain disruptions, and plunging stock prices. With a vaccine many months away, U.S. health-care infrastructure was severely strained."
In fact, the outgoing Obama administration setup this large meeting to help (train) trump's people on the above scenario, as a possible real future threat.
Today, that exact scenario is occurring.
Obama warned trump about this exact scenario. Yet instead, in 2018 trump fired (had removed) the National Security Council's leaders to prepare for pandemics, and the U.S. Global Health Security and Biodefense Directorate (office). trump dismantled our ability to prepare for and fight this exact pandemic -- that "Obama taught him" was realistic.
41
@RKD
In today's update, Pres. Trump's prepared statement included that 'regulations on the medical industry are being lifted so that Americans can receive the healthcare "they are entitled to."'
Has the Trump administration just taken the unprecedented, for Republicans, step of asserting that we are entitled to healthcare?
I hope some one will run with this before they walk it back.
11
@RKD not just the current administration - this is the result of DECADES of cutting funding for research and medicine and infrastructure. Cutting staff, reducing competencies, relying on the private sector to pick up the slack. THIS is the result.
6
Thank you Dr. Kessler. I hope officials within the federal government listen to your suggestions here.
As a longtime "student" of the Food and Drug Administration, including its leadership (or lack of same), I believe you were the last commissioner who took the agency's mission statement seriously.
As a former hospital COO and long time clinician in the medical and educational spheres, I am now listening most closely to California's state and local agencies for the latest recommendations and updates.
We have an opportunity to avert the worst catastrophe, as you clearly state here. Let's do so for the good of all of us.
390
One more thing that should be done. There should be a federal law against price gouging and hoarding.Your article: He Has 17,700 Bottles of Hand Sanitizer and Nowhere to Sell Them
told well the story of a man who has hurt many people by trying to make a profit from the virus. In any disaster, people rush out to clear out grocery stores, gas and any other supplies they think they need. That's normal. I can remember during several hurricanes in Fl where I lived for 25 years, prices were frozen but this took an order from the governor. What is lacking here is old news. No leadership at the top. I can only hope that man has to eat all his hand sanitizers and wipes.
3
I honestly believe that this is a failure, not of process, but of will. Trump isn's interested in an accurate talley of the number infected. He lives and dies by the polls and charts as long as they point in his favor. Anything else is fake news or a left wing conspiracy. The virus is a foreign "thing" and can be banned or blamed, which ever serves him best. In the meantime we have no means of accurately gauging where the virus has spread and the degree of infection, except by those seriously enough compromised to end up in the hospital or meeting a vague criteria of foreign travel or contact with a diagnosed person. But people need to remember there is no therapy available in simply testing. But testing is our only means of gathering enough information to reasonably inform hospitals of needs to prepare for an influx of patients, and for communities to institute reasonable expansion of restrictions.
1
Much information is still being withheld from the public. We still do not know what went wrong. I have seen government contracting officers in action. They are obsessive and intrusive micro managers, and they know the details.
We are getting information in the bizarre style of yesterday’s press conference. Every expert says something about trumps forceful and wise leadership, throws a few nuggets of potential truth out mixed with more trump attribution. “ thank you mr president for directing me to get up this morning and work on this test, couldn’t have done that lab experiment without your inspirational leadership”. And then Trump says he’s not responsible for stuff his administration does.
Zero credibility. It’s very hard to improve a complex situation when people are honest, and impossible in a culture of disinformation, misdirection, and blame shifting.
22
@George Trump's declaration that he had "no responsibility" for the sluggish testing deployment and then didn't know about the firing of the WH pandemic unit was just a stunning display of incompetent leadership.
And yet...Cult 45 labors on in undiminished support and defense of Donald Trump. It's baffling beyond words.
1
I was concerned about the way our health care system in Italy was considered like a "small country" health system or a third/fourth maybe fifth country health care system.
According to WHO our health care system (which is an universal and public system; we do not pay for almost all treatments or we pay a small amount) is one of the best of the world.
This is the starting point of any discussion to go to the second step of it: despite this very good starting point, if you do not control the outbreak peak and "smooth the wave" you can achieve to a very bad overload of all hospital and get very close to their collapse. The worst scenario in an virus outbreak.
We get very close to this situation in Lombardia, in which hospitals (you should take in your mind this) were usually done heart transplants, extremely sophisticated cancer treatments and so on. All these things, if not postponable, are canceled and whole departments (including ORs) are reconverted in ICUs. The queue of Ambulances at the ER in Lombardia, showed also in NYT, is an example. patients must be very carefully treated and this needs time and very strong mental application in order to prevent further spread of the virus. If you have something like this for many consecutive days also a very good healthcare system can go to collapse.
16
Unfortunately, there is a severe shortage of chemicals and supplies needed for the testing, including extraction reagents, pipette tips, enzymes, etc. This article does not address the supply chain issues, which are largely out of CDC’s control. There are also regulatory hurdles preventing labs from implementing testing. And what we really need for population screening is a rapid, point-of-care test that can be administered in a physician office or other non-laboratory setting. If Dr. Kessler could find a way to fix all that in 7 days, the laboratory community would be eternally grateful.
12
@JB As someone on the "inside" of virus testing, what would have been the barriers/constraints for the federal government to have planned so that they could have built a test capacity of... say... 100 million within 2-3 weeks elapsed time?
I get that now there are shortages of reagents, primers/probes, supplies but why couldn't they have been stockpiled? Why in the world would we try to make our pandemic response just-in-time? Saving expense via efficiency is not a valid answer IMHO.
And what ever became of VirScan (a single blood drop was to test for nearly all viruses)? It was on track to be "commercialized" back in 2014?
I KNOW that gowns and other protective gear, decontaminates/sterilizers, ventilators, mobile & rapid build fever/treatment sites, etc. can be made in advance so won't even ask why as the answer's obvious.
9
You are asking good questions. I expect that there are a multitude of reasons, and I am sure that I don’t fully understand all the considerations and constraints. One issue is that the nature of an emerging infectious agent is that it is hard to predict what new thing may be coming, so the test component that is specific for the pathogen needs to be developed “on the fly”. That can be done relatively quickly for a PCR-based test, but is more of a challenge for a serological test, such as what was needed for Zika virus. Because FDA requires that, during an emergency, tests require an Emergency Use Authorization, the exact reagents and supplies must be spelled out in the instructions for use. So any changes, such as swapping out one component for another brand, or even using a different testing instrument requires FDA approval. Labs don’t all have the same instrumentation, which makes it challenging for CDC to get a test out quickly if they have provide data to FDA on multiple instruments. And it’s tough to stockpile instruments. That being said, laboratories that are part of the Laboratory Response Network (LRN) do have the same PCR instruments. So it should be possible to at least stockpile ancillary reagents for PCR and have them available for emergencies. That way LRN labs will have some test capacity until commercial labs come online. Speaking of which, having commercial and clinical labs as part of the network would also be helpful.
The American effort to contain or mitigate the spread of the coronavirus has illuminated the rot in our political system more than any other series of failures in recent history. There is plenty of blame to share. Obviously, President Trump's refusal to take any responsibility for any of his multiple blunders, is an epic failure of leadership. His pre-election boast, that he could shot somebody on 5th Avenue without loosing a vote appeared to hold true, right up until he put the rhetorical gun to his own head in the Rose Garden this afternoon. His direct denial that he had any responsibility for the administrative roadblocks that prevented the timely implementation of Coronavirus testing, was an historic blunder that simultaneously revealed the depths of his moral cowardice. The resulting impediment in our effort to mitigate the spread of the virus will cost thousands of lives. Trump's proclamation of obliviousness was Political Gold for his opponents that will weigh on his re-election hopes like cement shoes on a swim in the East River
19
You can turn an underfunded public health care system and understaffed for profit system into an efficient machine overnight.
Understaffed public health care systems have difficulty doing contact tracing and monitoring home isolation. Understaffed private health care systems have difficulties creating capacity to manage the outbreaks while providing care to non covid 19 suspected and real cases.
With structural deficiencies, we need to focus if what we can do. Priorities are to protect the health care system from nosocomial transmission and creating more capacity to treat severe covid 19 cases.
Otherwise health care workers will die of covid exhaustion before they die of covid infection.
Testing is one thing. The existing capacity to handle all positive is another story.
4
Dr. Kessler,
Thank you very much for this article.
Dr. Kessler we need you to rejoin this task force in a senior position. Reassemble the former members of President Obama's preparedness task force - scientists, organizers, supply chain experts and turn around this crisis so you save thousand of American lives.
The trump administration has been totally incompetent and dishonest about this viral endemic and has endangered all of us. I watch the news casts and see the people standing behind trump and pence, smirking and nodding, and I can see he has surrounded himself by largely incompetent people.
At the newcast from CDC where trump moaned that he didn't want to let people off the cruise ship of San Francisco because the extra infected people would "run HIS numbers"
he meant his political numbers. I saw Dr. Redfield alternate between silent nodding (? in agreement) and being expressionless (also sign of agreeing with trump). Unfortunately Dr. Redfield appears to be an appointed political hack. And as head of CDC this leaves us even more vulnerable.
Dr. Kessler, we need you back in our government and in our lives to save us from incompetence.
retired MD
14
You mean if we actually tried to fix this testing mess we could?
6
Nahhh. When there were only 15 cases, acting president Trump said they were all recovering fine and soon there would only be 2 cases, and then it will go away like a miracle. He also said that anyone who wanted to get tested could get tested. How dare people not believe him?
10
I am not noticing any statement anywhere or in this article that the tests should be for free!
It leads me to believe Trump and private companies are trying to figure out how to make a lot of money on this urgent situation. It is outrageous.
9
How is it that a million tests of the same kind (RT-PCR to determine presence of viral RNA in sample) were made available for the H1N1 outbreak in 2009 in one month or so, and more than ten years later, with presumably much higher throughput technology available, we are still struggling towards testing 100 times fewer people after more than two months?
22
@gumnaam Great question. Of course this novel COV required a few weeks longer than influenza to be sequenced, but that was done by Chinese researchers back in December... and released to the world for free/full use.
IOW, don't let anyone say 'well, it's not the flu virus' as an excuse for the delay.
4
@gumnan: To answer your question, here’s a hint —
In 2009, we had grownups in charge of the executive branch of our government, who had not spent years denying science, dismantling the relevant governmental agencies and purging the experienced, knowledgable personnel required to respond to a health crisis because they were not sufficiently ‘loyal.’
In 2009, we did not have a President who conferred the Medal of Freedom on a loudmouthed, extremist college dropout who proclaimed a looming pandemic to be a ‘hoax’ concocted by political enemies and who told the millions of faithful members of the President’s red-hatted cult of personality that ‘it’s the common cold.’
In 2009, we did not have a President who resisted taking action for weeks, because he was more concerned that a crisis on his watch would ‘make me look bad’ and that testing would ‘make the numbers go up’ and affect his election campaign. We did not have a President who stated publicly, months after the threat had become apparent and days before declaring a national emergency, ‘it will disappear... it’s like a miracle, it will go away.’
1
One misunderstanding held by most of those writing the articles and the comments is that this test is as simple as - for instance - a blood sugar test, or a sodium test. Just get a sample and put it in a machine. Only Trump could be the explanation for the delay. However, - in actuality - this is a very complex test - one has options with antibodies and with DNA cycling and comparison. It is very complex technology. The CDC sent out bad tests initially - not because they have Donald Trump making the tests - but because it was so complex that the US CDC had difficulty making them. No one has ever tried to make a million tests of this complexity. Further who wants to look up the nostrils of a million people who think they have coronavirus? you would seem to need 50,000 non-medical people willing to do this full time. How much would you personally charge at an hourly rate for exposing yourself to hundreds of people who think they are infected, day after day. There are probably solutions. I understand that South Korea is alleged to have solved all this. However the WHO did not offer to give the US a million ready to go test kits whereupon Trump refused. They had a method to do the testing. This sort of thing is also a disaster for private companies because the tests are expensive to make and process and no one wants to pay for them. The US can offer billions to make and process - but manufacturing must be set up and testers must be hired. Yes they should have started sooner.
4
@AG Fact: The TrumpTeam refused the fully functional tests offered by the World Health Organization at the outset of the pandemic in the US and thereby squandered precious time at a point when containment of COVID19 in the US was still possible. You can find citations easily to verify this. Here's one: "The federal government refused to use a valid World Health Organization test. Then on February 12th, the US Center for Disease Control admitted that their COVID-19 tests were faulty." Source: "COVID-19: It’s Not About Europe, It’s About Incompetence" https://www.forbes.com/sites/stephaniesarkis/2020/03/12/covid-19-its-not-about-europe-its-about-incompetence/#14580b5a122e
Perhaps you were intending to present arguments defending the administration's failure to provide the fundamental support needed to protect the public health and safety of the American people. We need bona fide problem-solvers, not apologists, to get through the pandemic with a minimum loss of life and disruption of our health care system.
16
@AG
Trump is at least partly responsible for delays because he dismantled and defunded the agencies tasked with providing the guidance and oversight to the process. This has led to unnecessary issues such as the shortage of a critical reagent; which would be required for any test involving a virus.
If it is so hard to produce a test why did the WHO have recommended test; while Trump was still calling the pandemic a hoax?
9
@AG in South Korea they use the WHO tests. They didn't spend time to develop their own.
Sadly, it appears as if it's every state for themselves.
3
Thanks so much Dr. Kessler. It seems to me that every impediment to getting a robust, accurate, and rapid test regimen up and running could have been recognized, overcome, and ordered from the top of the Administration. The root of the problem was that the people who were needed and should have been listened to were fired or the decision makers didn't understand their responsibilities. It is the President's job to run the Administration and that includes protecting Americans from epidemics and pandemics.
2
We don't have an IT system already in place to track cases and tests for infectious diseases? How is that possible? Doesn't the CDC already have one?
5
As this cogent and practical article makes clear, coordinated action is needed and is very achievable. We have the resources and the skills.
But for 40 years the Republican party's whole approach to government has been to let the states cope individually and on their own. Hurricane in Louisiana? Poverty in Mississippi? Farm crisis in the Midwest? Too bad. The only purpose of the federal government, in its view, is to wage wars on foreign soil. This has caused a corrosive, poisonous erosion of the very idea of the United States, incrementally, for a long time. Every time the GOP is in power they move the concept forward.
Well, now we have a national (and international) crisis that can't be solved by taking away the green cards of foreigners, building walls, firing missiles, or sending troops overseas. The only way to beat this is through community solidarity - an idea the GOP derides as "socialism." But it turns out that we ARE a society and we need to coordinate together, under a federal government that leads and supports the states and cities. This isn't ideology; this is management.
20
Retired MD here.
Testing falls into two lanes for coronavirus, at least that’s what seems to be happening.
One lane is testing done by public health ppl for epidemiology but not for patient care. They have some tests, but not a lot. They’re in charge on tracing contacts, etc.
The second lane, largely empty, is clinical lab testing ... for patient care ... I and should be as easily available as a strep
6
@Dr. Dixie And clinical testing should be uniformly reported to public health as an aid to tracking the spread or decline of the disease. Same as flu, measles, polio, chicken pox, pertussis...
2
Any plan that hopes to fix what's wrong with the federal government's complete lack of leadership in the fight against the Corona Virus really needs to start with removing trump from office.
Without that first step in place, nothing of any use can come from Washington. We will have to look to state and local leaders for guidance.
15
@Jack Craypo With him having several possible exposures, it should be insisted that he be in isolation. This country would be better served by him being forced to stop having meeting and press conferences. We all need a two week break from him.
1
Dear David Kessler,
For all of us, and in memory of Anita and Max Pepper, who were your colleagues, and of Sara Pepper-Sullivan, I thank you.
Thomas Pepper
8
It is critical to have a test, and it is fundamental to have a medical protocol to have a response if proven positive.
Quest Diagnostics has a test for COVID-19.
While a vaccine is at least a year a way, Gilead's Remdesivir has been used in China, South Korea, and Washington State to save lives from COVID -19.
The treatment is also effective against other coronaviruses, such as MERS, SARS and H1N1.
It matters when the treatment is started after the diagnosis has been made.
It is unclear if it can be used prophylactically, but it is hope that the public health emergency can be tested, treatment provided, and self-quarantining is not a prolonged suggestion.
8
Now there are shortages of not only testing kits but also other materials that are required (RNA extraction reagents, viral transport media (VTM) and perhaps even swabs). Need to immediately determine if swabs can be submitted without VTM and still produce accurate results.
6
The easiest, cheapest thing for people to do is start taking your temperature every day. If you have temp, you may not have corona virus or the flu BUT you have a real piece of objective data to know you NEED to stay away from people.
It is easy to not know you have temperature. Take it before you do anything active. Not after drinking something hot. Not after exercise. If you use a real thermometer, it needs to stay under you tongue for a full 5 min.
9
@SB
And what about all those who've not read your comment? We should all keep a distance of at least 3' from other people regardless. Asymptomatic carriers can infect those within breathing distance.
2
The US response to this pandemic has pulled the scab off what most of us who practice medicine have known for years: there are glaring, long ignored SYSTEM problems with US healthcare.
Driven by a misplaced application of capitalism, information privacy law and poor leadership, our healthcare system is woefully behind in areas of informatics, universal electronic medical record and state of the art coordinated Public Health Service.
Politicians, pundits and the present government agencies like to use fancy press releases and scholarly consultants to gloss over this problem in our system. Until our leaders in medicine and government wake up to the reality that the best best health care requires a universal medical record, state of the art informatics and an operationally single healthcare system (not necessarily single payer) — we will continue to see these —and worse —problems.
25
@Matters
"our healthcare system is woefully behind"
Our healthcare "system".
Our education system.
Our prison system.
Our retirement system.
...
Woefully.
America announces a national contingency plan to confront the Corona virus ~ We and 114 countries in which the virus has appeared are likely to announce an emergency ~ Ok good ~ And when will we get rid of the virus ~ It was said weeks and the possibility of months ~ But I imagine that if the role of the virus lives up to two weeks ~ then the solution is for those countries to stop The activity and my choice is isolated at home for the people for a period of two weeks ~ and whoever has to go out to wear the full protection clothes ~ and thus we will save hundreds of hundreds of billions and unemployment will be only two weeks and the interaction will be on the Internet ~ and I hope scientists and decision-makers quote the idea and rest from anxiety
2
As public information shows, right after 9/11 companies like ATT used social networking techniques to help Homeland Security. Now there are many companies that use such networks for advertising based on telephone calls, emails, location sensing, etc. The government should use these to quickly identify the network of those testing positive and prioritize them in screening.
1
This is exactly the kind of thing that the pandemic team that Trump dismantled in 2018 could have already been doing.
Given the incompetence of this administration and its enablers, I have little hope of any concerted and coordinated effort like this.
26
Coronavirus testing so far in America has been a big joke.
NIH and the CDC have been asleep at the switch.
The White House's "stable genius" firing of a pandemic White House office was a really lousy decision. A Trumpian "strong and perfect" failure that will likely led to many deaths.
So much for MAGA.
21
@Rob
America has had two previous "stable genii": one was called "Francis" and the other was "Mr Ed". Trump fits very well into that company.
Why do they call it Make America Great Again? Because that’s what we’ll have to do when Trump leaves.
@Rob
They were asleep at the switch because Trump anesthetized them.
After a decade in America I returned to Quebec to retire.
I remembered the illiteracy and the lack of training and was amazed returning to a society that educates and trains and provides everyone with what they need to fit into a high tech society. Our local university trains everyone from cleaning staff to our nuclear physicists.
I remember the Chicago immigration office where finding someone who could actually read was a major undertaking and required unwarranted faith in the institution.
It is 2020 and a chain is only as strong as its weakest link.
Know the virus stays ready willing and able for days outside the body means not shaking hands is not nearly as important as cleaning doorknobs and handrails.
The corona virus is bad but it doesn't as of yet seem catastrophic but if America decides it can save a few bucks paying starvation wages to unskilled labour the Mexican wall will only keep Americans in as Mexico's growing middle class joins the 21st century and understands the need to educate and take care of everyone.
Shame, shame shame for listening to your conservatives and their society of privileges not rights.
29
Justin Trudeau gave a very sensible speech this morning from Ottawa. His wife has tested positive for COVID-19, and he has placed himself in quarantine. He’s working remotely, which is hard for a politician but sometimes necessary.
The consensus in Canada is to leave the medical decisions to the doctors. There is coordination at the national level through meetings between the First Minister of Canada (Trudeau) and the First Ministers of the Provinces and Territories. The larger provinces have their own Centers for Disease Control and significant medical resources of their own.
And progress is being made. The Vaccination and Infectious Disease Organization (VIDO) at the University of Saskatchewan has been working on the problem, along with other research centers.
To quote their website: “VIDO-InterVac researchers have successfully grown the virus in a cell culture and are now testing a new vaccine in animals as part of the global effort to combat the coronavirus threat.”
Canada does not have a major vaccine-manufacturing facility (our politicians are no more far-sighted than other countries’ politicians), but public money will be invested in setting one up.
There is no need here for “leadership” in the hysterical style favored by this article. Competent men and women are already on the job, and Trudeau has been forthright in praising their efforts. He declared this morning that Team Canada will win its way through, and it will.
11
Even lowly Cambodia has a rapid test that gives results in 2 hours and is being used on ?40 countries....why can't we get that who can wait for 48 hours?
8
@Somebody
Why can't we? We have a GIGANTIC handicap:
We think WE'RE NUMBER 1.
3
What’s the cost and who pays for testing , transport and database? These costs must be upfront , patients shouldn’t get a heart attack from exorbitant prices .
If testing is positive for Coronavirus is there a consensus for who pays for the treatment ?
I don’t believe the words of this so called president .
8
Sticking to the part of this I know something about, a massively scalable data management infrastructure is fundamental to administering the tests and communicating and analyzing the results. It would be impossible to design such a system in seven days or even seven months, and this neglects that the suggested experts will have conflicting views on the platform components. Consider the fiasco of upgrading the IRS system. Or the 10 years spent on the JEDI defense cloud.
It is a valid point that this is not business as usual, but seven days? Keep it real.
7
@Roger H
Well, if tech apparently can't accomplish what humans can very quickly, then it's not all it's cracked up to be, at least for this testing task at hand.
It will take the good will of thousands of people with good organization and leadership. I agree with the commenter here above who said the first step [in the National Emergency] is to move Trump and Pence out of the way. But then you have to look at the damage they have done to all leadership in government all around them and as far as the eye can see. All cretans. Now we wake up to A.) the damage and B.) the purpose of government in the first place.
1
If the Kessler plan was implemented it would forge a national pathway which would support the country not only during this crises but support the country in dealing with future crises. Daily I am struck by discrepancies between claims provided by people within positions of authority in different locations, and the experiences of people on the ground, as in the case of test availability and screening at airports. To give indications that all is well when all is not well, has similar impacts to gas lighting. It not only puts people in danger, it confuses people in ways which can lead to states such as demoralization and learned helplessness. As an example, if an authority figure directs people to call public health numbers for advice on these matters, there should be efforts to make sure that there are sufficient people manning the phones, and there should be efforts made to ensure that these individuals who answer the phones are equipped to answer questions and direct people. If an authority figure states that there are sufficient tests or tests on the way, then efforts should be made to ensure that people can access these tests as needed. Valiant efforts are underway throughout the continent, but as Dr. Kessler has indicated, there is a need to bring in coordinated plans on a national and even international level, and to draw on added layers of expertise where these are available.
7
We can get the testing infrastructure up that quick but can we get a significant number of test kits into the infrastructure?
I work at a major southeastern university medical center and as of yesterday we reportedly had to run a series of tests taking 24-36 hrs. just to get permission to run a covid test on a patient showing symptoms.
Having infrastructure to take samples up and running in 7 days won’t do any good if we don’t have a way testing those samples.
12
A beautiful, simple and elegant plan!
1
Emotions and Hysteria is what's driving the country right now. Facts and scientific-based evidence are at an all-time deficit presently. Groceries stores are dealing with scarcity like bread, water and the very basics of staple goods. Informing the public at large about the when, where, why and how we will triumph and prevail through this pandemic will go along ways towards normalcy and sense of brighter sunshine tomorrow.
11
@Michael elam
Um, how can we predict "the when, where, why and how we will triumph and prevail through this pandemic" when we don't know how many people are infected, and we don't have enough tests (nor the infrastructure) to find out that critical info?
I guess that we're supposed tobelieve Trump when just a few days ago he said "The virus will disappear on its own" and "We will have a million test kits next week."
Yup, that certainly gives us all a "sense of brighter sunshine tomorrow."
1
Thank you, Dr. Kessler, for providing this insightful reply. It does require a lot of coordination (working with others). I am hopeful that the U.S. will be able to improve its testing capacity.
12
Dr. Kessler was an inspiration for me in my early years of Public Health work. I suddenly have a glimmer of hope that a competent adult is now in charge of testing.
29
I became a fan of Dr. Kessler’s when I read his book on his battles with big tobacco. A true hero!
@Matt Jaqua: But does he think Brett Giroir is a good choice? I don't get that sense from this column. He seems to be just happy someone is in charge.
"Dr. Robert Redfield, the C.D.C. director, replied that his responsibility was only to ensure that state public health laboratories have access to the test." He did not know who was in charge?! This is the level of incompetence that is built into Trump's appointment of political hacks to important roles. Redfield has an MD and taught at the Univ. of Maryland in epidemiology. So far so good. But he also was involved in fighting needle programs for HIV and offered the solution of traditional families and prayer. He was also brought up on ethics charges for pushing an ineffective HIV drug. He has been a supporter of right-wing Republicans for ages. All I can think of is, "Heck of a job, red."
63
Today I travelled back from Germany to the US to avoid the travel ban (I work and live in the US but I'm not a permanent resident). I have fever and a dry cough. I called Northwell Hospital (large nearby provider) to ask for a Corona virus test but was refused. Of course I will try to self-quarantine, but the response to the many people I met with while traveling on business would have to be quite different depending on a test result. As would be the degree of self-quarantine. When will testing be ramped up?
23
@Torben Ott Were you not asked, or checked before boarding if you had a fever? Correct me if I am mistaken, but it sounds like you exposed everyone on the plane, knowing you had fever and a cough. How were you not sent to one of the established quarantine facilities?
4
@Torben Ott Were you not asked, or checked before boarding if you had a fever? Correct me if I am mistaken, but it sounds like you exposed everyone on the plane, knowing you had fever and a cough. How were you not sent to one of the established quarantine facilities?
@Torben Ott
You need to make every effort to get tested and notify all you came in contact with plus the airline.Your symptoms and travel history are strong indications to be tested.Good luck to you.
1
The person running the Government either is or is not responsible for how those under his authority perform.
8
@W.A. Spitzer
t is in charge - of course. The significant problem is he doesn't know what he is in charge of nor do his sycophants. All they seem to be concerned with is the DowJones numbers. folks at the 3rd, 4th and xxx level in the health systems of the government are doing the best that they can considering the ineptness of the appointees of the 1 and 2 level in those agencies. Political appointees with a t relationship doesn't make them experts in anything including health issues.
They seem unable to conceive of the issues arising before them but for the DowJones numbers. Where did they come from and who annointed them as health experts???
1
I'm befuddled.
Is testing so simple that our problem is authorization? Is it accreditation? Is it funding? Is it lack of manufacturing capacity ? Lack of laboratory capacity to develop and read results?
Is every source of testing accurate? etc.etc
16
@Reality
It's was the CDC's protocols which have been in place for years that resulted in the testing fiasco. Dr. Fauci has readily admitted that the CDC's process was not suited for the pandemic we are currently witnessing. This has now been rectified.
2
@Reality
I've heard all kinds of problems mentioned. Today I heard someone at a lab say they have the test kits but not the reagents needed to run them. There is also a shortage of RNA extraction kits. Last night I heard someone in touch with labs who said their ability to process was being limited by a shortage of protective gear.
Everything is in demand throughout the world. And we've only just begun to get serious about producing large numbers of tests.
3
@Reality - We don't have enough kits. No one in authority (or at least our president) wants to admit this. As a result we are rationing the kits, by testing people for everything else first and triaging to prioritize testing those known to have come into contact with someone who has tested positive for COVID19.
Our government (or our president) turned down kits offered by the WHO. The CDC tried to create their own, those did not work properly or were missing components.
In response to COVID-19, our president has repeatedly made statements that were not true, made assurances that were unfounded, and has generally taken steps the resulted in significantly worsening the crisis.
He is incompetent. He has recklessly endangered peoples' lives and our economy, as well as the global economy, for years to come. He should be removed from office.
1
Every person that doesn't survive this catastrophe should be a lasting testament to what WE need to do NOW and on 11/3/20.
"Small government" for 330 million people? The only expanding job opportunities will be for digging six foot holes in the ground.
30
@flyinointment And small government was put in place to weaken the Federal government and allow the crooks in.
1
Trying hard to look on the bright side, once citizens become comfortable with the gummint providing free or reduced-cost exams and diagnostics, maybe just maybe the concept of healthcare as a right of citizenship and not for the wealthy only will sink in. And interest-free students loans going forward? Fingers crossed on that point as well.
32
@Michelle S. Thompson Telling every American he had to enroll in healthcare with no restraints on premiums turned the entire nation into fish in a barrel waiting to be shot by the the entire healthcare "industry." And talking about interest-free (presumably unlimited) student loans, ditto for the "education" providers.
In Canada, newly minted doctors have to initially serve in under-served areas. How about that in exchange for student loans?
4
@Robert Doctors have been serving in under-served areas in exchange for student loans here in the US under the auspices of the National Health Service Corp for many years.
3
Trump announced today he would spend billions on Google, Walmart and other testing and private companies to get the testing program up and running. But, as typical of his philosophy, not a cent on the working class person. The Democrats want to help out the average, working person and have proposed paid sick leave provision, enhanced unemployment benefits, free virus testing and additional funds for food assistance.
The president says no. This country is going down the tubes rapidly and Trump is lining himself up as a one term President.
56
@Frank From your lips to God's ear.
1
@Frank One can only hope that he is a one-term prez
Thank you for this article and blueprint to get the testing up and running. The lack of leadership in this dire crisis — where decisions and action (or the lack of them) will mean that some will live and some will die — makes me want to scream.
24
Dr. Brix said the false positive rate for South Korea was 3-4%. This means that 1 in 25 persons was quarantined for the wrong reason. This suggests the reason why the US is not testing widely is CDC is concerned about incorrect diagnosis. Also, consider: false positive persons were housed with others with Covid-19 and almost guaranteed infection of those persons. Of 250,000 people tested, 10,000 were wrongly quarantined. If death rate is 3.4 percent, 340 people died because of incorrect test.
4
@NC Sure, but how many hundreds will die and thousands sicken because we did not use the WHO test before this epidemic became rampant? In effect almost no testing vs a test with a small percentage of false positives seems like the wrong choice was made.
5
@NC So better not to test? Of course, if nobody is tested, than nobody will die of the disease! Dr. Brix statement was dangerous deflection, with the implication that COVID is no worse than the flu. We should be very worried if this woman has any position of responsibility.
1
@NC
If you're going to start tossing around statistics, you might want to compare the low false-positive rate of 3-4% versus the Ro rate of around 2.5 for coronavirus. In other words, each person who carries the virus is likely to spread it to 2-3 other people.
Given the fact that each of these people will be asymptomatic for a few days, each of these people will likely infect 2-3 more people before they're quarantined.
2.5 to the fifth power equals 97.6. In other words one single undetected carrier can create a cluster of about 100 infected people in a week.
Sorry, but we'll have to accept a 3-4% false-positive rate in order to stop the exponential spread of the virus.
4
Yes, but someone, please, explain exactly how an accurate detection of a CORVID-19 infection --- the test issue at hand --- will provide any actual health or treatment benefits to a person tested and detected to harbor the virus.
Corona virus infections, of every sort (such as colds), are treated solely in regard to symptoms, are they not? We get treated for colds without any identification or testing of the actual corona virus causing our particular cold. Simply, symptoms are treated; successfully without knowledge of the particular viral etiology.
Again, tell specifically how widespread testing for the virus might change in any way the course of the disease within American populations.
Is the lack of testing a made-up or inconsequential side issue? Seems so.
2
@John of Ohio
The effects of tests are at least two-fold:
1. Limit "community spread" of the virus from both asymptomatic and variably symptomatic individuals. Data suggest that the virus is highly transmissible (20-40 times greater than typical influenza strains) and has a long lifetime on surfaces (up to 72 hours under laboratory conditions). If you are thinking that this is just another "common-cold" virus, you are mistaken. Individuals who harbor the virus have a civic duty to minimize contact with others and thereby reduce the rate at which the virus spreads through the population.
2. Reduce the load on resources from individuals who are sick, but don't require the same level of support to recover. All indications are that we will be facing a shortage of hospital beds (the US has an average of about 2 beds per 1000 individuals) and critical medical equipment and supplies (respirators, etc.). If the current estimates are correct that about 30% of the US population becomes infected (over 100M people), the US health-care system will quickly become overwhelmed. This could lead to triaging of cases, which I understand is already the case in Italy (a country with a good, first-world medical system). Absent a vaccine (more than a year away), our best hope is to "flatten the curve" so that the total number of cases can be stretched out over a longer period of time.
29
@John of Ohio
Broad based testing is enormously consequential from a public health/disease surveillance perspective. As medical providers, we need to know how quickly our resources will be taxed in a given community, assuming that 20% of patients will need to be hospitalized and 5% will need ICU care. Also, if we had wide spread rapid testing, we would be able to track individual cases and their recent contacts and decrease further transmission. The concern about the delay in testing is that there may now be many thousands of people walking around infecting their neighbors, and spreading the virus ever more rapidly.
21
@John of Ohio the professionals have more detailed answers, but for laypersons even this simple point should do: if you can't measure it, you can't manage it.
16
Trust is earned not bought. We could have declared this pandemic a "crisis" a month ago rather than Tweeting that is was "Democratic hoax" and today's commercial for Walmart, Target and Roche and Quest Labs and a political commercial for the Trump organization coupled with the coordinated intervention by the Fed/Treasury "plunge protection team" shouldn't inspire anything other than on-going skepticism of what motivates Trump and his cohorts.
Had the DNC and Russia not intervened in our democracy in 2016, Sanders might have been elected and we'd be well on our way to having the same kind of national health care system which can handle the long term health and economic impact of this. It is the poor, the homeless, those who can not even go to Google's WEB site to get a "drive through test" that will show up in your grocery store, Target, Walmart and touch the food you are buying and then because they can't get the healthcare they need you will end up paying the price for the greed that pushes Walmart and Target vs. having a well staffed Pandemic staff and having the FDA and its scientists and administrators working to actually protect our citizens from bad drugs, contaminated food, and testing GMO's rather than being staffed by council from Monsanto and the drug companies.
It took a trillion to bailout Wall Street. $50 Billion?
It's fine to have the private sector working with government but in a system like Bernie has proposed, that would be integral as
11
Sanders and Trump are from the same root. Both would bankrupt the economy. Just in different ways.
2
@Tom Paine
Bernie will never be President.
VOTE BLUE NO MATTER WHO!
We pay $1 trillion good taxpayer money yearly for defense.
To make up for shortage of hospital beds, we probably can't build new hospitals in time but how about emptying a military base near a likely outbreak area and stocking it with the needed equipment?
Our friends the Chinese no doubt can tell us what is needed to succeed.
24
Testing is only one of the necessary critical steps. There are two more:
1) ensuring availability of anti-viral drugs that are showing signs of efficacy in China and other countries (and ensuring doctors are authorized to use them even if not approved for Covid-19);
2) ensuring hospitals have sufficient ICU spaces available for reasonable estimates of numbers of people who fall critically ill and/or very quickly creating temporary ICU centres. (The Chinese government built a whole new hospital in Wuhan in 10 days; we should be able to do the same)
In addition, there should be a forceful public awareness campaign to stress that everyone who feels even slightly ill, especially with a fever, regardless of whether or not they have travelled to "affected countries" should self-isolate, as should their direct family members. By continuing to say "most people only have mild symptoms", the public is likely to think the illness is not terribly serious. For the 5% who develop serious symptoms, however, it is a frightening illness. We all should do everything we can to limit the spread.
24
Great plan!
The only problem is that it omits a very key piece of any Trump/Republican plans: blaming Obama and the Democrats (and immigrants).
If you can amend it to include that oversight, it might have a chance of being signed by Trump.
21
@Kingfish52
Don’t forget the tax cuts!
When Trump wants to do something, he does it -- or at least he tries to do it. He didn't want to make it easier for the relevant agencies -- CDC, FDA, and HHS -- to coordinate so as to make widespread testing more available and accessible. Respect for regulations and established protocols has never been an obstacle for him.
10
We will see. Production of reagents, test kits, recalibrating all the testing equipment for this novel virus. Training of personnel, keeping in mind they have other things to do for their real jobs. Some machines are already saturated with tests to process. Trump in charge.
Seven days? I take the over.
12
@gratis Austin, Texas has its first case. It will spread quickly now. Be alert, be aware and be careful. All of you.
1
@gratis
I’d prefer you take over now.
We have to wait that in short time all will work in the right way because the country needs effective actions immediately.
1
A serious minded people would never elect a person like Donald Trump to a position of such importance as Head of Government and State.
Incompetence leads to poor and erratic results.
The American people put themselves in this situation. Our inability to cooperate and the general distrust of government from 40 percent of the population limits our ability to do anything positive on a national scale.
Moving forward, the states have to act like independent countries and build up their own infrastructure. Elected government officials from places like Mississippi, Wyoming and Kentucky don’t support any level of government investment unless it’s defense related.
38
You lost me at bring in Amazon, Google, Apple, Microsoft and Salesforce to create a data management system and do it in seven days.
Really? We have no ability to report and manage today? We’ve had bioterrorism threats for years. We’ve had no government plans? Isn’t this a key responsibility of public health departments?
54
@Cindy P They have to hire people since their budgets have been cut for years. Like Trump said last week or so.... I don't like people sitting around doing nothing, I'll just rehire them when we need them. Good plan Brain.
2
@Cindy P
Hey Cindy - you live in the US of A. And Republicans currently run it. Trumpies all, with a hatred of real life health-care unless it's making a profit for GOP donors. "Responsibility" costs extra, and they refuse to pay - or even pretend to play.
Just re-read that CDC director's response. Redfield doesn't even know who's in charge - he has to "look into it". Heckuva time/way to go ga-ga.
Sadly, "lost" is the right word for what's NOT happening right now. But I know another four-letter one that fits - and it's not "hope".
2
Correct!!
And what you are really saying is that the country needs a National Health Care System, that is integrated for personal health care and integrated for health epidemics.
Today at the presidents news conference on covid-19, that is what many were trying to say but could not say.
The last question of the news conference was excellent, but the reporter could not get an answer although she asked repeatedly. Experts could not give her an answer. And that question was when can anyone who wants a covid-19 test get one. Go to your doctor and get one? Go to a hospital and just get one? No answers were given, but if the system they are now trying, with panic, to set up for testing, is the national health system we need. Perhaps Google can help us set it up and private testing companies can of course participate, but it must be a government centered and coordinated system.
And we call that Medicare for All.
46
And here's the best reason for Mr. Trump at least -- if he manages to get it fixed in 7 days, his re-election is guaranteed. (Personally I don't want him re-elected but I want this problem solved.)
3
@GinNYC
The only way Trump survives this is if he figures out a way to buy off the virus or, as too often happens, Trump's strategically located horse shoe works its magic and defeat virus in a couple, few days...I don't think even his horse shoe can work that kind of magic.
10
@Rw I think at some point we should start looking at Coronavirus as a threat to the society and not as a threat to Trump presidency. Sometimes we have to stand together and support the President irrespective of his political hues.
4
@Subash Nanjangud Americans at many levels are stepping up to support their fellow Americans and will continue to do so. Given Trump's incompetence, a successful effort does not require supporting him and I think he is beyond help anyway. You can bet many federal officials are finding workarounds to complete what needs to be done with or without his knowledge.
24
Dr. Kessler wants al these private outfits to all sudden
do the things the government should have been set up to do.
How is this going to work well? It won't.Now we are faced
with begging private industry to suddenly do everything
the government should have been doing all along.And it
was your friend and mine John Bolton who disbanded the
group of people who were in charge of doing these things.
43
@KT Keep in mind, Bolton issued that order under trump’s direction. Put the responsibility where it actually belongs.
I am a stable Genius. I alone can do it. I have unmatched wisdom.
44
@W.A. Spitzer Other geniuses have failed also!!
To tackle a public health crisis like the Coronavirus outbreak a country needs three things. Resources. A plan. And leadership.
The USA lacks all three.
67
@Van Owen
What? No resources?? What about those tax cuts?
17
@Van Owen
The one thing going for us is that Public Health folks like Dr. Fauci are out in front of the public sharing data and the facts.
To recap, it will be weeks before tests are available. WHY DID THE ADMINISTRATION DECLINE THE WHO TEST KITS THAT WERE READY?
115
@KB most people are confused when they talk about the "kit". The kit relies on a method called quantitative real-time polymerase chain reaction (qRT-PCR). it consists in extracting/isolating RNA from samples (since the virus is a RNA virus), then the RNA is "reverse-transcribed" into DNA (using a reverse transcriptase enzyme in a tube) and then using a second enzyme to amplify and identify specific DNA sequences (which are only found in the coronavirus). The kit/method is the same everywhere (WHO vs CDC/US), it requires the exact same enzyme and technology, the only difference is the type of DNA sequences used at the end to identify the virus (by the way, both sets of sequences are fine). Using the (WHO-recommended) sequences to diagnose would not make the diagnostic faster, nor would it make more kits available. This being said, it is still a mystery that the "greatest country on earth" does not have enough kits to start with, because most of the companies that manufacture these kits are american (except for one, that is German). athe the end of the day, I believe the main issue here is the lack of a universal healthcare system, which gives everything a price, that companies or patients/people might not be ready to spend "if it's not worth it". We need more kits in the US, but most of all, what we need is healthcare for all!
41
@Steph
Like the Italians' universal system? I don't see the world looking to any researchers in Italy to develop a vaccine.
Pure incompetence mitigated by the Trump crowd who know not what they do.
46
This administration is like the blind leading the blind. Trump cannot see pass his own ego. He had the opportunity to lead and failed miserably.
39
Local labs have ample capacity to do this work. Let them.
6
It saddens me to have a president who has not accepted any responsibility for the 6 to 9 week delay in starting to combat this virus but it's not surprising because he accepts responsibility for nothing including disbanding the early warning committee set up by President Obama or claiming this will all go away soon. And why isn't Trump who has been exposed getting tested for COVID 19? By the way, I sincerely hope Deborah Birx doesn't have age - related tremors or Parkinson's because Birx's head has nodded incessantly during Trump's comments as though her job depended upon agreeing with every statement he tries to make. I still trust Fauci above anybody in this administration. And will COVID 19 testing be free or will republicans deny that right to poor people?
40
It’s a shame America doesn’t have Medicare for all instead of a hodgepodge of ‘for profit healthcare’ providers led by incompetent snake oil salesmen.
Every other country can test large numbers, but the US?? Nah. Not so much.
54
@Barry Henson
Yeah. Makes you wonder what was ever great about the SUA.
Put this person in charge. Or at least, Giroir, pay attention if you didn't already think to do this or something equivalent. Ya ain't gonna get any help from above, that's for sure.
12
The President has hollowed out the executive branch such that the current staff has been remolded to fit the management "style" he was more comfortable with in his businesses. A model that is centered around him and more attuned to the machinations of a hotelier not pandemics. Until this president can get off the messaging where he blames everybody else and refers to this event as an unforeseen foreign virus, it appears he will spend his time spinning any responsibility for the lack of leadership and response to covid-19 on anybody besides himself. My only hope is that there are enough people with the skills left in government that can navigate us around this president's stilted view of the world and this virus.
32
If Trump does get it, he will, no doubt, blame Hillary or Obama.
Trump and his administration is still playing catch up. Some positive things happened today, but they’re still playing catch up.
11
I support Dr. Kessler as Biden's VP running mate if he wants to enter polictics.
6
Trump must be scanning to make sure that the health officer he puts in charge is "loyal" enough to him or not. What a juvenile person we have running this country.
44
OMG, This corona virus is going to get my school shut down. I really hope that the smart people out their can help the U.S fight this battle. But people are overreacting to this virus like it's the end of the world.
1
Not an over reaction. Without dramatic action the projections from CDC are millions of cases and thousands of deaths. But don’t let it inconvenience you.
42
@Stephen Luebke
The worst case number of deaths is one million.
6
@InTheKnow
One million in the U.S. is not bad at all. With 100% infection rate, that would be 0.3% mortality. Given that it would be slanted toward the elderly, the coronavirus might actually save the Medicare and Medicaid future budgets for anyone under 50. The actual mortality rate is likely much lower given the completely unknown denominator in the general population. The politicians citing death figures are as absurd as physicians who tell terminal patients how many days, weeks, or months they have to live. Nearly 80% of those infected have nothing more than a bad viral illness, so stock up on some fluids (Pedialyte, apple juice), blankets, soup packets, and over the counter medications.
Trump is politicking. Pence moves his lips. Redfield is either covering or clueless. The Keystone Kops were slapstick. This has been a national slap-in-the-face. Hopefully, a wake-up call for citizens to listen the scientists instead of the charismatics.
52
Physician here.
I was a young doc in training back in the bad old AIDS days in Los Angeles and San Francisco. I could tell you some stories.
Fauci was running things in those days. He was first-class. Calm, reasonable, had good judgement.
He needs to be put in charge right now. He is able to see where things are, but, more importantly, he is able to see where things might be going.
This is no time for that dummy Pence. The CDC head is also an unimpressive stiff.
221
@vbering
Yes, I've been wondering how Redfield, presumably put in charge of CDC for his ability, could be such a lump of jelly.
Dr Kessler, you end the column with a line that you are advising but never the less this is a non-partisan issue.
True that the issue should be a non-partisan issue, but working for Mr Biden should disqualify you from giving opinions on such an important subject to the mass public.
You may have worked for Republican and Democrats previously, but if you now work for the opposition party, your opinions cannot allow you to give the sitting President any due compliments. Which should and does disqualify you from giving opinions in a national newspaper.
But since the year is 2020 and the NY times will only publishes opinions negative to the sitting President (when the President is right or wrong) and even during such a sensitive time, everything goes. I cannot imagine after 9-11 such partisan politics out in the open would have been allowed.
Being an advisor to Mr Biden at this time is only a liability for Mr Kessler and his informative ideas, as his opinions cannot be trusted. And as a former member of Democratic and Republican administrations Mr Kessler's unbiased opinions are surely needed.
@David
Only members of the Leader's party have the right to express their (Leader's) views!
30
@David You are assuming that Dr. Kessler is giving Vice President Biden something other than expert scientific advice. Why would you think that? Whatever advice he is giving, it’s too bad trump isn’t listening. It could save a lot of lives.
16
@David After rereading this column in search of political bias, all I could find was this: "On Friday morning, President Trump took a belated but welcome step..." Is that what you are objecting to, David? The use of the word "belated?" Apparently you think that, up until now, there was no need for Trump to put someone in charge of testing because that whole effort had been going so smoothly. You bemoan the lack of compliments paid to the current President, but he already basks in the glorious praises offered up by his underlings and his base. That should be more than enough to sustain him through this very difficult period.
6
I keep wondering why we can't leverage Korea's capacity. They're already up to speed on this.
19
@Rod Stevens - we could if 45 would have agreed to use the WHO's test kits. There is no reason we couldn't be testing 50,000 per day or more.
13
The FDA good old boy$ cannot do anything in a hurry. Trump needed to get them out of the way first.
I am $ure the hold up wa$n't about the be$t te$t, but about WHO wa$ going to get their $wift approval by $electing the "mo$t appropriate" te$ting con$ultant$. Once enough pre$$ure was put on the$e good old boy$ - thing $tarted to get done..
Fancy That!!
12
@Dr. Sam The "good old boys" as you call them would have been able to do plenty had Trmp not eviscerated the agencies assigned to do this simply because -- let's be honest here -- it was something that President Obama had funded. He is obsessed with his distinguished predecessor.
The ones who were left were also ham-strung by the administration. Oh, but you probably believed that the docs standing with Trmp who professed that Dear Leader was just the bestest at everything, despite their shotgun-in-the-back delivery.
12
But since the year is 2020 and the NY times will only publishes opinions negative to the sitting President (when the President is right or wrong) and even during such a sensitive time, everything goes. I cannot imagine after 9-11 such partisan politics out in the open would have been allowed.
Being an advisor to Mr Biden at this time is only a liability for Mr Kessler and his informative ideas, as his opinions cannot be trusted. And as a former member of Democratic and Republican administrations Mr Kessler's unbiased opinions are surely needed.
1
@David ......Partisanship? Where did it come from? Who said week one that our number one job is to make Obama a single term President?
28
@David - Obviously you don't read the NYT, they have several conservative editorials, they are not out on the extreme right wing spectrum since they must at least agree to only print as factual information as they can, unlike many websites such as Bannon and Co. write in daily.
@David If you believe that the NY Times is so biased, why are you reading and commenting here?
Check out these astounding comparative numbers (https://www.worldometers.info/coronavirus/covid-19-testing/) displaying worldwide country by country testing in response to the pandemic. ...A grim picture is on display telling everything we need to know about how the CDC and the Federal response is failing us - here is a sampling:
Mar 2: UK - 13,525 completed Covid-19 tests - (199 tests per 1 million people)
Mar 2: USA - 472 completed Covid-19 tests: (1 test per 1 million people)
Mar 9: UK - 26,261 tests (387 tests per 1 million people)
Mar 9: USA - 8,554 tests (26 tests per 1 million people)
The USA population is 5 times larger than the UK population. Yet the UK testing response has been disproportionately more practical and robust. What's wrong with this picture? Make America Great Again?
36
@A part of the whole ,
UK: national health service
US: patchwork of insurance programs and PPOs with high deductibles, co-pays, and millions uninsured, and an undue belief that corporate entities will save the day.
25
@A part of the whole
Why are so many NY Times readers confusing testing with treating? You can test 100% of the population, but it is the treatment arm that matters. Pandemics are a mirror image to vaccination's herd protection. Behavioral change matters more than knowing who is negative or positive. If you have symptoms, isolate. If you do not have symptoms, isolate. The winner is not the country that tests the most, but the country that behaves the most logically. Hence, the rampant Italian progression versus the Singapore or Hong Kong stoppage. Societal norms determine the victor here. When you have "known positive" people still going to cocktail parties, university functions, and traveling on planes, it is hard to say that a lack of testing is what is hindering our war on this virus. Stereotypes ring true here - the Asian nations fall into line amongst familial and societal pressure, while Americans and Europeans still think and act as selfish individuals. Testing does not solve that.
@James
"Why are so many NY Times readers confusing testing with treating? You can test 100% of the population, but it is the treatment arm that matters. Pandemics are a mirror image to vaccination's herd protection. "
Much of what you say is true, but it's only half the picture. Testing is a necessary part of our response. It tells us whom to treat, whom to isolate, etc.
We can't simply isolate everybody. For instance, we can't isolate all non-positive physicians and healthcare workers, first responders, etc., or society would fall apart more than it has already.
@jrinsc "I have many questions, and am still unclear as to why South Korea has been giving 10,000+ tests a day and we're lagging so far behind."
1) S Korea has a unified health care system. All their labs and hospitals operate on the same procedures, same tests, and same information system. Any person can go to any lab to get tested. All results are reported and available to a doctor anywhere. The US is unique among "developed" countries in that it does not have any kind of system at all. Just hundreds of independent clinics and hospitals, none of which "talk" to any of the others and all of which have their own procedures, tests and information systems.
2) S Korea and the other Asian nations went thru the SARS crisis 10 years ago and this is very similar (another corona virus). They knew exactly what to do and systems were already in place.
3) For rapid testing (ie "10 minutes") they are using an antibody-based test, just like a store-bought pregnancy test, rather than the longer and lab-based PCR test (for genetic material). This is what they use for most of their drive-thru testing. They are most likely then sending samples of each person to central labs for PCR testing as confirmation.
This episode is a good argument for the US to develop a unified medical system. Unfortunately Repubs are dead set against having a modern system like all other developed countries . We are now paying for that backwards mindset.
67
If either Biden or Sanders had been president, things would be much worse because they would not have closed the border to China as Trump did. They criticized him for that.
1
@Snowball
Well, closing borders to China was a bit like closing the barn door when the horses were out.
Of course now that Ivanka has been exposed, it has been declared a National Emergency. All these facilities that were open and eager to help ... now it's a good idea. Trump could have taken care of that from the start.
29
@Snowball I'm very sorry to disappoint you but by the time the border was closed it was already far too late. It was already here.
31
Oh. My. God.
15
Wow! Did Trump ever screw this up. Months of inaction (and possible coverup) are irresponsible and maybe even criminal. How can anyone support this horrible human being.
48
@RBodge Equally horrible humans support Trump. Sad.
1
Marc Benioff should see this and put his Salesforce team to work on the data! Worldwide, even! What an exciting opportunity to give back.
1
@D
What could possibly go wrong....’-/
These steps need to be taken but we also need to think about privacy concerns. Current laws require patients permission before anyone can have access to medical files.
We need to add to this "to do" list a review of the process that might preserve as much of our privacy as these unusual circumstance may permit.
Swipes and swabs for corona tests also contain our DNA samples. Keeping track of who has been tested and test results requires being able to identify samples by name, address , contact information and potentially much more information.
There must be a way to move forward quickly and efficiently while also preserving our privacy. If we don't, we may be solving one problem, only to open the door to another one.
7
I have a strong feeling that Trump is starting to very seriously tank in poling and his base will shrink; Republicans in government can begin to act more responsibly. There can be a bi-partisan work (around of the President and VP) and testing can get ramped up, just as this competent doctor has described. I have some confidence in Nancy Pelosi as leader of the house; I believe McConnell will not be able to do as many wrong headed things in the Senate. Good luck to everyone; hoping for the best.
10
@Sues
Amazingly, the site 538 (which averages together all polls to arrive at its numbers) find his support still steady with polling from this week.
Its that shoot someone on 5th Avenue thing.
14
@Jerseytime they are conservative, white, male, gun owners who will vote for republicans no matter how badly flawed those republicans are.
16
Trump isn't to blame for the initial testing screw up by the CDC, but he is for the slow aftermath to do the specific kinds of things Mr Kessler is laying out. And if Trump is doing some of them why don't we know about it. Pence sounded ridiculous reading talking points about how tests were everywhere they were needed when he started doing press conferences more than a week ago. He was being fed bad information by someone and wasn't challenging it when it was an obvious disconnect.
5
@bill
The boss, or commander, is always responsible for what his workers/underlings/troops do. For he is in charge.
This is true legally, morally and militarily.
28
The President has gone even further by recruiting retailers and healthcare co's to push the agenda forward. Now, if only the Obama Administration had learned from the H1N1 pandemic and ramped the CDCs ability to test for future crisis we would have even a greater head start. With all the attention that ObamaCare had, it's amazing that these steps weren't taken during the previous administration.
@Ray Ozyjowski
They were in place, then the budgets for CDC were cut and cut again since 2016 by guess who.
58
Are you kidding? This administration disbanded the pandemic team on the Security Council two years ago claiming it was useless and has been doggedly undermining science, experts and objective facts from day one. This president and his surrogates have spent weeks denying the virus' existence, playing politics and claiming hoax. Don't try to blame our previous president for this administration's incompetence, finger pointing, lies, obstification, misrepresentation, political games, self-centered obsessions and flagrant disregard for the public's health.
78
@Ray Ozyjowski This statement is not true. Retailers and healthcare companies (do you mean pharmaceutical companies?) are not involved in the testing. State health departments and commercial diagnostic laboratories are developing and performing tests. I work at a diagnostics company, so we have been informed about what is going on. They have been stymied at every turn by the CDC, who wasted weeks developing and distributing a cumbersome and defective test, and FDA. The administration has been lying about the number of tests available, even up to the address on Wednesday.
42
A Suggestion: Have the data gurus and the CDC create an online data map as impressive as the data maps the NYT posts on its website on election nights. So people can click on a State then a county then a city then a precinct and see where the Covid19 cases are. People in the community partly are anxious because we don’t know how exposed we are individually and thus what level of precautions we should take. The state of IL is now only disclosing age and gender of positive cases by county, in a list, as they occur each day. The public needs mapping info and more transparent info on the number and location of cases, while respecting legitimate privacy concerns of people who have tested positive.
12
@Mark Wallace
No, actually, that's one of the failings of the CDC. It came up in the Congressional hearings. Forget about maps -- when the tests go out to the hospital, academic and commercial labs, the CDC doesn't have a system in place for getting results back. They're working on it -- but they have plenty of time, since they won't have the high-volume tests for weeks anyway.
My doctor sends my blood tests to the lab and gets a report back electronically after they're done. When Frieden was NYC health commissioner, he had the labs automatically send notices to people with blood glucose in the diabetes range (yeah, privacy).
In Taiwan their national health system has a computer system that can, for example, print an anonymized report of, say, everyone in Taiwan who was treated with steroids for lupus, and how many of them had heart disease (an adverse effect of steroids), over the next week.
If I were an epidemiologist, I'd like to see every lab send back to a central database in the CDC the results of each test, with positive/negative, zip code, age, and an anonymized patient ID number that you could track back to their death record if any. Then you could make maps and look for hot spots. You could say things like, "Hey, there seem to be a lot of cases in the Amoy Garden."
Now it's like mailing a letter to the fire department to ask them to put out the fire in your house.
11
Its time to give states more authority to find solutions to the testing debacle. The Fed gov't has stumbled in the dark long enough. We keep hearing that it will only take another 7 days for the Feds to get its act together for the past two weeks. NYC was finally given authority to contract with Roch to obtain the necessary tests. This is the only sure way to get the necessary testing done in the short term. The Feds need to streamline this process,not obstruct it.
14
In today's update, Pres. Trump's prepared statement included that 'regulations on the medical industry are being lifted so that Americans can receive the healthcare "they are entitled to."'
Has the Trump administration just taken the unprecedented, for Republicans, step of asserting that we are entitled to healthcare?
I hope some one will run with this before they walk it back.
51
@pi Trump is trying to spin a narrative that testing wasn't happening because of regulations. Just more lies.
If Trump and his cronies can't make some bucks out of this, I don't care what he declares. It isn't going to happen.
22
@Tom You are already wrong Tom. Wait for more Dem talking points later today, I'm sure the press is waiting for them as well.
Always good to hear from Dr Kessler!
9
This is exactly what happens when you thin out the deep state.
14
Who is the Surgeon General of the US? (see wikipedia)
2
We need a vicious streak in our democratic leaders
4
Dr. Kessler's prescription is what competent government looks like. Oh, how I wish for a competent government.
49
@Richard Robinson it's only as good as its leadership.
5
It was over two weeks ago that Mr Trump made assurances that everyone that needs a covid-19 test will be be able to get covid-19 test.
Nice to see that Mr Trump is finally getting around to giving it more thought.
16
@Bill
Not so much "thought" as Newtonian physics. "For every action, there is an equal and opposite reaction." The stock market was tanking, and it would not stop. The virus was not going away.
Such were the "action".
Trump finally doing something is the "opposite reaction".
14
This opinion ignores the most critical barrier to doing more tests in an expedited manner: the shortage of reagents supplied by Qiagen. Without these reagents, the tests don't happen, regardless of how many kits are distributed. And this problem fits a profoundly disturbing pattern: Quiagen was recently purchased by Thermo-Fisher. It is their practice---executed dozens of times---to buy up nimble, innovative scientific suppliers, eliminate half the products, reduce the inventory of other products to 1, and assimilate it into an organization which knows nothing about the company it bought. Their anti-competitive practices, inventory restrictions, supply chains, and pricing present an enormous challenge to small biotech firms such as mine. It is no surprise that their business practices will now lead to unnecessary deaths. The next president needs to dismantle this vampire squid, even before Facebook and Google.
60
@JLW Thank you for sharing another piece of this travesty puzzle.
This makes way too much sense. Expect Trump to announce that he alone has come up with it.
10
There is no cure, so what is the point of testing? The sky is still there last time I looked.
@Gary, We need testing to know who to isolate or quarantine. This will "flatten the curve", limit the stress on hospitals, and ultimately reduce fatalities. Even in the absence of a cure, there are smart things to do.
29
1. Unless people are treated, we have no accurate idea about how many people are infected, who we don't know what emergency medical measures to have in place, or where they are most needed. 2. People who are not yet infected can take appropriate precautions when they know how many in their communities ARE infected. How can you even seriously ask that question?
23
@Gary Please do some reading as to why testing is important. It is not only key to getting data that will help others to plan and prepare (like the health care system) - if you are positive then you should self isolate. At one point - 12,000 people were self isolated in Hong Kong as a result of testing positive. Hong Kong - despite being an incredibly congested city - did not have a significant problem with coronavirus. Nor did Singapore. You are the beneficiary of medical knowledge (and actions in some cases) provided by all those who preceded you
26
Here in Texas 4.1 million people are uninsured. Today the governor said there were two ways to get tested if you were one of those people. Both are difficult and the governor seemed clueless. The uninsured are being forgotten in this crisis. That puts our entire country in danger. If there was ever a time for national free healthcare for everyone it is now. Anyone who needed proof as to why healthcare should be available to each and every person for free this virus is the proof.
50
@Weiler - It seems people are just discovering that if the people you come in contact with each day are more healthy then you will be healthier. I know this sounds like socialism but it's true anyway, whatever you call it.
18
Yes and yes! Thanks for your post
The only thing Trumps thinks about is his legacy. He could care less how many Americans die. His track record of selfish behavior speaks for itself. History does not lie and he has plenty of history.
18
Beyond outstanding – kudos...
As far as G, M, A, A, S....
Don't stop with the testing data management – draft them for fixing the sad embarrassment that currently passes for our current health care IT ecosystem…
4
Americans do not know or understand math. It is not a fact based society. If you want to survive the 21st century you must again separate church and state. God will not interfere and do anything to ameliorate the damage of ignorance.
Start paying a living wage to those who take care of of you. All the steps you take are worthless if you don't educate everybody. The greatest middle class in history need troops to that understand their jobs.
11
Dr. Kessler does not address the fact that there is not enough reagent available for laboratories to perform the testing.
13
What's scary is that we are only seeing expertise and competence in opinion pieces, because the people with the know-how are nowhere to be seen in the current administration.
What's ironic is that this clueless administration is probably now desperately reading this paper for ideas on how to save the country (and only because doing so might save their own hides).
What's tragic is that the know-nothing party's know-nothing-ism has cost lives and will cost more lives before this is over.
What's sad is that they will spin this, however it turns out, as a victory ("Only I can save you"), and most people will still fall for it.
19
@An Observer , Oh, you mean mistakes like establishing an epidemic response team? Good thing Trump "fixed" that one.
5
NYT readers have a magical view of the CDC and FDA.
In actuality, the FDA and CDC are the source of the testing delays. They had to approve every lab for testing. (In early March, some states hadn't even been approved to test.) And every single test kit had to be returned there for testing.
This is what Trump is referring when he says he had to "undo" Obama mistakes. (Many of these controls were introduced under Obama.) Dr. Kessler can now talk about working with labs outside those agencies because of the overrides Trump implemented.
2
@AACNY Sorry, Trump had since early January to get moving on this and did absolutely nothing. A few weeks ago he was saying the then-15 cases would go down to zero. Nice try but anyone who is paying attention isn't going to fall for it.
202
Is there a statute of limitations on blaming the Obama administration? Perhaps two years , particularly when your own party was in control both houses of Congress.
28
@AACNY
Not so.
Testing kits were offered to Trump by the WHO in January.
He said no.
And this blaming of Obama (who hasn't been President for three and a half years) is just more of his typical dodging of responsibility and his unwillingness to admit his stunning failure to keep the America people safe.
This is all on Trump.
______
“On Saturday Jan. 11 — a month and a half before the first Covid-19 case not linked to travel was diagnosed in the United States — Chinese scientists posted the genome of the mysterious new virus, and within a week virologists in Berlin had produced the first diagnostic test for the disease. Soon after, researchers in other nations rolled out their own tests, too, sometimes with different genetic targets. By the end of February, the World Health Organization had shipped tests to nearly 60 countries. The United States was not among them. Why the United States declined to use the WHO test, even temporarily as a bridge until the Centers for Disease Control and Prevention could produce its own test, remains a perplexing question and the key to the Trump administration’s failure to provide enough tests to identify the coronavirus infections before they could be passed on…”
- https://www.politico.com/news/2020/03/06/coronavirus-testing-failure-123166
144
The best thing Trump did was to ban travel from parts of China. He was called racist. Now he took the bold step of limiting European travel. Identify blasted him for that.
Do you need further proof of Dems politicizing the issue?
2
@John
Trump has made all the right moves, especially getting rid of those regulations that were hindering testing and the production of test kits.
We'll see the fruits of his efforts soon as tests reach the market.
1
@John limiting travel from Europe makes no sense at all. The virus does not distinguish between a citizen from the US who can travel, and a citizen of a banned European country. Furthermore, my German friends manage to come her via a non restricted country.
17
@AACNY Again, not factual. This failure so far is all on Trump.
24
As Dr. Fauci has indicated, we have failed to deploy adequate Covid-19 test capability in a timely fashion that could at least potentially have reduced public panic and partially mitigated virus spread.
As a clinical lab scientist who has worked with and for both CDC and FDA, I would submit that a portion of that failure can be attributed to the scientific arrogance of both agencies themselves in the initial insistence on a CDC-developed test and in the FDA not granting Emergency Use Authorization to US medical center researcher and foreign vendor-developed tests.
Even with the increased availability of Covid-19 RT-PCR tests, the brief persistence of Covid-19 in clinical cases suggests we may already be beyond an accurate assessment of disease prevalence in the population, which may require the advent of Covid-19 acute/convalescent IgG/IgM antibody serologic tests to assess seroprevalence. To my knowledge, THOSE test kits developed by several biotech vendors still await FDA approval.
21
Let's go one step further: mandatory tests for all Americans, whether they feel ill or not. Starting now where tests are readily available and expand it as supply increases. Make them free, make them available in drive thru's everywhere. The sheer public demand for them will spur a speedy and adequate supply, especially as private labs are enlisted to increase the effort. Have the government pay the labs handsomely and let the profit motive take over. We need a map of the entire country to see the virus in it's entirety. I think it can be done in four months if enough money was thrown at it.
8
There are two contemporary and intertwined pandemics caused by the coronavirus and brainvirus.
The first one attacks the lungs and results in high fever. The latter attacks the heads and makes the people come up with the wrong conclusions.
If our health care system was completely unprepared to confront the coronavirus pandemics and conduct enough testing, you don’t blame the White House incumbent for the structural deficiencies but the entire health care system and its unpreparedness.
If that were the case, we don’t have the superb health care but the inferior one in comparison to the other countries.
If our health care system is failing us, then we have to blame the lifelong politicians for it - like Nancy Pelosi, Mitch McConnel and Joe Biden…
We should promote the leaders who advised us about the imperfections of the current system.
Who was the only one to do that?
Bernie Sanders…
27
@Kenan Porobic Obama did set up a virus response group at CDC, Trump got rid of it. There has been an overall shift to privatize medicine in the US that de-emphazies public health. Many people have advised reapeatedly about the problems with our current system, so in this respect Sanders was correct and has plenty of company.
146
@Kenan Porobic Oh please.
The nitwit in chief disbanded a pandemic appointment, and has done nothing to work on this in three and a half years. Your narrative is designed to sheild the complete incompetence of Trump. How about that fact that he didn't want accurate numbers of Americans who were positive for the virus because it would impact him politically? Attempts by Democrats to improve public health have been foiled by Republicans over and over again under the guise of some superior altruistic private sector that doesn't exist. Get your facts straight.
163
@Kenan Porobic You blame the person in the White House who disbanded the team that was set up during the Obama administration to prepare for this epidemic.
82
The AMA controls the supply of doctors who have to be inserted into every public health decision so they can justify their high net worth.
The FDA controls the release of tests and their incentive is to ensure public safety through a slow process
The Executive Branch is being instructed to shield the facts that professionals can effectively communicate with the public
The political parties and their social media thugs are busy deciding if it's actually a problem.
Meanwhile, I have faith in our government to rally and do the right thing by the people through actions like what the governers of CA, WA, and NY are doing.
9
@Linus one correction-the AMA does not control the number of physicians. The bottleneck is at the residency level which is controlled by the federal government. Medical residency slots are funded through Medicare. The number of slots has not increased in many, many years. This issue needs to be addressed if we ever hope to have an increase in the number of well trained physicians in the US.
11
@Linus
Someone in power is hindering national COVID-19 testing in America. I'm not necessarily referring to our current president. It just seems odd that no one here is working together to solution this situation while other countries are pulling off COVID -19 testing without a hitch. We seem to have a child-like faith in the American system to a fault.
4
Thank you for including the American Nurses Association. My sister was a nurse practitioner for 30 years in CA, I'm in entertainment, and she told me, "If ever there is a medical emergency at a concert, ask, 'Is there a doctor or a nurse in the house?' She said to not just ask for a doctor, because in many emergency situations nurses are as prepared as doctors are to improvise in unusual situations. The older the nurse, the more experience to draw from.
So far it's happened twice, both times I remembered, and both times nurses worked alongside the doctors and no one died.
Need help and can't find a doctor? Ask a nurse.
25
I agree, though I'd also add we should be getting test kits from any source in the world - China had capacity to test 1.2M people per week and they've likely got surplus now. The time is up for Qiagen to get their act together... a couple days ago, the word is they've got "millions" of test kits, but no "RNA extraction reagent" which is needed to use them.
10
Agree. The reason South Korea is testing over 10,000 people a day is they are using test kits they are getting from China. My guess is that our government could be doing the same thing but the powers that be are refusing to use Chinese test kits. China has probably offered to send the kits to us but DC said no. Disgraceful. WHO offered to send us some of their test kits, and we said no to that as well. American exceptionalism I guess.
16
@Neil
My cynical side would also add (besides pride) that some Republican-connected entity is to profit from this. Our healthcare system seems to put profit first, and there's no reason to expect this is different.
11
As an engineer, I've led many teams and projects during my 40+ years in the business. I've often heard optimist dribble at the beginning of a project or from a CEO who has no experience in such things. The weeks you're talking about should be multiplied by a factor of 10 --- at least. And, that prediction is optimistic.
In successful projects, you learn and develop the scope as you go. Solve a few key problem every few days or hours; identify bottlenecks; establish pathways ahead of the main progress.
I remember fondly what Gene Kranz said when the Apollo 13 mission fell apart: "Work the problem. Don't make matters worse by guessing." Science is very unforgiving. Sometimes you only get one chance to do it right.
So, there's my two bits.
29
@Rocketscientist
So true. Nothing demonstrates this better than the claims, "Trump had 3 months to prepare!" Given the realities on the ground, Trump has moved things through remarkably fast.
1
@AACNY:
Actually, you are incorrect about trump moving things "remarkably fast".
China released to the WHO and the world, the DNA genetic sequence for the SARS-CoV-2 coronavirus, back in December 2019.
trump and his administration ignored this, and came up with a test to detect the virus only at the middle of February. More than 2 months late. The type of test the CDC released did not require that much time since they were handed the DNA sequence, for free. China did all of the heavy lifting for that.
What @Rocketscientist is talking about are entirely different things. He/she is describing the logistics, and reality, of R&D in a scientific field. The CDC, NIH, FDA, (and the trump administration) do not do -- and did not have to do -- any R&D in a scientific field. They were handed all of the data required to simply manufacture a test. And they failed.
The trump administration has botched this big-time. They initially ignored it (saying nearly nothing). When the virus hit U.S. land, trump's response was "the 15 [confirmed cases], within a couple of days, is going to be down to close to zero. That’s a pretty good job we’ve done."
trump was congratulating himself, and lying that the virus will be "close to zero" in a "couple of days".
THAT (trump's buffoonery) led to our current mess, and vacuum in leadership. And eventual large(r) number of deaths.
41
@Rocketscientist
It’s problem solving 101 as you described. Work the problem, stop guessing, quit following the directives,
clear out the politics and get the job done!
My two bits!
4
The only way to fix testing is to fire Trump and Pence.
I am absolutely convinced that restrictive guidelines for testing from CDC are on request of our Supreme Leader. Quest labs announced that they are starting testing, but still have to follow CDC guidelines ( symptomatic patients with history of travel to certain countries or with history of contact with Covid-19 positive person).I think this is criminal, not just plain incompetence.
52
Trump is trying to do damage control but it is obvious even to his supporters he has no idea what to do.
14
@Dr.MD Trump et al. want to keep the numbers down, so that they don’t look like the incompetent idiots that they are. If testing is minimized, the numbers stay low.
1
I hope with all my heart that, in this emergency situation, you American people will be able to avoid a serious mistake that I believe has been made in Italy. The Italian health system is totally focused on the Coronavirus. Doctors seem to care (and worry) only about this disease. The other patients seem to be forgotten. My father is 82 years old and has cancer. He cannot move from his bed at home. During this time, it has become practically impossible to talk to a doctor and ask for a home visit. This is because there is Coronavirus.
The advice I give with all my heart to all the people who take care of a seriously ill person is the following: organize now the health care of the person you love. If you know a doctor, ask for advice now on what to do and how to behave. I obviously hope not, but in a few weeks (or a few days) in the United States could happen what happened in Italy, i.e. you could be literally locked in your house and the health care system could be totally focused on Coronavirus. In this case it could be much more complicated to take care of the person you love.
Hugs to everyone.
28
Oh all I can say is how sorry I am for you. You and your father are in my prayers.
7
@Alfredo Alfredo,
Having also cared for my 82-year-old father through very serious and complicated illness and knowing what is involved in the care of such, I really feel for you and I am so sorry this is happening. My heart goes out to you and your father. Thank you for reaching out with wise advice for others to be prepared in case the same thing happens here. I truly hope the situation improves soon for you, your father and all in Italy. I will be keeping you and your father in my thoughts and wishing you the very best.
5
I t seems reasonable to assume that many people have already died from Covid-19. But due to a severe lack of testing we do not know who they were, where they lived and whom they contacted. This can only mean that we are about to be overwhelmed by a huge problem.
12
@fermi100
I am convinced that someone I know of in Michigan died from it in January, but of course the ME wasn’t looking for it.
7
The testing process will open up significantly over the next few weeks and will likely introduce an entirely new set of challenges for local health care providers.
First, just conducting the actual tests, which require masks, gowns, etc., and may already be in short supply. Second, dealing with all those who have tested positive and believe they are dire need of medical attention (when they aren't).
There is a big chance that all the positive test results will cause people to panic. It would be helpful if the media could educate and not incite emotional responses.
6
@AACNY
That is not the medias primary responsibility it is the presidents. He dropped the ball, people have and will die. In his press briefing just moments ago no one gave any indication when test kits would be available or when testing would start "just in the coming weeks", not good enough, not good enough.
12
@AACNY ....Gee, Maybe we should ask the media to provide test kits instead of reporting on their absence.
With the virus spreading in large part via people who do not (yet) have any symptoms it would seem that „making sure that everyone who needs a test can get one“ means EVERYONE can (and must) get one.
9
He should resign!
No American president has been this negligent with a well being of its citizens. No testing for months has been available in most cities. Reckless firing ..1,600 + scientist in an effort to clear the table for corrupt and dangerous EPA policies. Meanwhile ,the nations senior populations are greatly at risk, because of the incompetent roll out every safeguard that was needed. He really doesn't care. Just like her jacket said.Resign now!
32
@Carole
But... but... he had an uncle who taught something or other at MIT and was a genius. Doesn't that give you some comfort?
1
@Carole He should have been removed in February 2020.
Other countries have been more successful at this because they care. They care if their people get sick and die. Republicans here do not care. The electoral college cements their advantage even if a large portion of their supporters (older people) kick the bucket. So why would they care.
30
How many issues could benefit from a few persons rolling up their sleeves with a white board and breaking it down to the simple things that need to happen to get it done? This is obviously one of them. The fact that no one knew who was in charge means these sorts of conversations are not happening. This is outrageously ridiculous. Katrina on Acid.
31
@Michael Schiesser In the age of internet and social media, professional can form effective linkages without an imposed Czar. The progress we are making comes from the bottom up. Putting someone "in charge" is out of the 20th Century.
Donald Trump is the most spectacularly unfit disastrous president in the history of these United States.
If you put 5 female PTA presidents together in a room at 10 am, they would have designed, funded, produced and distributed a comprehensive testing program for patients-in-need before they had to pick up their kids at 3pm.
186
@JM this. exactly this.
In my life experience, this is literally true.
16
@jm with an hour break for a healthy lunch.
Let’s hope this is happening at the state and county level!
3
Who knew Putting Mike Pence in charge of a public health crisis would be a disaster? Everyone in Indiana? Public health experts and non-experts alike? Poor decisions all around.
43
We have missed the boat on testing. Shore up the hospitals. 1. Start ramping up production of the specialized CAPR masks (hoods) needed to care for COVID19 patients. Currently hospitals have a ridiculously limited supply for healthcare workers. Also ramp up N95 Mask production. How did we mass produce war machines in WW2 but are clueless about how to mass produce Personal Protection Equipment? 2. Ramp up the production of the experimental antiviral meds that seem to help the really sick patients. 3. Mass produce Ventilators!!! Anesthesia operating room machine ventilators can be used in a pinch but why can’t Detroit factories be revamped to produce ventilators for ICU’s. Revamped hotels to house patients helps no one without equipment. 4. Why is there a shortage of sanitizer? Ramp up that too! How are we the greatest Democracy in the world but we cannot figure this problem out? The Governors need to take the lead.
23
@Sasha We're seeing more leadership from governors and mayors in this crisis than from Trump.
9
In 2019, when Obama did his testing for Swine Flu, labs across the country were free to perform tests.
Fast forward 7 years, and the FDA and CDC were responsible for all testing. Everything had to go through them.
On February 2, 2020, Trump restored the ability of labs across the country to conduct testing.
These are the facts, folks.
6
@AACNY ...Wonder who appointed the heads of FDA and CDC. Wonder who cut the budgets of FDA and CDC?
18
@AACNY:
You are completely incorrect.
The FDA does not run tests on people. They only decide what test kits are "legal" in the U.S.
The CDC does not run tests on people. They are a "data collection repository" and a planning body for the federal government, to help monitor and track disease (pandemic) progression, and sometimes coordinate inter-state responses.
The responsibility for all testing was above both of these agencies. Above them is the president and the HHS Secratary (who reports to trump).
15
@W.A. Spitzer
Sorry, those were Obama-era regulations that centralized all aspects of the testing process.
2
And that is what should have been done two months ago.
13
This is a big help. I will add "no talk about how many business days it will take," "I expect my calls to be returned," and numbers of tests completed each day and results made publicly available.
And fire Dr. Redfield. If his testimony in front of Rep. Katie Porter is how he is working, he is over his head. The CDC used to be something I was happy to know we had in this country.
17
Our health system is a byzantine mess of regulations and responsibilities. That the CDC should palm off responsibility to the states for testing is unconscionable. Perhaps we will see if Pense's assistant has the authority to over ride the ney sayers and get things rolling for tests and other medical necessities.
At this point who knows who has the virus or is just having another form of the flu or an allergic reaction. In our small city gatherings are shutting down and rumors are rife as to possible corona virus cases in the hospital, but not one is formally reported.
This is no way to cure a pandemic with fear and uncertainty rampant.
7
One other suggestion: incorporate multiple redundancies into the system so that if something gets screwed up there are backups. This seems critical.
15
@Michael:
Much of the healthcare system already has backups: procedural, systemic, and electronic systems.
Remember, the entire industry is extremely risk-averse. They do not want to cause a death or to get sued. They have backups everywhere.
1
@WeNeedFacts
And yet, if I understand what I've heard from Fauci, there was a technical glitch that held up the works to get the test up and running, which he admitted was a failure. I am assuming there was no backup.
A historic market crash and fear of more damage to his re-election effort IS what is mainly motivating trump to take action... finally. With trump EVERY thing is focused through the “what’s best for ME” lens. His foolish supporters have been badly played and the rest of us have been screwed by republican policies and the past 3 years by trump. “Sad!”
38
The US now has drive-through testing facilities.
3
@AACNY Yes, and how many of those per capita do we have? And how long did that take? Want to compare that number to South Korea? South Korea performs 25,000 tests PER DAY. Good ol' exceptional USA has performed less than 10,000 IN TOTAL. In a football analogy, Trump and his agencies have fumbled the kick-off and recovered the ball on its own 1-yard line. It then fumbles the snap, picks up the ball and runs the wrong way. It is still the first quarter but we are already behind by at least four touchdowns and they do not know the difference between defense and offense. Our signal caller thinks he is the greatest QB of all time, but the statistics say otherwise. He is really just a clown mascot with orange hair jumping up and down on the sidelines.
14
@AACNY Yes, and how many of those per capita do we have? And how long did that take? Want to compare that number to South Korea? South Korea performs 25,000 tests PER DAY. Good ol' exceptional USA has performed less than 10,000 IN TOTAL. In a football analogy, Trump and his agencies have fumbled the kick-off and recovered the ball on its own 1-yard line. It then fumbles the snap, picks up the ball and runs the wrong way. It is still the first quarter but we are already behind by at least four touchdowns and they do not know the difference between defense and offense. Our signal caller thinks he is the greatest QB of all time, but the statistics say otherwise. He is really just a clown mascot with orange hair jumping up and down on the sidelines.
6
@AACNY
Here in Seattle, the epicenter of the virus in the US as of this morning 03-13-20 there is all of one drive through facility in operation and at the University of Washington. It is only available to employees of the university and students. They have a current capacity of of a whopping 50 per day. We are a city of over 500,000 and a metro area over 2 million people.
9
How does one declare an emergency when the virus was initially deemed a hoax?
33
The U.K. is approaching the Coronavirus COVID-19 pandemic we a realistic management goal. The first problem to tackle is massive population COVID-19 testing. Young healthy adults and children are not particularly affected by this disease but once the symptom resistant individual contracts the virus then that person will develop immunity to the disease. Virtually the same as being vaccinated. When a person who is a mildly affected carrier is identified that person needs to self quarantine 14 days and if he or she are asymptomatic and test negative that person no longer has to worry about social contact problems. The concept of herd immunity is developed. The vulnerable population of course needs to stay socially isolated to prevent the worst outcomes. If a person is identified as being part of the immune herd that individual can fully return to the normal social economic life without risk. This includes participating in the delivery of healthcare.
4
This is bad.
Having incompetence at the top is a danger.
Imagine if, instead FDR and Churchill, the free world had been dependent on Donald Trump and Boris Johnson....
28
Seven days? My confidence level in this administration is so low that I believe they will find a way to delay it further. After all, trump firmly believes low number of infected will be better for his re-election chances. He hasn’t thought ahead to how badly the number of deaths will reflect on his governance.
17
thank you for this guidance. may trump have the wisdom to follow this counsel, finally. and may joe biden stay healthy.
26
There are large American companies with nationwide networks that do medical testing for a living. I don't see why if a reliable test became available and could be manufactured en masse that the existing infrastructure could not be used to make testing widely available.
10
@Larry L
Because FDA and CDC regulations required every lab to be pre-approved and every test kit to be returned to them for testing. Until Trump overrode them.
5
@Larry L They are waiting for things that enable them to scale up are in place.
2
@AACNY
The Trump Administration prohibited WHO testing kits from being used, cut funding and cooperation for all health programs and agencies, and put all faith in a weak program of travel restrictions as the solution for containing the virus. His so-called travel "ban" permitted over 300,000 U.S. citizens and others to fly into the U.S. from China, as well and continue transportation of cargo from China into the United States. The numbers speak for themselves -- we have rampant spread of the virus. So, the Trump approach clearly did not work.
The CDC did an excellent job of developing and distributing tests for H1N1 and Zika. But that was under a different Administration, with adequate funding and qualified leadership.
Trump had to take the action to engage private labs because he and his hand picked leadership failed. Period.
14
Testing is an entirely false focus at this point, as the virus has spread too far and wide in society for us to isolate hot spots even if we had the political will to do that (which we probably do not). It was probably a false focus from the beginning. Besides, present treatment protocols are to treat symptoms, in the absence of proven antivirals. People should be told this, and that their primary focus should be on protecting and isolating the elderly and those with compromised immune systems from contact with younger people. The young should be providing succor, running errands for, and bringing food to the elderly -- safely, of course. Societally, we need to be ramping up our capacity to treat people in intensive care. That's the best way to flatten the curve and save lives at the same time.
11
@Snowball Shouldn't we flatten the curve to the extent possible and also ramp up testing capabilities?
7
@Chris W In a perfect world, sure. But our world is not perfect. Focus on what will actually get results, which is flattening the curve and protecting the vulnerable elderly. Don't panic about your kid getting COVID-19. It'll be somewhere between a cold and the flu for them. Do panic about your kid being a vector to your octogenarian grandmother.
9
@Snowball
I used to think this, but the problem now is how will we know when the curve is "flattened enough" and more normal life can resume? We need data for that - from testing.
7
Nice article accept, where are we going to get the test kids in quantity?
I've heard that the only source of successfully "tested" testing kits is made in Germany and Trump won't allow them in because they're not made in America or FDA approved.
I've also heard that Medicaid money can't be used to help poor people get test and treatment.
I can't verify this information. I'm hoping the Times will do so soon. The first I heard during a discussion on the Tom Hartman radio hour between a caller and he and the 2nd a read as report coming from the Guardian in the UK.
Hoping we get an answer soon.
5
Great advice. It is to bad that Dr. Kessler isn't in charge.
11
This article is brilliant. It should take 7 days, be free, and widely available, with no barriers, no doctors order necessary (no doctors or staff then put at risk), and not involve insurance at all or any payment - just anyone everywhere
There should also be an eventual test soon to determine immunity for health care workers so they can know if they can work without fear of getting sick or endangering their families
H Nayak MD MPH
16
@Hemant Nayak Health care workers would need to be tested several times as long as they are working with people having the virus.
4
@Hemant Nayak
Healthcare workers and those who have symptoms must be tested first.
3
The Belgium GDP is $37+Billion.
The US GDP is $19+ Trillion.
Belgium has drive-thru testing for Covid-19 for anybody who shows up with their Belgian driver's license.
United States has zero drive-thru testing.
30
@Maura-Incorrect. Seattle has a drive-through testing set up already. Colorado has one, but it was overwhelmed by the numbers of drivers. They are now trying to set up additional drive-through testing centers.
4
@Maura3
NYS just opened a drive-thru testing site in New Rochelle. But your point is spot on.
Better yet, how about self-testing kits that can be sealed for safety and sent to the lab, reducing health care workers' exposure?
7
@DG
There is also test with a one-hour response time.
2
Dear Dr. Kessler & NYT: Please present your analysis of progress
and needs weekly. We need to keep track — independent of government or congressional self interests interfering with numbers, analysis, projections, potential interventions, needs, risk and advice — when trustworthiness and timeliness are beyond the abilities of this President and his Congressional cronies. PLEASE. Thank you.
19
@Neil
The GOP Senate Majority Leader, Mitch McConnell apparently doesn't think all this fuss is necessary.
Mitch sent his people home for a long weekend despite the fact his President is about to declare a national emergency.
13
Why not obtain test kits from Australia where there seem to be many?
3
@jane
Because the FDA has to approve it, and that is not a fast process. Every time someone says, "Why can't we just do x,y,z" assume the answer is because of our regulations. Nothing happens quickly in a highly regulated environment.
1
@jane:
We can. It requires someone (in this trumpian administration) who can write adult English. They need to write/submit the request, called an "Emergency Use Authorization (EUA)".
The CDC did this for their test, and the FDA approved it on Feb 4th, within 24 hours.
4
The underlying problem is that Republicans believe that "government is the problem, not the solution", in the words of their Saint Ronald Reagan.
Until the public wakes up to the fact that this is a dangerous belief that ends of killing people and that is turning the United States into a banana republic, these kinds of disasters will continue until the Republican Party is gone.
28
@MVonKorff At least Reagan had the good sense or good luck to name Everett Koop as his Surgeon General, and to actually listen to him.
7
HE hastily declared a national emergency in order to divert funds to build his WALL, but has delayed pulling the trigger on this real emergency.
41
Hey, hey, hey, slow down there mister. We need to assure that anything we do in medicine is profitable. We don't have all these serfs because we want them to have a good life. Let's just see who is best connected in DC and get them the money for testing as fast as we can. I suggest Halliburton since they have experience with taking money from corrupt administrations.
18
The President has done something right by naming a person in charge of Coronavirus response. A broken clock is right twice a day. The man is completely irrelevant.
Funny how fast we have embraced a post-Trump era.
6
High-risk people should simply stay home and minimize the chance of contracting the virus instead of everyone undergoing self-quarantine and potentially losing their jobs. The alternative to propping up the economy with a workforce of healthy people so the bottom doesn’t fall out, would be for us all sit this one out of solidarity with the older at-risk members of society. I’m sorry I may seem callous, but this is where the arrogance of the boomers really begins to shine. If the elderly and at-risk were to stay at home and self-quarantine, essentially giving time to medical professionals to stymy the spread of the virus, this could very well mean a swift resolution to an otherwise catastrophic health crisis. However, per the suggestion of media organizations run by, you guessed it, boomers, we all have to stay home and watch our futures crumble in front of our very eyes? No, thank you. Sometimes the practical solution doesn’t seem like the moral solution. And it’s not as if my suggested advisory would leave those in need without care. All I’m saying is that generally the elderly and at risk should stay at home if possible. That is all.
Guess who also run the stock markets.
(psst…Boomers.)
2
Dr. Kessler's advice should not be in the NY Times today, hoping Trump acts on it. Dr. Kessler should have been in Oval Office briefing Trump at least 8 weeks ago.
Of course that assumes Trump was paying attention and knew to ask the right questions to the right people, which assumes Trump has hired the right people to be around him, respond to his requests, and then transform the president's ideas into a plan of action.
Of course, Everyone, Everyone, knows none of those assumptions are true. Trump doesn't pay attention. he doesn't know the questions to ask, and he doesn't surround himself with competent people. Trump needs to resign. He is a deadly and toxic humiliation. Trump's incompetence and ignorance is a greater threat than the coronavirus.
22
What needs to be done next is for the Republicans to do their jobs and remove trump from office. He is an extreme hazard to the health of the nation.
25
Dr. Kessler, thank you for your suggestions. As a former FDA Commissioner and an expert with experience, did Trump or any of his political appointees reach out to you over the past two months to get your input? I doubt it. Trump’s “planning” was non-existent and bogus.
17
No, doesn’t look like Trump reached out to this experienced health expert...
But Biden did...just really hope that everyone remembers that in November
10
Is Trump's stuttering response and overall failure here a high crime or misdemeanor?
7
A strong, transparent response by the Trump administration now will win him applause
2
@Orion - Sorry, but a strong, transparent response by the trump administration is beyond their willingness or ability.
11
Trump had the whole month of Jan to get this and other necessary items ready when it hit. His "3 AM" moment has been a Yuge failure. Even with Faux News backing him he will never "fake news" his way out of this one. Our only hope is the the states hard work and cancellations of sports, music and schools as well as big meeting have put a dent in its spread.
On MSNBC Thursday night it was announced that Dems are washing their hands multiple times a day by a 2:1 ratio vs Rs who are not washing there hands multiple times a day. Yikes!
9
Oh come on man, I perused your qualifications to write this opinion piece and I think I will just listen to what Trump said about this "flu" 9 days ago. He knows more about it than you do just ask him !
6
It is not just able to provide tests to the State Labs, it is the logistic for getting samples from patients, delivered to the Labs, get tests done in appropriate Labs... doctors need masks, protective clothing to get samples, secure delivery to the testing Labs ..... learn it from China, set up fever testing station in specific hospital and clinics would be more efficient Most politicians and head of CDC doesn’t know the operation logistic —- they just know how to TALK Waste of time
3
Problem here is that the writer is an expert and a scientist - the two qualities that make him persona non grata in the Trump administration.
21
A potential Kirkland is possible at thousands of care facilities for the elderly, thanks to the (Trump-regime-created) test shortage.
And the lack of transparency and candor at these facilities is misleading the public and giving the federal government a pass, instead of putting vital pressure on the Trump Administration and the Republicans enabling policies that are literally killing people. Meanwhile, the NYT should not report, eg, that there are 30 cases in NJ without a major asterisk. Editors—like rest of us—don’t have a clue.
Case in point: The facility in West Orange NJ where my mother —93, with Alzheimer’s—lives. The director emailed families Tuesday
saying “no one —staff or residents—has the virus.” I wrote back asking how they could possibly know? The director had told me privately she had zero access to tests. Next day, new email: Without noting it as a correction, the message: “No one, staff or residents, has symptoms.” My reaction: unlikely. Youngest resident in her 80s, always fevers and colds, and staff coming in from all over. Still no tests. I know they’re doing their best and want to reassure. But I’d rather they be honest. Tell us “We see symptoms that could indicate a virus. But we have no idea if staff or your loved ones have virus—because we can’t get tests from the feds. Remember to vote.” (Note:Unlike Kirkland, they have already closed to nonessential staff and all visitors.)
13
These recommendations sound like they come from an expert, who is not necessarily a Trump loyalist.
Accordingly, I have no expectation they would even be considered by the current administration.
6
It is interesting to me that other countries like Canada, Germany, France, England are not having difficulties with testing people. Once people have symptoms it is pretty meaning less to test them. We can then say , "Yep, they have it." What about people who say they might have come into contact with some one who had the virus? We need to test people who aren't showing active symptoms to get a handle on how far this thing is going to spread.
4
Dr. Kessler's plan appeals because it is audacious. Ambitious goals and processes that involve this country's most powerful resources to meet them are what is needed to get ahead of the virus. That, and slowing the spread by declaring no-go zones and closing businesses and schools BEFORE we have passed the point of no return. Thousands of lives are at stake and nothing should be off the books.
5
I think the entire point of this article is in the Disclosure: Biden is engaged personally, and with experts, to address next steps in this public health crisis.
11
Much of what Dr. Kessler says is prudent, and will improve the domestic pandemic situation.
I especially agree with his recommendation that "Seven days. That’s what it should take to bring the badly lagging United States up to speed". (with regards to availability of reliable precise test kits)
However, today we are many weeks behind in having a proper response, and we cannot catch up or make-up for that lost time. We will always remain behind, because SARS-CoV-2 (this coronavirus) has been easily spreading throughout the country, since we ran very few tests to thwart its progress. This fact, of not knowing the actual (and still unknown) number of infections, will drive and limit our ability to respond as well as the death toll.
I applaud him for correctly describing our situation as "the badly lagging United States", though I suspect if he were asked privately in a non-political environment, he would use much harsher words.
We should have immediately taken China seriously when they notified the WHO and the world, and released the full DNA genetic sequence for SARS-CoV-2, back in December 2019. The U.S. leadership vacuum we've endured for three months will take tolls.
16
The central problem in this debacle is that Trump is more concerned with his reelection than a proper response to the crisis. He didn't want much testing because he "liked the numbers" showing fewer cases. He was telling people there were 15 cases and it would be down to 0 soon a short time ago. He didn't want the unload the cruise ship because it would double the numbers. His energy now appears to have shifted to claiming that President Obama is responsible for his mishandling of the crisis, while Pence and the other appointees continue to praise Donnie incessantly at every chance, as if he were the messiah, sent here to save us all.
21
@Douglas So your point is that Nancy Pelosi should jump into the Oval Office and declare a national emergency? It isn't any of the Democratic candidate's role to step in either. Why have a POTUS if he is not going to take the reins and provide leadership.
12
@Douglas
I couldn't disagree more.
3
Don’t be silly. Trump has the authority to formulate and lead the response; Democratic leadership in the House does not. While we’re on the topic, though, the House has passed a bill to deal with the Coronavirus and sent it to the Senate, where it will probably languish on Mitch’s desk. Trump apparently doesn’t like what’s in the House bill.
5
Wasn’t Pence in charge? Very grateful that he has been replaced by someone with a medical degree. The response to this emergency has been botched from the very beginning.
28
@She Persisted
OMG Trump if President Trump declares a national emergency that would give him authority to use $40 billion allocated by Congress for disaster relief to address the coronavirus crisis.
How could ANY one trust that Donald Trump will use this money for CV victims? He'll probably bail out the hotel industry first to protect his many properties.
11
@She Persisted "pence in charge" is an oxymoron!
4
Dr Kessler is offering good advice to an administration that doesn’t value science. In fact, the White House is attempting to centralized a purposefully decentralized system of healthcare delivery.
What’s striking is, the bungled response to the Coronavirus is spreading as fast as the virus.
15
@Mark
Trump will certainly blame the bungled testing on Pence.
And now Trump can officially dump Pence as his running mate and choose Nikki Haley for his 2020 running mate, like he has planned all along.
8
@Mark
You have it backwards when it comest to testing. The White House is decentralizing a purposefully centralized Obama-era testing process.
1
This does need to be accomplished within 7 days are close to that. The lack of testing availability is inexcusable but the country has to deal with where things are now and speed is of the essence. South Korea and China are examples of what can be done when sufficient action is taken. The number of new cases must be limited before the healthcare community gets overwhelmed as has happened in Italy with dire consequences.
18
"There’s no reason the testing infrastructure can’t be up and running in seven days so that every person in America who needs a test can be tested. The president should demand it."
Trump IS the reason the testing infrastructure can't - and hasn't - been up and running. And I'm sorry to say that I believe that after your specified seven days from today (March 13th) the whole thing will still be a mess.
Prove me wrong. Please. I'd like to be wrong on this.
23
Easier said than done. Have you ever been involved in such a project, along with the complexities of handling every American's sensitive personal information? "Big tech companies... should be brought into the effort to work with testing laboratories to set up a data management system"
In addition, all of the risks would not be mitigated in 7 days. For example, it can take weeks for symptoms to appear.
3
Great tips. The sad part is that it even had to be written at this point in time. And at rate things should have been moving it will be seven days too late.
13
Thank you Dr. Kessler. Stay well and safe please.
11
This will never happen because it is relatively simple, logical, and effective.
13
Brett Giroir was nominated to head the FDA. His nomination stalled in the Senate over concerns of his comments and history concerning women’s health issues. Other than that, he seems to have the experience and expertise to organize a testing response. But watch carefully where government contracts go. He also has a history of promoting public-private initiatives that have made some corporations a lot of money.
10
Yesterday referring to the 'National Emergency' powers of the Stafford Act Mr. Trump said “I have it memorized, practically, as to the powers in that act. And if I need to do something, I’ll do it. I have the right to do a lot of things that people don’t even know about.”
So let me first say that the current president of the United States is completely unqualified to handle the health emergency facing the country and the world.
Having said this and noting that now Brett Giroir, the assistant secretary of health, will be responsible for the government’s testing response perhaps there will be some lessening of the confusion that has characterized the administrations messages.
I, like the rest of the population, have known from the beginning that this epidemic was far worse than trump or pence were admitting and that precious time has been loss.
But let's hope that now we are looking at an honest messenger and a clear way forward.
37
@Lalo You should look up the law authorizing FEMA. The government can declare martial law and make this country an authoritarian dictatorship. FEMA was created way before Trump's time.
1
Dr. Kessler makes a number of good points, but the lingering question in the minds of most Americans is a simple one: Why was the testing for Covid-19 not organized three months ago or more?
59
@sdw
We had to wait until we received the genome sequence in January. That's what the test is based on. The CDC chose to use its own test, which it believed was better because it tested for more strains, and its first test had problems.
Once the test was fixed, the testing process came to a screeching halt because every decision and test had to be handled by the CDC and FDA. It had to approve every lab and every test kit manufacturer.
The were "organized" in their mind.
6
@sdw The WHO had a testing method already up and running but Drumpf thought it was inaccurate so the CDC had to come up with a new method to detect Covid-19 which didn’t help.
6
@AACNY
I would add that many government entities such as the CDC, FDA, NIH are silos competing with each other as well as with academic medical centers throughout the country. In their own minds they are the best and brightest and not open to constructive criticism or change. Although they perform important functions, they are not flexible in a crisis and need someone objective to make sure that the individuals within these entities are all working for the common good.
3
Kessler completely ignores the FACT that the US does not have a centralized medical information system. ALL THE OTHER COUNTRIES ALREADY HAVE THIS SO THEIR TESTING AND REPORTING IS SEAMLESS.
Layering "google" etc on top of the hundreds of independent hospital computer systems is not going to solve that core problem.
The primary problem with taking in samples is getting the correct information about patients and doctors contact information - and that is a huge problem even in routine daily work. And that does not even include billing and insurance info (and the best practice would be to ignore that and just bill the federal government).
Instead these "sample centers" should be set up at hospitals, clinics etc that are already part of some system. All the reporting can be done thru their system. The catch is beefing up staffing to handle the crush of samples.
16
Tests should have been ready 2 months ago, the delay is inexcusable and heads need to roll.
40
@Paul Adams
Start with whomever disbanded the pandemic response group at CDC and defunded many other relevant public health programs.
10
@Paul Adams
That would require firing everyone at the top of the FDA and CDC, the two agencies tasked with the manufacture and testing of all kits
Good evidence that Gov't Agency Appointments DO matter. The inadequate and faulty leadership of numerous individuals here ( as CDC, FDA , Health agencies.) highlight why Politicl Appointments are bad governing, which in this case hurt our country and its citizens. Republicans shouldnt support a president who depends on his incompetent political appointees to protect him instead of our country and citizens. This should not be partisan, since Republican party historiclly should believe in protecting our system of governing, regardless of
stands on policy. Who runs our various agencies, military,etc. DO matter. Republicans SHOULD be up in arms, just as Dems are.
27
@NG
This is a blinding illustration of why Republicans are not fit for responsible government positions.
3
The advice to do what's described in the below quote is frankly wrong, and will cause more problems than it solves:
"Big tech companies like Google, Microsoft, Apple, Amazon and Salesforce should be brought into [...] to set up a data management system to handle the flow of specimens and the resulting information"
The requirements for doing this is driven by many regulations, that consumer companies (like Google, Microsoft, Apple, et al) are not able to do, nor would they be able to gain that expertise in sufficient time. You cannot simply "hire experts", if they are unavailable or working on more important problems addressing this coronavirus.
Existing laboratory testing systems used by major labs already have, and are linked to "data management systems" that are very sophisticated, have been tested to ensure near-zero failures and software bugs, and can handle the data/reporting requirements for this pandemic.
This is not a bottleneck.
9
@WeNeedFacts
The answer is NOT big social media and retailers. New York state is using the 200 labs it already has. Each state has medical labs that are already close to the sites. It seems logical that state labs should be front and center in the testing. The federal government has been castrated by half-blind ignorant appointments handed out like party favors rather than merit- and expertise-based. For those of us who die thanks to this incompetent government may our relatives send the funeral costs to the criminal white house.
3
Utah already has their own test. The test is presumed positive until the CDC confirms. However, health officials are assuming a positive test is a positive test. That's reassuring.
Why the federal government isn't so proactive is disconcerting.
Most of the White House is presumed positive at this point. Let's think about this for a moment. I'm not sure leadership becoming totally incapacitated is a bad thing right now. That's definitely disconcerting.
12
@Andy You're assuming that there's leadership in the White House. I'd say that's open to question.
8
@Bob Bunsen
Yeah... I kinda meant a vacant White House would prove net positive to public health outcomes.
4
Finally!
A professional who is also a scientist maps out a solid, reasonable and workable plan of action.
I find more comfort in this plan than in anything that has been said or "done" in this Administration.
Thank you Dr. Kessler. May your words not fall on closed ears or eyes.
23
I would ask the South Koreans. They have a PCR test that is about 95% accurate in detecting the Covid-19 virus. The tests used by the CDC in this country have a sensitivity that is only 70-75% accurate. The Chinese determined that a CAT scan is much more accurate in diagnosing COVID-19, about 97%, even before the infected person begins showing obvious symptoms of respiratory infection.
With a sensitivity of only 75% it is very easy to miss a diagnosis, especially if the person is tested too early.
Don't take my word for it. I'm nobody. Look it up.
20
@Aristotle Gluteus Maximus Correct. Laurie Garrett pointed this out; more here: https://www.mountsinai.org/about/newsroom/2020/mount-sinai-physicians-the-first-in-us-analyzing-lung-disease-in-coronavirus-patients-from-china-press-release. We should be working backwards on all pneumonia patients since January on this, if contact tracing is even still doable.
2
With all the experts giving suggestions and advice, it's very clear the only "wall" in the process is President Trump. Please, someone get him out of the way.
98
Sorry, but to me it was Trump's deliberate desire to limit the truth about infections that accounts for the lack of tests or accessibility for those even exhibiting symptoms. That is likely what Trump wants to keep the deliberations about his response secret. Not very complex, just Trump's gut response to try to minimize the severity of the pandemic to bolster his "perfect" response to the problem.
131
We have lost lots of time because Trump thought if testing was limited it was better for the Stock Market and his reelection. We're way behind the eight ball, but without quick and massive testing even mitigation will be very difficult. Geometric increases daily while no accurate way to contain.
50
This is the tip of the spear. Next it will be beds, ventilators, medical professionals. The entire country needs to mobilize a wartime response. It is a war.
104
Since the virus incubation period (based on Chinese and Korean studies) appears to be 3 to 5 days, waiting an entire week to get test results back means two generations of infections may have occurred in the meanwhile. That's just not acceptable. It's literally like mailing a letter to the fire department to let them know the high rise is on fire.
University and other local laboratories have the ability to return test results they process themselves, onsite, within hours. But they have to receive approval to do testing. And they need resources.
We need leadership to step in and realize, this is going to take new approaches, fast action. The US has already lost track of infected persons who've been out spreading virus in the community for two weeks. Adding another week or more just waiting for test results is an utter failure in preparation and logistics.
South Korea and China have figured that out - why is the US medical system so completely out of touch? Maybe there's just no profit in being prepared to fight a pandemic.
101
@Neander
I believe the reference to 7 days is for putting in place all the infrastructure that Dr. Kessler describes - not the time needed to sample, test and return a result.
20
@the more I love my dogs You should be aware - current testing at Quest and other labs takes days to one week for results to be returned. The delay has to do with shipping the samples to remote labs. Stanford U and other institutes are gearing up capacity to do in-house testing, to avoid those delays. But it's not clear the government approach will expedite them, versus the snailmail version we presently have. Korea has drive through testing with results in hours. The US is still trying to ship test kits to hospitals. This is the flaw in privatized health care.
17
@Neander
I read that it is likely that the incubation period can be much longer than 5 days. I also read that during that time the virus is not detected by tests. I am not sure this is all still true; there may be more knowledge about it.
Let’s try to do our part in moving above partisanship to deal with this virus. Even the most cynical among us can agree that Trump does care about one thing: getting re-elected. So with a little luck he will do his job and appoint the experts he needs to and then go back to Tweeting about whatever while the feds actually address this crisis.
8
@Aaron This. Right now we need to convince him its in HIS best interest to have a strong rapid pandemic response. He deserves all the criticism, but appealing to his ego is the only way to get him to act.
8
@Aaron Trump slammed Democrats and Obama again today, essentially blaming all this on them. You need to send your message straight to him.
2
A brilliant plan. We "should" do it.
We will not do this well laid out, clear plan, because Donald Trump must always be the smartest person around, in the room, and out of the room. Trump despises people smarter than himself. That's basically 98.6% of us.
Trump will not listen to you. He has surrounded himself with No-Nothings to filter out purely sound advice.
But - still - hope still is with us that someone prevails over Trump with your good plan.
We also hope that it won't take 344 days to what you say can be accomplished in 7 days.
28
Trump is expected to declare a national emergency this afternoon. At this point, I suppose it’s just so that he can say he did it.
25
@El Gato It releases $40 bn immediately and puts FEMA into the mix, hopefully without greater uncoordination among the many agencies. This was why Obama put the structure in place that Trump destroyed and is now quickly trying to reinvent. Fine, but let's reinvent freaking fast because this doubles every three to six days when uncontrolled, as it essentially currently is.
@El Gato Well,and so he can free up funds that he can then appropriate for his wall. Oh, and possibly lay the groundwork for cancelling elections. (Was I always this cynical?)
4
Ideally, a nationwide effort would be coordinated with the White House. Unfortunately, since the Trump administration is hopelessly inept, we will have to rely on governors and local leaders for guidance.
13
Of all the reasons why Trump should not be president (read this as CEO of a very large complex organization)...this tops the list.
17
please. please. look at china for a medical model.
massive testing.
fever clinics.
isolation.
wartime offsite clinics.
come on
14
@Pamela
Oh you forgot China's initial response was = to Trump's and then they used their authoritarian government to ram everything into place. The South Koreans showed how it can be done in a democracy.
4
@Pamela Seriously ?
They killed some of the early whistleblowers. They hide the truth and are now trying to spin this as this was a US created event.
Better off looking at South Korea as a model.
3
Of course it's good we're finally taking belated steps, but shouldn't some (or most) of the infrastructure needed to do mass testing in a pandemic situation already have been in place in this country? It seems Taiwan, which as of yesterday has 50 cases and 1 death (in a nation of 20 million), started building such an infrastructure after learning lessons from the SARS epidemic in 2003.
This seems incredibly logical and farsighted now and one wonders why many other countries (including the U.S.) didn't follow Taiwan's example.
https://www.nbcnews.com/health/health-news/what-taiwan-can-teach-world-fighting-coronavirus-n1153826
12
@x We have historically allowed states to lead the way in a public health crisis, with guidelines from the Federal Government. This administration gutted the CDC, DHHS, The NIH. Defunded. Fired. Brainiacs moved on. Science was devalued and denigrated. These idiot men in suits know nothing about microbiology, epidemiology, or public health. Public Health? That costs too much. We will now overwhelm emergency rooms and intensive care units (which are finite) with the ill and dying. Decisions at THAT level surrounding who will get ICU beds will be harrowing and will create a shitstorm. All because we put some men in suits (instead of white lab coats) in charge of our health. AND. Might I add: NO ONE should get a bill for the care it will take to get them through this. THAT is PUBLIC HEALTH!
I like most of you want answers. Why aren't kits available two months ago? Why aren't they widely available now? There is a story there and we want to know what it is. Period.
14
Two days ago I spoke with a friend who is a gynecologist at Jamaica Hospital in New York, hospital that serves two airports. The number of test kits for Corona virus? His answer? Zero!
This is crazy!
Hopefully this demented situation - the woefully inadequate state of national readiness - will send a message. It is not just the response to corona virus Now but the monumental necessity to reform the entire American health care system in order to protect the health of our nation in the future. Read socialized medicine!
25
Yesterday I checked Reddit. A guy said he came through JFK on an international flight. No temperature scanning. No questions about where he’d been. How can there be so little effort?
6
The president should have demanded testing be developed and deployed in January. It's March. Less tweeting/more leading.
25
So...how many people are actually in charge? VP Pence, Jared Kushner and now Dr. Redfield. And all the information still comes through the WH?
10
Typical American response. “We can fix it in seven days.” A problem that has been building for years can be fixed in seven days...
10
@Walter Bruckner Dr Kessler has worked for both Republican and Democratic administrations and I think he is horrified sitting on the sidelines watching this unfold. We would be smart to listen. Hopefully someone on the White House staff is listening.
11
Makes me wonder if the White House does not want the testing done as the number of cases will sky rocket and further rattle the stock market (which is the President’s chief concern). No proof means corona virus is contained and everything is under control.
14
@KB If they're that stupid, it'll be hard to cover up tons of deaths and hospitalizations. That won't help Trump's re-election chances. If Trump is literally this braindead, he should simply be 25th Amendmented out of there. I'd take Pence over him at this point. My guess is he's delegated everything, as seems the case, and people are desperately trying to keep him out of the way and quiet. To little avail.
I read that Jared Kushner was essentially asking random people ( the father in law of his brother) how to approach coronavirus and a that a Facebook group was serving as a sounding board for ideas for Mr Kushner. I hope the WH will read Mr Kessler's submission and also Susan Rice's.
21
This directive would be hilarious if the stakes were not so grave: the Trump administration's incompetence has now reached such epic proportions due to Trump's paranoid, psychological insularity that the only way for the citizenry to get good information on managing the pandemic into the hands of the executive branch is to have an epidemiological expert, medical doctor, professor and former commissioner of the FDA write up a single sheet bullet point plan, stuff it into a NY Times bottle and toss it into an ocean of punditry foaming in the midst of a hurricane of concern and hope that somebody on Team Orange happens to notice it.
The desperation of the maneuver itself in light of Trump's legendary intransigence bespeaks a wondrous type of faith in the Executive Branch not warranted by circumstances.
It would be better for the states to immediately create an emergency office for Dr. Kessler and being taking their direction from him. When are people going to realize that talking to Trump is a fool's game and a waste of time?
25
@Kip Leitner TRUTH. Just because we're reading this article doesn't mean anyone in the White House is listening.
8
"The president should demand it." ? i.e. quickly get tests to everyone who needs one. He has no understanding of the situation. He cannot be trusted to make rational decisions to address the problem. He is concerned only with his own image and how the unnecessary deaths of thousands of US citizens will affect his chances of re-election. The American public should demand that he step out of the way, keep his mouth and Twitter account shut and let medical professionals do what they can to clean up the mess that he has created through months of inaction and lies.
17
This move should have been made by the Feds 2 months ago.
There needs to be a thorough investigation and root cause analysis of the gross testing failure in the US which has been outperformed by various third world countries. And in particular: who in the administration refused the WHO standard assay, developed in Berlin and offered to all nations? Who made that decision? Was it the political appointee at the helm of the CDC, whose incompetence has been ghastly?
26
@MO I'd like answers to those questions also, and I'll be pressing my representatives to find out just what happened there.
8
@MO Given the extreme reluctance to name names, we can probably guess. Otherwise there would be someone under the bus.
"How to Fix the Coronavirus Testing Mess in 7 Days"
How to fix it in 1 second, Trump resigns.
44
On January 21, the first coronavirus case in the United States was confirmed in Washington state. Six weeks later was the first death, in Seattle. By March 12, Washington state had had 31 fatalities from 457 cases. King County ( the Seattle/ Kirkland area) had 27 of those deaths from 270 cases.
The United States today has a count of 1,268 people who have been infected.
And only now has Trump put someone in charge of national testing for this pandemic?!
15
@Jean Those numbers are massive underestimates because little testing. 11,000 at last count, out of 330 million. Insanity. Richest and most powerful country in world history; plenty of advance notice since December.
We were already woefully unprepared just under Obama, let's not lie. Who took any of this seriously, even though it was literally inevitable. As is nuclear war or accident or terror, as is climate collapse. Who takes any of that seriously at the policy level?
We're all guilty; those with more power, moreso. Let's fix this right now or this country may well be finished, literally. We can't have millions of deaths and basic services falling apart.
1
Yes, of course those numbers are massively too low. That is why with the 5 cases identified in Ohio, the Governor, DeWine yesterday emphatically stated multiple times that he and health officials are convinced that there are at least 100,000 Unidentified —but infected—people in Ohio.
1
The testing is the first step. The next is acquiring all the respirators and intensive care beds that will be needed. This is simple but not easy steps to accomplish. The flu season is already using these resources, so we need more.
7
How to Fix the entire Mess in ONE Day: Trump Resigns.
20
One think we all can all count on is a dysfunctional government.
4
Now, imagine if we had a unified healthcare system. Let's call it 'Meducare for Alk'. How much if the administrative and political efforts described by the author would simply be unnecessary?
9
Now we're talking! Thank you, Dr. Kessler.
7
Forget appointing anyone. Write an advertisement requesting a company or an individual who can get this done because they have the background and the knowledge. We can’t wait to see if someone can get this done once appointed. We need people with a defined clear track record of how to manage these types of events. Trump has made a bloody mess of this and he will kill people as a result. Let’s get the right people who want to do this working.
7
Redfield's response makes me cringe. He is so typical of a bureaucrat! I don't know who is really responsible for this testing mess except it falls under the responsibility of the CDC. They need to pull together and get this done. Now, the President has to micromanage them. Pathetic. I worked for the gov't for 20+ years and I know how these department heads work...and how they deflect blame. We need to hold the CDC responsible...not the President. I will remind you that the CDC guidelines they're using we in place during Obama's administration, so this is nothing new. Stop using this testing mess for political purposes and make the CDC fix itself!
2
@J. G. Smith
Nope. Not buying it. A few weeks ago, Trump was claiming the number of cases in the U.S. would go DOWN, and focusing on the stock market. He dropped the ball. You can't claim credit for good times, and then shove off the blame when things aren't done right.
3
@J. G. Smith The cognitive dissonance must be getting extreme, Mr. Smith. Even Tucker and Michael Savage are rebelling. Soon everyone else will too because reality.
Sure, all of us currently alive are responsible for blowing off this literal inevitability since forever. Ditto nukes. Ditto global warming. Ditto soil loss. Ditto lots of things. No kidding.
But Trump is literally the most powerful man on earth. He had tons of advance warning just for this one outbreak. We can all see what he did and didn't do.
And you pay the cost for being the boss. Or else you're a fraud. It's that simple.
1
HEADLINE: "How to Fix the Coronavirus Testing Mess in 7 Days"
Consider this day 1. Let's all take bets on Kessler's assessment and see where we end up 6 more days from now. My bet is we won't fix this testing mess in 7 days. A month maybe, but not seven days.
South Korea is testing 20,000 people a day, A DAY! We've got a long way to go.
10
Can the Veteran Hospitals help with the testing? I don't know their capacity.
On a side note I did announce on Twitter that I was voting for the NYT for President. You will have to draw straws for your positions.
I wonder what is in it for our dear "leader" He will make any plan unworkable. That is his way!
4
First priority is to make testing kits that are complete. Our governor just announced on CBS that the testing kits California received are missing components!
4
We knew this under Obama, and we are prepared. Trump - totally another matter.
INCOMPETENCE RULES. Just look at his vacant stare when someone tries to explain something to him! His head is empty and he's plotting his next crime instead of understanding what he needs to.
17
It would have been great if this were done months ago.
Maybe if Trump hadn't fired all the health experts and gutted the agencies responsible for managing a pandemic we wouldn't have to explain to him what to do by writing Op-Eds in the newspaper.
17
How is it that the Utah Jazz was able to test 58 players??
14
@Andrea $$$$$$$$$
1
Finally somebody 'official' willing to be in charge of communicating what's going on, based on the truth and evidence, to the public, about the coronavirus crisis. Enough of Trump's variety of rabid dog-type attacks (if not on Obama, then on democrats, etc). Our vulgar bully in-chief would do well in reading the Bible: "You see the mote in your brother's eye but you do not see the beam in your own eye". Hypocrisy? Indeed!
1
Who the heck is Brett Giroir?
What educational professional expertise and experience does he have to deal with COVID-19 diagnostic testing development and distribution?
What are the duties and responsibilities of Vice President Mike Pence and Secretary of Health and Human Services Alex Azar in the COVID-19 crisis?
5
@Blackmamba They stand behind Trump, nodding their heads and murmuring and then saying what a great leader his is. #thatisall
2
@Blackmamba No sweat, Jared's on Facebook.
2
How can you test for a hoax?
We learned the test for a fake - have the GOP make him President.
3
Excellent points, and a useful intervention in these times of weird confusion. But I’m afraid that the one way to ensure this president does not follow that advice is to publish it in the New York Times. You might undermine the idea that the whole epidemic is a Dem-abetted hoax
3
Within a week ..... Oh come on!
We are where we are because of lack of experienced labs that are set up to handle the load and one key missing ingredient that extracts RNA from the virus so that it can be tested.
That's going to be fixed in a week ... And that message is coming from folks that have been telling us for up to a month that we would have "millions" of tests. It is also from an Administration that, according to Reuters, is keeping key corona virus information classified. We don't really have a clue how many tests have been performed in the US, and hence, we also don't have a clue how many cases there are.
Pardon me for my skepticism, but for all its lies, this Administration is going to have to actually hit its own deadlines at least 20 times before I'll accept even a word about future projections.
7
Dr Kessler comes out with this. Meanwhile, the White House put Jared Kushner in charge.
9
Private lab and university testing???
“Leading clinical labs Quest and Labcore have capacity to do 1,000 tests per day. for the nation.”
UCSF and UCBerkeley have donated their research labs to process kits. And each has the capacity to process 20-40 kits per day. And they are not certified.”
https://www.linkedin.com/pulse/notes-from-ucsf-expert-panel-march-10-dr-jordan-shlain-m-d-
And to think South Korea was doing 10,000 tests per day starting weeks ago.
How embarrassing.
9
@Robert Tobin this is what happens when you gut the NIH, The CDC, and the DHHS, and the science guys get told what to say or they lose their jobs.
4
Let's hope David Kessler gets on Fox & Friends and that they don't laugh at him and shout him down, otherwise Trump won't do this.
9
Gee, Donald—see how easy that was? Now get to it.
2
OMG! No one is in charge. More trump chaos.
7
If the NYT got its hands on the Trump Administration's classified communications about the coronavirus, we might learn why its response has been so abysmal. If the lack of testing has anything to do with the White House push to keep the number of cases down, let’s go full Fox conspiracy theory and impeach this con man again.
14
Generally, with this administration, if it appears in the NY Times, regardless of the merits of a suggestion, it won't get done. Just because.
Juvenile spite.
7
It's all about leadership, of which we have none. All Trump is concerned about is somehow, someway, blaming Obama for this. What a loser. Everything Trump touches is ruined.
8
promises made
border walls hyped
coronavirus gaslit
economy tanked
promises unkept
populace duped
11
South Korea and Australia have "drive through" testing, for god's sake.
We look like idiots.
Thanks, Trump.
12
Admiral Thad Allen,retired Coast Guard. He was brilliant at coordinating the control of the Deepwater Horizon effort. His nightly report to the nation made me confident in our government’s ability to respond to disaster, even if it had been an enabler. Call him up!
5
Pretty poor reporting on testing, which has ignored the actions Trump has already taken to fix the problems he inherited from Obama.
On February 2, Trump signed authorizations to bypass the regulations at CDC and FDA to allow private labs to evaluate results (versus sending every result to the govt) and private firms to develop test kits.
As a comparison, when Obama dealt with Swine Flu, testing was conducted at labs all over the country. By the time Trump took over, the FDA and CDC has consolidated control of all testing, creating major road blocks to fast wide spread testing.
2
@AACNY You believe that, you'd believe anything! Just for starters:
"The time to prepare for this was two years ago, when Trump fired America’s pandemic response team. Trump didn’t manage this alone. He did it with the strong assistance of John Bolton.
"The entire global health security team that was inserted into the National Security Council to deal with emerging health threats—and specifically pandemics exactly like the 2019 novel coronavirus—was disbanded in May 2018. That included the firing of Rear Adm. Timothy Ziemer, the former executive director of the disaster response and global assistance organization World Relief"
15
@AACNY
"Before we dig into Trump dismantling the Pandemic Reponse Unit, let’s first recall that Trump has previously tried to slash funding to the Centers for Disease Control and Prevention (CDC), America’s preeminent authority on disease and pandemics. Unbelievably, he just proposed 16% in cuts to the CDC’s 2021 budget at the same time COVID-19 coronavirus arrived in the U.S.!
"When first questioned about why he disbanded the Pandemic Response Unit in 2018 — the same year Trump and Republicans had no problem giving a trillion dollar tax cut to people who didn’t need it— he responded:
""I'm a business person," he explained two weeks ago in response to a similar question. "I don't like having thousands of people around when you don't need them. When we need them, we can get them back very quickly.""
20
@AACNY
Not buying your talking points for a hot minute. You're talking about the same "I alone can fix it" Trump who said the problem would go away "magically," and that the 15 cases in the U.S. would be "down to zero." He was focused on the stock market and downplaying the risks to the health of Americans. If there was any roadblock to the test production, it should have been cleared months ago. This debacle sits at his feet.
4
Sorry Dr. Kessler, these are perfect solutions and great public policy advice, BUT the Republican party and the Trump Administration aren't capable of 'governing'.
The can divide and conquer and cut taxes and divert our attention with lies and misdirection, BUT actually doing the fundamentals of good government is simply not part of their repertoire.
You might as well speaking Farsi to the Trump Administration.
They simply are not capable of comprehending the basics of 'governing for the people'.
Remember in November.
448
@Socrates I agree. The Trump GOP has two goals. Take the federal government apart, and stay in power for the sake of the wealthiest. We can only hope that their failures — maybe this time!?— will turn more people against this entire ideology so that never will this kind of preposterous “conservative” win another election. This requires a belief in the rationality and good will of the American people, and since 2016, I’m not optimistic that this is possible.
36
@Socrates
Much of the Republican base thinks that Trump was sent by God to shepherd us, and is therefore infallible. His word is much more reliable than that of, say, an epidemiologist.
Now he's blaming the CDC and Obama for the failure to produce tests. They'll believe that, too.
20
The Republican mantra is Make America Greatly Anarchic.
They have been successful in achieving their goal.
3
Thank you Dr. Kessler! Finally a truly educated, experienced public health expert weighs in on the steps to follow.
Dr. Redfield was more of a political appointee than a medical one. Yes, he's a virologist with a degree in medicine from Georgetown, but that's not why he was appointed. I watch his body language around this president, and anyone who laughs at his clowning, in the middle of a deadly pandemic, shouldn't be heading an agency as prestigious as the CDC.
Of course America has the wherewithall to roll out tests for anyone who needs one (as the president so cavalierlly said last week) with one big caveat. There must be someone in charge to coordinate all the moving parts and companies towards this end. That person must have full authority as well--let's hope Brett Giroir is able to fulfill the role he was given.
19
@ChristineMcM As opposed to dr. EMANUEL who held the post under Ob6. He had no experience at all in infectious diseases. But he was Rham Emanuels brother.
@John: As opposed to Jared Kushner who's been more and more given pieces of the virus mismanagement. I urge you to read the account of asking Dr. Kloss, a remote connection to him through marriage, to help come up with virus management strategies. The good doctor obliged by asking a Facebook group of ER doctors for their opinions, many of which ended up in his press conference today. I'd go with Zeke Amanuel any day, with his vast brainpower and public health perspective than any doctor who thinks querying random colleagues on Facebook for their ideas.
2
If this has taught us anything, it is the we need a robust well funded public health system in this country. Trusting Capitalism to your health is not a recipe for health, or success.
And probably universal health care of some form or another, with private insurance on the side.
30
@Celeste
On the contrary, what this has taught us is that centralized control of something as critical as testing should NEVER be funneled through a federal bureaucracy.
As these testing delays have demonstrated, that is not the system you need when speed and volume are needed.
Thank goodness for private industry in this case. The CDC would still be producing 50 results per day if Trump hadn't stepped in.
2
@AACNY
Uh - sorry, but Trump CREATED the incompetence in the CDC. And when did Trump step in? Do we now have more than 50 testing results per day? Uh - NO.
7
@AACNY
You mean the same Trump who was downplaying the virus and claiming it would go away magically when the weather got warmer? That Trump?
4
I agree with Dr. Kessler's thoughts that appointment of Mr. Giroir is an important development. I also agree that Dr. Redfield's response during House testimony yesterday was criminally disappointing. Noting that Dr. Kessler is a former FDA Commissioner, there is another point to make here. The current Commissioner of the US FDA is Dr. Stephen Hahn. The FDA has been victim of the same issue as many agencies in the Trump era: turnover and instability in leadership. The previous Commissioner, Dr. Scott Gottlieb, a highly experienced leader, left over a year ago. The position was filled on an interim basis until very recently when Dr. Hahn, who completely lacks public health or regulatory experience, was appointed. The FDA plays a critical role in the availability of clinical diagnostics in this country. Every bit of evidence suggests that test availability during these extraordinary conditions was handled at the FDA though arcane regulatory mechanisms. A more experienced leader would have identified this as a problem and would have provided leadership towards a solution. It is likely that this did not happen. This is not necessarily a personal indictment of Dr. Hahn, rather, another example that the calculated evisceration of effective agency leadership by the Trump admistration has tragic consequences.
15
@Eric Thank you for that succinct wrap up of our terrible situation.
I wish someone would explain exactly what the problem has been with the tests. The testing method being used is one that is commonly used in research laboratories across the country (as well as state crime labs) every single day. The kit components are routinely ordered from IDT, Qiagen and other companies on a large scale every day. What was the problem? Access to positive control RNA from the virus? Something else? What?
11
@Elizabeth
While the CDC did have a problem with its first version of the test, the problem isn't the test. It's who was allowed to conduct tests and where the results could be evaluated. The federal government had to approve all labs, which could take weeks, and then all test kits had to be sent back to the government for testing, which slowed everything down.
These controls were put in place under Obama. Fortunately, for him, they were implemented after his Swine Flu epidemic. During that epidemic testing was still permitted in labs across the country.
On February 2, 2020, Trump signed an authorization to free up testing. The results are now coming to market.
1
@Elizabeth The main issue is that the CDC, who evidently had an opportunity to acquire a functional and validated asay over a months ago, declined in favor of producing their own. To make matters worse, their initial attempts failed. Next, the FDA slow-walked their approval process. When the failure was evident, private institutions leaped into the void, but this created an acute shortage of reagents (for instance, RNA isolation kits) that are required to produce a validated assay. Private diagnostic companies are now being invited in to salvage the situation, but we've effectively lost 2 months.
6
@AACNY
Keep trying. Everyone heard Trump downplay the virus for MONTHS, and claim that the first cases in the U.S. would be "down to zero" soon. We also heard his closest staff--the people he trusts above all others--claim as recently as two weeks ago that the virus was "contained." No one at the top, especially Trump, gets a pass on this.
4
As we can see, it takes congressional democrats to pin down the Trump administration about critical things like, who's in charge or when are those tests coming? I shudder to think where we would be if Republicans were controlling the House.
16
I do not think testing is going to meaningfully expand even with increased availability of tests. There is no talk of changing the circular criteria for testing. Maybe they are waiting until more tests are available to say anything about that, but I'm not holding my breath.
The appointment of an admiral and pediatrician is a mistake. Like all tests the testing for exposure to SARS-CoV-2, the virus that causes the disease COVID-19, has a sensitivity and specificity to determine the positive and negative predictive values of the test results, based on the prevalence of the condition. While Admiral Giroir may be an expert in military logistics, which might help distribute the tests, the program should be run by a qualified laboratorian with the assistance of the Admiral. The logistics of distribution are important, the analysis of the distribution of the testing kits and the analysis of the testing results will be a key determinant in mitigating the spread of the virus.
Dr. Kessler's disclosure that he worked for both Democratic and Republican Presidents offers no support to his claim that "This is not a partisan issue." The incumbent president has politicized the situation to the detriment of the public's health and well-being. Dr. Kessler is a fool if he believes his past employment has eliminated politics from the issues surrounding the pandemic.
9
@Nate Grey
Agreement from a different angle - any good and decent person knows that testing is not a political issue. The fact the doctor takes time to point this out is what makes me question him.
3
@Nate Grey I think you may have misunderstood the intent of Dr. Kessler's statement. My understanding of his statement is that he was describing himself, and his recommendations, as not being driven by his favoring one political party, but only by the science and medical issues. He did not intend to characterize any other entity or person as being nonpartisan -- he wisely chose not to address that question, as he is interested in promoting solutions that will save lives, not in blaming anyone.
6
@Sarah I read that to mean it is not a partisan issue for him. Had he not disclosed, he would have been immediately eviscerated by Biden haters and the like.
Why is the news that the CDC and the federal gov is ordering labs from doing testing not front page news with big headlines. The press should press forward on this fundamental issue. More articles on why testing kits are so fundamental should be published to educate the public, to push public opinion to demand the right to be tested and to show the total inadequacy of the management of this crisis.
I bet that if either Trump or Pence get infected they will not reveal it to the public (at present they say they do not want to be tested but secretly they may if they feel ill). Trump is old so he may learn his lesson the hard way.
10
Dr. Redfield and the CDC have done a truly terrible job with testing. It seems that instead of facilitating and promoting (where appropriate) testing as the rest of the world has done the CDC has failed to provide for available and reliable test kits and has done everything in its power to prevent the vast majority of people from getting the test, even when the a sick person wants the test and is negative for flu.
10
@Peter If that is true, some people should go to jail.
Any leader is only as good as his ability to find and delegate responsibility to qualified specialists. It’s a skill you don’t learn from running a small closely held realistate development company. When we ask our government officials to be more businesslike, we mean more efficient and not more marketing orientated and nepotistic.
22
Unfortunately, the CDC and the federal government have been preventing labs from doing testing, ordering them to stop testing, and making it difficult to get tests. It reminds me of the scene in a WWII movie where Pearl Harbor is being attacked, and someone objects to opening a door to a room with weapons because proper authorization has not been given. In the movie, one sailor shoots the lock off the door, making the weapons available to shoot at the Japanese planes. But that is a movie -- little hope that there will be an outbreak of spontaneous practicality in the coronavirus pandemic in the US.
23
@seattle expat I expect the CDC was vin under pressure from the Administration- no one should be in fear of bullying by a Tweeter - a little courage please men.
3
@seattle expat
Exactly. The only way the second Seattle area case was discovered was because researchers on the flu project ignored rules and tested samples for coronavirus, too. As a result of their work, they notified the high school boy just before he was going to go to his high school in Snohomish County on a Monday morning.
This is what the former epidemic response team could have thought about beforehand. Had Trump not dismantled the epidemic team they could have foreseen this problem and removed the rule preventing the use of flu study samples from being used for an epidemic.
6
@seattle expat
This is what government bureaucracy looks like! And this is why having someone to cut through the red tape is so important right now.
I would immediately put Bill Gates in charge.
He has extensive experience in managing large organizations, organizing public health programs, and close relations with all of the other necessary people who command huge resources.
I also know that he can push *very* hard for solutions and he is not motivated by politics.
24
@John
A gameshow host as president and now an advocate for a former CEO who has never done anything like oversee a medical crisis in charge for testing. Gates hasn't done any of the things you state, some people who work for him or for his foundation have.
We have a plethora of highly educated professionals with the knowledge and skills to run this program. Why are we not picking one of the best to be in charge? Perhaps it is because the guy who is ultimately in charge is so ignorant and irresponsible.
1
In 1941 America was attacked by a foreign power. Then as now we were asleep. The 1941 President woke us up.
“The only thing you have to fear is fear itself,” Roosevelt told us - again and again.
With that president’s quick response and continuous personal encouragement, the nation woke up. We went to work, fought the enemy and won the war.
Hopefully our response to this foreign enemy is not too late.
14
@suschar Hello. This is not a foreign enemy, regardless of whether our President, in his infinite wisdom, says. It is NOT a foreign enemy, it is a virus that affects all creatures of the species homo sapiens the same way, and doesn't care about politics, nation boundaries, culture, etc.
1
@suschar Of lcourse he said that regarding the Depression, not the war. If Trump spouted a similar line ;, no doubt you would claim he was minimizing the danger.
@Daniel
Thanks Daniel. Yes, this virus is foreign; foreign to anything homo sapiens have experienced.
All this should have been done 3 months ago. By this point we should have been testing every health care worker weekly regardless of symptoms and every individual at possible risk or with suggestive symptoms at any time.
All this could have been paid for by a mere fraction of the trillions of dollars lost so far.
The lack of testing is an absolute managerial fiasco and a spectacular failure of the executive branch of the government. However, it puzzles me why the Democrats have not started the necessary, vociferous criticism months ago.
105
@Alexander K. The criticism doesn't help. Remember when they tried to impeach the President too? It didn't work. In November of this year, with a rock solid turnout, we can finally get this country back on track.
23
@Alexander K. "... it puzzles me why the Democrats have not started the necessary, vociferous criticism months ago." Perhaps because "months ago" they were still focused on impeachment? Also, the Chinese did not sequence the virus which causes COVID-19 until the first week of January, which is just over 2 months ago. So asking for this all to have been done "3 months ago" is sort of crazy.
7
@Alexander K.
Shifting blame for the Administration's failure is not a good look.
9
I wonder if this sensible advice will reach the Trump team, and, if it did, would they be willing to implement this advice. I have my doubts, because the Trump team seems immune to timely, sensible advice, especially when it comes from experienced medical/scientific experts who have served in the federal government.
29
trump really has some gall dumping on Obama for the Coronavirus outbreak.
The trump administration over the last three years has been drastically cutting budgets and gutting public health agencies, eliminating preparedness teams, and abruptly dismissing expertise. It has been a deliberate concerted effort to dismantle the important measures Obama made to effectively protect the nation from the 2014 Ebola infection crisis. And as with all things Obama, trump is doing these things vengefully and recklessly. The nation is already paying a huge price with the emergence of the COVID-19 outbreak and more is definitely on the way.
Meanwhile FOX news (essentially trump’s propaganda agency) is fully engaged in a concerted cover up to camouflage just how badly managed the COVID-19 response has been and continues to be in the US.
255
@John Townsend
The propaganda is not for folks like you and me. It is for Trump’s base, giving them some small shred of bs that they can use to not think critically about their failure of a leader.
23
@John Townsend
You say "The nation is already paying a huge price with the emergence of the COVID-19 outbreak and more is definitely on the way."
I would put it more starkly: People are dying, have died, and more will die because of Trump's vicious amorality and that of those who support him.
21
@John Townsend
Here’s how Obama is responsible. He signed into law an incredibly weak finacial reform package after the 2008 meltdown. A complete capitulation to finance. (It was so weak Paul Volker wouldn’t even sign it.) He also allowed eight million home forclosures. The Republicans were empowered by this and the post Obama legacy of the entire Federal elected government going over to Republican rule. The Presidency, both Houses of Congress, and The Supreme Court and forty plus governorships, all went Republican. Why would Republicans do anything that helped real human beings other than call them entitlements? If Obama had done his job and helped regular people rather than the banks we would have testing today for the virus.
3
Finally....someone with knowledge and relevant expertise in *actual charge* - and presumably with command of the requisite resources to mount an effective national response.
"Lead, follow, or get out of the way." One of the most critical obligations of a president is to identify, recruit, and *retain* capable individuals with knowledge and expertise - so now, Mr. President, follow and/or get out of the way. You are not leading.
33
Trump may have difficulty navigating through a whole paragraph, whether coming out of his own brain or on a teleprompter. He also cannot derive information from text- I suspect he has a severe learning disability that he is in denial of. But as long as FOX news doesn't keep telling him there is no crisis and we need to get this testing in gear. I'm confident he can yell at the proper people to get them on it. As long as he had an adviser who can tell him who those people are.
I'm so glad to be in such competent hands. 3+ years of amateur hour at the White House.
27
There is a tremendous opportunity to use data science to learn from this experience. Since it is new, getting historical data to understand the population health lessons of the illness is not a challenge as it is with pre-existing diseases and disorders. Health Plans, Labs, and companies sophisticated in making data tell stories have a unique opportunity to create predictive modeling for this and future epidemics and I hope someone is already on it.
6
@beth Trust me - this has nothing to do with capability and experience but lies at the door of the Oval Office - the reality TV Guy who thinks it’s still all about ratings.
2
@Barbara This is a non sequitur. I am talking about nothing that has anything to do with him, or politics at all. I am talking about the intersection of medicine and data and how they can be made to talk when combined by people who have that competency.
1
I understand the felt need to put forth a non partisan face. I know that if this is seen as as political issue than some, perhaps many, will ignore the science and refuse to take reasonable precautions to avoid spreading the virus. And I think it's also dangerous to deny that this is a political issue that requires bold political action.
We need free testing clinics, free treatment and paid time away from work. In short, we need the sort of social democratic infrastructure that other western democracies already have in place.
We've heard so much about the cost of Medicare for All. Now we are facing the very real human cost of not implementing such a common sense policy.
65
Abbott and Costello's "Who's on First" skit comes to mind here.
And by no means am I wanting to insult those two amazing comedians by comparing them to your impeached president.
Abbott and Costello were on stage and television for comedy.
Right now we are living a tragedy with bad actors.
So, Who's on First?
17
It looks like some hospitals in Michigan (metro Detroit area) started drive through testing. That is a good news that is giving people hope that somebody is in charge.
19
Germany offered the US tests, but Trump et al refused. Governors should obtain these tests on their own and begin massive tests and quarantines. It is the only way to push the curve down and keep our institutions (health and others) from collapsing.
68
have German tests passed fda?
3
@Campion
Any idea long does it take for a test to be approved? Clearly you don't understand the regulatory red tape involved in using another country's test. Our CDC and FDA cannot even handle our own test.
Most people are engaged in magical thinking when it comes to the CDC and FDA.
2
Making political hay of health scares is a commonplace activity that’s also unfailingly bipartisan. Democrats complained that President George W. Bush was too slow in responding to the West Nile virus and SARS outbreaks that occurred in his first term... Republicans returned the favor in the runup to the 2014 midterm elections, when President Obama was trying to keep West Africa’s Ebola epidemic from crossing the Atlantic...
Mr. Trump understands by now that he will be knocked by his political opponents and their friends in the media regardless of how he proceeds. If he overreacts, they’ll say he’s creating a panic. If he underreacts, they’ll say he’s lackadaisical. WSJ
3
@RP
Overreact, under react, how about simply getting organized and moving forward. That’s what’s so surprising, Trump can’t move his team forward. Neither it seems can Pence. Get the lead out and run a play. Somebody take the ball.
8
@RP And when Trump gives information to the country that is demonstrably false or misleading, he will be pinned to the wall by those who know better, and have the data to prove it.
13
@RP
Please. The president endangered the american people by his failure to act in January. You can spin it any way you want but thems the facts. I hope your RP doesn't turn into RIP.
4
Thanks to Dr. David Kessler for his leadership.
Massachusetts needs to see this amping up of testing in 7 days. Governor Baker asked for it yesterday. Every city in Massachusetts and every hospital in every city needs to have this data. In addition, we need to have the data in order to prepare for the next pandemic.
8
@Believer in Public Schools Massachusetts is currently in fourth place in the "standings" for known cases. Governor Baker should immediately declare a statewide
two week blizzard much worse than the blizzard of '78 and simply make everyone except first responders and medical personnel stay home (= self-quarantine) for 14 days to radically cut the spread of the virus. Then he should just ignore the incompetent federal bureaucracy and hire the South Koreans to come here and test the entire population of the state. We can all pay for the South Korean experts through a temporary gas tax and/or sales tax surcharge until their bill is paid. This is war and war requires shared sacrifice by all residents of our state.
Putting someone in charge of making sure testing, a fundamental step in pandemic response is available, efficient, and affordable is a great step.
In January.
So why is it only happening now? Another fail by the Trump administration... too little, and too late.
147
@Jim Brokaw
Why the US is so far behind on this is largely due to Trump's shortsighted "leadership", specifically his decision to shut down the White House office for Pandemic Preparation in 2018.
16
@Jim Brokaw
Trump was was being tried under impeachment in January. He was kind of busy. Might not be an excuse but it is a likely reason. Maybe the people who pursued a political agenda meant to hamstring the Chief executive should take some responsibility.
Google, Microsoft, and Amazon? Whoa Dr. K - we need an ironclad agreement that there will be no retention or harvesting of ANY data from this effort from any of these companies. Don't know about Microsoft, but a very up front part of the business model of the other two is monetization of personal data. This is not the time for that.
30
@Les Fair point, and I am so skeptical about state / corporation collusion that I would read the very fine print in the contract and wouldn't be surprised to see handlers have a proprietary claim to DNA findings, or something like that...(more of Marx's prediction that capital seeks profit in every nook and cranny of existence.)
2
@Les
Hardly a time for fussing about data--you want a ventilator or not?
2
@SheWhoWatches
False dichotomy. You can get a ventilator without silicon valley selling your information! Super easy - just tell them 'no'.
1
“An ounce of prevention is worth a pound of cure.”
Why can’t I get a bottle of isopropyl alcohol at the store?
We once had a war in which ration cards were used.
We once had a gas shortage in which a rationing system in place.
Today, what do we have? A loss of memory?
“Hoarders. There’s nothing we can do about it.” That’s not an acceptable position.
43
@Daniel Kauffman I strongly agree. I've been sick, probably not CV, but have been self-isolating to protect my self and others, so not able to get out to stores. By the time I do, likely everything will be gone.
7
@Daniel Kauffman : I love the idea of ration cards for Purell, isopropyl alcohol, disinfecting wipes, bottles of bleach, masks.
The ration cards themselves could be distributed based on need. Suspected case of corona virus? You get ration cards for extra masks and cleaning supplies for your house.
Ditto for any suspected cases that are quarantined.
And, of course, first dibs on masks go to the medical professionals who are risking their lives to treat others.
13
@ginny
Your neighborhood watch should step in to provide logistical support. If there isn’t one, then there is a task. It needs to be available and specific. The APP NextDoor might help fill the gap temporarily. Also helpful is a video communication method in place, particularly for any quarantined elderly in the neighborhood. So much to do, so little time!
1
Dr. Giroir has a compelling resume and seems like an excellent choice for this responsibility, perhaps the first time the Trump Administration has ever appointed someone based on qualifications and not loyalty. In addition to getting testing capability ramped up quickly, shouldn’t there also be a major push to get more ICU capacity and increased manufacture of more ventilators?
31
The proposed "fix" seems to make sense, but leaves out an essential element that must be addressed before any other single item can be successful.
Remove this president!
He's a denier of fact, and a denier of science. His interest in money leaves him, apparently, no room for human empathy...and that leaves our leader clearly not wanting to deal with this crisis, or even to recognize it as one.
His narcissism results in the continuous onslaught of disinformation to society, and his clearly limited mental capabilities mean he cannot keep up either with the speed at which this crisis is proceeding or with the needs the society needs of its leader in response to such a crisis.
If left in power, Americans will suffer needlessly in huge numbers and many more will die who might otherwise have lived through this nightmare.
It's time for Americans to realize that not all people are smart, or capable, or suited to being president...that at election time "giving it to the man" can very dangerously backfire... and that being "elite" is a worthwhile goal and not a bad name because "elite" means you've worked hard and have above-average knowledge, training, and/or experience to bring to bear - especially in crises.
REMOVE TRUMP NOW, or this nation will pay a heavy, heavy price.
118
@Not Amused,
You have captured him and America’s plight,what is unfortunate is a segment buys his gaslighting and sociopath pathological lying,which just scares me.
10
@Not Amused
Seriously?...now’s not the time to be bias & political.
1
@Not Amused
The self-centeredness of someone who demands we remove a president during a pandemic is off the charts.
1
Shouldn't we send medical providers to make house calls for the testing? Isn't it obvious? Safer for the patient, safer for the rest of us. Cheaper in the long run.
That's what would be done in a first world health system, instead we are stuck in the third world.
14
I think South Korea’s approach for drive through testing is a good one. Instead of providers running all around to do testing the public comes to them, and they’re isolated in their cars thereby limiting the chance for infecting others. All completed tests are in one location for distributing to labs etc. Email or text results to the patient with instructions.
29
@PNBlanco This would require many more providers than otherwise, and we don't have sufficient numbers as it is.
1
I hate to be a downer on what is the start of the right direction, but in a few months if things improve, Trump will say he fixed it.
Sadly, much of the country may believe him.
16
@Lisa
Trump has proved his incompetence to the nation. Millions watched his television address on Wednesday night with dread. The futures market sank in real time with every minute he talked. As of this week and the worst Stock market drop since 1987 and our weakness revealed to world, Trump has no clothes.
4
At last! How many lives would have been saved if these ideas had been implemented a month ago? At last! Finally someone is acknowledging the existence of the United States Public Health Service - 6000+ doctors, nurses, and other skilled medical personnel whose sole mission is safeguarding our nation's health. Thank you David Kessler M.D.
47
@Linda Tarlow
6000 public health personnel nationwide? If that is true, it does not sound reassuring. That's 1 professional per every 50,000 people. If they had a 5 minute session with just half those people, it would take a year for them to get through the appointments if they did nothing else.
1
We have smart, trained, qualified, experienced, seasoned, capable individuals that can solve problems. Dr. Kessler is just one. Neither trump nor anyone in the trump party has any interest in these folks nor what they can contribute. Top priority is keeping those numbers low.
20
Keep the numbers low...
Yeah, cuz the numbers will remain low if nobody gets tested. Crazy, but true.
3
Labs don't need help with sample logging and data reporting. What they need are
1) the actual testing kits and perhaps,
2) the people to run them.
There are a LOT of manual steps in this particular assay. You don't simply put it on a machine and press START.
All those profits in the healthcare sector? A lot came off the backs of the clinical laboratories - staffing was slashed, as were required certifications for technical staff. Neverthess, they are smart people. If problem 1 is solved, they will take care of 2.
60
President Trump bungled the United States non-response to Covid-19 when he de-funded the CDC's capacity to spring into action when the virus was initially identified.
Most egregious in this debacle of a national medical emergency was the reaction from the Federal authorities to Washington state epidemiologists and to academic scientists at UC Davis in California to layoff trying to devise a means of testing for COVID-19 pending a plan from the CDC. (Nero fiddles while Rome burns.)
Meanwhile we have the example of South Korea managing their outbreak with aggressive testing to identify carriers and staunch the growth of the virus by identifying where and among whom iCOVID-19 is present.
Why wouldn't our medical authorities want to know what kind of virus is infecting people? I know of someone here in Portland area who has been ill with a high fever, coughing etc. He went in for a check up and was swabbed for the flu and asked about his travel history. He was negative on the flu and was sent home where he is trying to heal but remains feeling crumby and it has been going on three weeks.
So, he doesn't have the flu but does have something, and it isn't a common cold.
Odd that medical authorities don't routinely endeavor to identify the viruses and bacteria, or other creatures that make us ill.
69
@Chuck
Unfortunately I suspect that Trump wanted to keep the number of cases low and purposefully made diagnosis difficult. Politics superceded public health. This man is out of his mind and yet we allow him to drive the car.
It is beyond absurd. I am sorry about your friend. Hope he gets well soon.
2
Don't think state health departments, though many of them excellent, have the sample throughput capacity or even the call volume capacity to be effective players. Though I don't want to bang the private healthcare drum too hard, private labs like Quest and Labcorps already have relationships with doctors and hospitals and have a pickup system already in operation. But even that probably won't be enough. What is needed is a some kind of consumer-mediated test, like a pregnancy test, that people can get, take home, and use on family members. That should be the goal.
26
How about we recommend everyone turn on any cell phone personal location tracking apps, like Google Maps Timeline, so if someone is tested positive their movements can be used by public health officials to track the spread of the virus and possibly alert the public?
11
@bmesc
That's how South Korea has done it, and let people know where hotspots of outbreak are. I hope anonymized, etc. They are also testing 3600 people per million vs us testing 5 people per million.
You would think having a 2 month head start we would be able to do better.
30
@bmesc NPR had recent inteview with health official from Singapore, and that's how they tracked contacts. But in Singapore the government maintains 'digital fingerprints" like this on all citizens, so it was easier there. The official said it's hard to recall everyone you saw the past several weeks, but presenting them with their "fingerprints' was a way "jog their memories". When asked if digital privacy was an issue, he paused and said "not really"... Our opinions may differ on that!
4
And it seems like those 5 people per million are celebrities and politicians
1
One bottleneck in coronavirus testing has been the use of the acute care health system to do what should be the function of the public health care system. To be tested, persons must first present themselves to a physician. The public health care approach, as Dr. Kessler has advised, would use mobile health units to test individuals. Such mobile facilities would make the test available to a wider swath of the population, including those who cannot see a physician first. Of course, this assumes that there are enough test kits and the infrastructure to process the specimens. The success of the Koreans in reducing COVID-19 mortality has been due to the public health infrastructure that they created in the wake of the SARS epidemic. They make use of mobile health units to gather specimens, as well as ramping up the number of technicians and processing labs. When Dr. Fauci was testifying to Congress about the federal response to the outbreak he may have been alluding to the lack of public health outreach. Even if a much larger number test kits become available, if people are forced to see a physician in order to be tested, then the health care system as a whole will have failed in its effort to address the coronavirus outbreak.
184
@Moso
indeed, the US health care "system" is not geared to addressing rapidly emerging epidemic diseases. We must thank the relentless defunding by the senate and the house, in addition to the administration. This is what reliance on our governmental elected officials brings us.
This outbreak clearly lays out in stunning detail how unprepared and unable to respond (too late) to such threats. Lobbying, working on re-election(constantly), bickering amongst one another (with finger pointing) and lastly, spending trillions on eternal foreign wars, in place of "making America great again) becomes not a joke, but a rage-filled call to flush the entire lot. We need intelligent, compassionate human beings as our leaders. Not forever politicians-they have clearly demonstrated their organizational and planning skill sets.
6
Not reassuring that senior administration officials and Trump himself are refusing to be tested after known exposure(s) and are going about their business as usual, for photo ops or Trump's famed face-to-face negotiations or whatever.
But hopefully Admiral Giroir can get this going. Even if we don't want to test everyone … we need to test exposed people so they can be isolated if positive. So much can be done remotely from home to protect other people and their extended families (including elderly members or those with compromised immune systems) and eventually all of us.
8
I have many questions, and am still unclear as to why South Korea has been giving 10,000+ tests a day and we're lagging so far behind. Presumably they were given the virus's genome around the time we were as well. Did they have the infrastructure already in place to ramp up mass manufacture of the tests? Did we also have that capacity and didn't act fast enough, or are we only going into high gear now? If the W.H.O had already developed a test, why didn't we adopt it? If we deemed the W.H.O.'s test unreliable, does that skew results from other nations? Or do our pharmaceutical manufacturers stand to make a profit by developing proprietary tests?
If anyone knows of any information that can answer these questions with fact-checked information from reliable, well-known sources, I'd appreciate a link.
253
@jrinsc my understanding and reading of SK, it that they have highly automated testing (ie use of robotics and high throughput instruments). In the US (for whatever reasons), testing is being handled by lab technicians (with very low throughput capacity). The big question is how is it that SK and other developed nations have the high throughput capacity while the US seems to lag so far behind? Presumably, the same instruments that SK has are in some labs in the US, why haven't they been repurposed for this crisis. Lack of leadership (and permission to disregard burdensome bureaucracy/regulations), methinks.
45
@jrinsc
(Apologies for the redundant post - I received an error message when I hit "Submit" the first time.)
2
This is a link to a 3/6/2020 Politico article that gives the background for U.S. refusal to use the W.H.O. COVID-19 testing kits: https://www.politico.com/news/2020/03/06/coronavirus-testing-failure-123166
I think the reasons boil down to an ironclad bureaucracy in Federal health agencies and that out-of-date notion of “American exceptionalism”.
73
I have many questions, and am still unclear as to why South Korea has been giving 10,000+ tests a day and we're lagging so far behind. Presumably they were given the virus's genome around the time we were as well. Did they have the infrastructure already in place to ramp up mass manufacture of the tests? Did we also have that capacity and didn't act fast enough, or are we only going into high gear now? If the W.H.O had already developed a test, why didn't we adopt it? If we deemed the W.H.O.'s test unreliable, does that skew results from other nations? Or do our pharmaceutical manufacturers stand to make a profit by developing proprietary tests?
If anyone knows of any information that can answer these questions with fact-checked information from reliable, well-known sources, I'd appreciate a link.
8
@jrinsc : Indeed!
Something else to think about. South Korea's population is a mere 50 million. Our population is around 320 million.
That means we have more than 6 TIMES as many people, and should be doing 6 TIMES as many tests -- so at least 60,000 daily, more to make up for lost ground during the past weeks.
8
Finally a competent, smart, organized, non-political person who believes in science is driving the bus. Late, but hopefully in time.
156
@Lynette Either I didn’t understand this article or you didn’t. Mr. Kessler isn’t driving the bus, is he??
Just another sane individual tossing ideas at a group of folks that can’t catch.
8
@Minskyite
The "competent, smart, organized, non-political person" @Lynette is talking about is Assistant Secretary of Health Brett Giroir. He apparently is a medical professional with a background in managing complex organizations. Sounds like a (finally) proper choice to be put in charge of federal testing efforts.
https://en.wikipedia.org/wiki/Brett_Giroir
1
You make excellent points, a coordinated effort is needed right now. I am deeply appalled at the ignorance and lack of compassion exhibited by this current administration. It must be corrected asap or many people will die needlessly. It is obvious that we need to be able to test everyone. Pharmaceutical companies need to jump in here and make sure that drugs, like albuterol sulfate, that are used with a nebulizer to treat respiratory infections are not in short supply. We must all act now and if our elected or appointed officials do not exhibit the competence to deal with this pandemic they must be removed promptly and people with compassion and expertise must take their places. This is an all-hands-on-deck moment.
35
@ridgewalker1 Remember the administration's incompetence in November.
4
Having tests available to every person in America who wants it is laudable, but in the meantime why not do scientifically valid random testing to first get a good idea of how many people are infected?
39
@Jay Orchard or at least test people who are most likely to be positive: fever and cough should get you a test without question. We'll miss some people this way BUT we'll be more likely to catch those who are sicker.
11
@Jay Orchard
You need to prioritize those with rule-in symptoms, and if possible do random testing.
2
I’m guessing that that would take away too many resources from the places they are needed most: areas with infections and vulnerable groups.
1
This would be perfect. But since it calls for expenditures by private companies, Republicans and some long-seated Democrats will call it "fake news". Their desire is to reward a political supporter and pick an economic winner, to decide which private corporation gets the exclusive right to create their designer test, all at taxpayer's expense, even if it takes months. In other words, if the solution doesn't help the shareholders of Pfiser and LabCorp, it's not going to happen.
19
I'm no expert on public health, but isn't testing the sine qua non in a pandemic? Without widespread testing we cannot know where, to whom, and how quickly the virus is spreading. I don't think it's an exaggeration to say it's criminal that the Trump administration has ignored this necessity.
Another question: We're told that a person can be a carrier for more than a week before experiencing any symptoms. Are the tests that we have able to detect the virus in this "silent carrier" phase?
322
@EveT emerging data suggest that 'silent carriers' might actually shed higher virus quantities than those with symptoms. This is something that needs to be determined but impossible to test (in the US), since in the US only those with narrow symptoms (and certainly not assymptomics) are being tested.
34
@EveT
Yup. If only there were someone in charge with a public health backg.... oh wait, now there is.
They might as well have had Pence try and fly a F-16.
44
@EveT -- Testing is fundamental to addressing the response to a pandemic threat. How can you direct resources for a rapid, effective response if you don't know who has it, where they are, and how severe it is, so the disease response can be focused and strong where needed.
But testing makes "the numbers" look bad. Trump likes "numbers" that make Trump look good, not "bad numbers". So if you slow down testing, that lets Trump look better... and if that's "criminal", well, that's Trump.
Corrupt, through and through. Vote Them All Out!
28
At the Kirkland nursing home where the epidemic first started in Seattle, there were delays in getting residents tested, and even now, employees have still not been tested.
Yesterday at a news conference, the Washington State Secretary of Health John Weisman was asked about this and he bobbed and weaved. He said he "did not have details" on the testing (or lack thereof) of workers at the Kirkland nursing home, and suggested that maybe workers had not asked to be tested, or that responsibility to see that they were tested laid elsewhere.
Meanwhile, the UW lab in Seattle said Tuesday they were operating at half capacity because they were not getting doctors' orders to test, and they were sending tests out of state to make use of their capacity. A nurse who was not identified said doctors are not ordering testing because hospitals did not want admissions.
The issue of testing seems to be more complicated than just getting the tests. Here in WA, even though there are groups of people like employees of nursing homes who are surely infected and infecting others, testing is not being done even where it's available.
People in the Seattle area would like to have some answers to this mystery which seems more and more like a scandalous failure.
220
@Sherry
Please see the article elsewhere in today’s paper about the UW drive-thru lab. It’s highly unfair to assert that they aren’t testing because they don’t want people admitted. They’re testing health care workers first. And, as Dr Cohen mentions, they’re nearly out of swabs.
Implying that there’s a conspiracy to withhold testing is highly irresponsible. It’s the definition of “fake news” and it’s the kind of statement that causes people to panic.
13
@CaliMama
Good to know about the UW drive-thru-lab.
However, its existence is consistent with the comment by Sherry. Sherry reported that UW was operating its testing at on-half capacity (so why not open up a drive-thru test facility).
It is either a fact or not that the staff in the nursing homes have been tested. In my (non-medical) opinion, testing every member of the staff who has significant contact with patients in the Kirkland nursing home should be ordered to get a test with testing of others optional and immediately and conveniently available--as a condition of their employment. Not being tested in a hot-zone when dealing with the most vulnerable members of the population is somewhere between criminal negligence and attempted murder.
I have no problem with using triage to manage admissions to hospitals capable of treating COVID-19 and to the ventilators required for survival by many. However, triage is a logical process based on the best data available. Denying tests to manage hospital admissions sounds like you need to bribe a doctor to get a test to get treatment. Very Trumpian, but not behavior that should keep anyone else out of prison. You manage admissions by admitting those who need the services and who are most likely to benefit from them--and this requires testing.
We are fighting a war. It is time to start thinking that way.
5
@Sherry I have to agree with Sherry, and I find the comments of CaliMoma unduly harsh. Sherry is right to draw attention to a situation that I for one find incomprehensible, and a blot on the reputation of King County health and the state. The Kirkland nursing home, it seems to me, rather resembles the cruise ship, with residents and employees infecting each other as they are forced to interact in close quarters. There is no excuse for what has happened or the deaths that have resulted. An investigation should be launched by the Centers for Medicare and Medicaid.
5
Ironic as the US has finally decided to buy Roche (Switzerland) testing kits that are both better, and faster, than the home grown product.
Switzerland, on the other hand, has decided that testing is a waste of time and money. They are focusing their efforts on protecting the most vulnerable. Everyone else will survive with only mild symptoms
22
@Thomas Perhaps you missed this article in today's Times: https://www.nytimes.com/interactive/2020/03/13/world/asia/coronavirus-death-life.html?action=click&module=Top%20Stories&pgtype=Homepage
Xia Sisi was 29 years old. Coronavirus killed her. "Everyone" else will not survive.
49
You must have missed my remark about protecting the vulnerable. In our case it’s easier as we have universal health coverage, in your case it will be protecting the vulnerable who have health insurance that will cover this extraordinary event. (Read the fine print carefully)
5
@Thomas
Jack Ma is donating 1M masks and 500K test kits to the US. Trump will not understand what this means.
3
Let's hope someone in the administration is listening. Every day of delays causes deeper and deeper damage to small business owners throughout the country. The seven-day clock needs to start now.
50
Dr. Kessler, a question. What do we need to do beyond the next seven days, seven weeks, seven months? How do we emerge better off than before?
28
These are great suggestions, but so far there seems to be very little emphasis on early stage screening. Where are the immediate result, fever testing scanners that we see are being used overseas. Surely these would help.
15
@Peter Hunt
Not so much if the virus is there for one to two weeks before symptoms appear--which seems to be the case.
1
And how does one create the physical tests, complete with tubes and PCR primers in such a short time? Your proposal only deals with high level organization.
18
This is not a technological or logistical problem. It’s a matter of will.
2
@Steve W
PCR primers can be made rapidly (that's what PCR does) and standard gene test labs have the stuff needed to do this. The bulk of the remaining work is packing and distribution.
And not staring into space for two weeks always helps.
10
@Steve W
I second these very good questions!
1
The former commissioner of the FDA knows what to do, but no one in the trump administration knows what to do or who to put in charge.
447
@Nm
Mr Kushner is reportedly casting about for an approach using a Facebook group.
21
@Nm
Trump claimed in his first COVID presser that all those dismissed scientists were easy to get back, they can just jump back into their govt roles.
Not remotely true. They're not minutemen.
25
@Nm
He was commissioner when the FDA regulations were implemented that prevented entirely capable medical centers from proceeding with testing on their own when the CDC got bogged down.