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Now seems highly likely that there has been undetected community transmission ongoing in parts of the upper West Coast for weeks, at least.

How did we end up with major surveillance failure on par with Italy and Iran?

Let's talk about how that happens.
This may get spun as a technical failure (e.g. flaws in the test kits).

It's not. It's an interconnected communications, strategy, process, and execution failure, reflecting a serious breakdown of crisis mgmt.

Direct line from that failure to sick people in a nursing home.
Recall how, in the run-up to the Iraq war, the White House signaled preferred policy outcome so heavily that it skewed the analysis and advice it received.

Can see similar alignment b/w preferences Trump and his team were signaling, and strategic posture of his crisis managers.
Trump wanted to calm markets, avoid threats to his re-elex, and keep the disease out of the country.

He and his team made those preferences very clear. And got angry at those who deviated.

(WaPo has an infuriating tick-tock on all this out today:…)
That inevitably colored - both overtly and subtly - the strategic emphasis of the crisis task force.

They operated from presumptions that containment was possible, the risk to the US was low, and transmission was not happening here yet. Repeated those things like a mantra.
And those assumptions set the frame for the testing failures.

The key question is not "why didn't CDC's test kits work?"

It's "why were flawed CDC test kits allowed to bottleneck all US testing capacity when alternatives were available?"…
And to be clear, alternatives were available. China has managed to test hundreds of thousands. @WHO has sent working test kits to 50+ countries. South Korea is doing drive-through testing clinics, for goodness' sake.…
@WHO And to be equally clear, experts outside the administration - including Trump's former FDA commissioner - have been clamoring for weeks about the need to ramp up testing. He and Lu Borio wrote this nearly a month ago:…
Adding to the debacle, the bottlenecks on test kits meant that CDC kept the case definition artificially narrow - tied to China - even as cases were expanding globally (and, we now realize, domestically as well).…
The result of that definition, as @JenniferNuzzo and others have eloquently argued, was that we were blind to community spread - because CDC had defined suspect cases so narrowly as to exclude that possibility.

Can't see them, so can't test them, so blind to what's happening.
@JenniferNuzzo Now - why would policymakers let that happen?

Well, if you assume that community transmission *is* ongoing (as most experts outside USG did), then this looks like a real problem.

But if you assume it's *not* happening, as the Task Force did, this all looks much less urgent.
@JenniferNuzzo (Taking a lunch break and will resume later)
@JenniferNuzzo Ok, picking this up again.

Seeing some folks in the mentions saying COVER-UP!! and LIES!!, etc.

To be abundantly clear - I don't think that's the case. I think this was an honest but avoidable mistake, driven by groupthink, unexamined assumptions, and process failure.
@JenniferNuzzo So by the logic of the assumptions the Task Force was making, and signalling to the public, the USG's posture seemed rational.

If you think the biggest present danger is introduction of cases from overseas, you focus on that. And so they did.
The core emphasis of policy was on keeping it out - travel controls, screening, traveler quarantine. And finite testing capacity was targeted at that.

Those assumptions and signals reflected POTUS' clear preference, and the process' failure to question it.
And sadly, as a result of those assumptions, they squandered the weeks of delayed spread that the travel controls may have bought us.

Because rather than scale up surveillance and prepare the health system for community spread, all emphasis went into containment.
The core of policy became a self-licking ice cream cone: we're not seeing community spread yet so we don't need to aggressively test for it, and anyone who is saying we do is being alarmist. The situation is under control; the risk to the public is low.
And that mentality also means there's less urgency to solve the testing bottlenecks - because there's no sign of community spread.

So rather than trigger Plan B (development of tests by private labs), as they finally did last Friday, you stick to Plan A (wait to fix CDC test).
That's a strategic process failure. A good crisis mgmt process doesn't put all its eggs in one strategic basket - it looks for vulnerabilities in strategy, red-teams those, and either falsifies or addresses them.

That doesn't seem to have happened.
What this looks like: during the Ebola response, @RonaldKlain drove us crazy (I saw this with love, Ron) with requests for plans to deal with X,Y,Z contingencies. I remember spending a weekend working a briefing paper on what we would do if all air travel to W. Africa shut down.
My team thought that very unlikely, and so it drove us slightly nuts at the time (again, Ron, love). But I have come to appreciate it, because it achieved two things: it forced the agencies to recheck our assumptions, and meant the White House could be sure we were doing so.
That kind of check-your-math mentality doesn't seem to be present in the current management of the US response.

So it's not just on CDC or FDA for failing to resolve the testing bottleneck. It's also on a White House that failed to recognize that as a mission critical problem.
It's that sequence of interlinked optics, messaging preferences, strategic assumptions, and execution breakdowns that leaves the USG with a blind spot this big.

And that in turn is how ongoing transmission in the US can be missed even as the govt assures us it isn't happening.
And all that is why competent governance is actually pretty important.

My sincere apologies for the length of this thread.
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