Thread by @hilzoy

1/This is interesting, but in some ways frustrating. The overall picture: they needed one person in charge of the response, someone with the power to knock heads and overcome obstacles.

The Lost Month: How a Failure to Test Blinded the U.S. to Covid-19 nyti.ms/2JkLno5

2/ But while it's got a lot of interesting details, key points are vague. Most notably, no answer to the crucial question: who decided not to use theWHO test once it became clear that the CDC test didn't work, and why?

3/ Likewise: "Dr. Redfield played down the problem in task force meetings and conversations with Mr. Azar, assuring him it would be fixed quickly, several administration officials said."

Why did he do that? The article doesn't say.

3/ About the WHO test: "Dr. Anne Schuchat, the agency’s principal deputy director, would later say that the C.D.C. did not think “we needed somebody else’s test.”"

How could they NOT have thought this once it became clear that the problems with the CDC test weren't being fixed?

4/ FDA: "Dr. Hahn took a cautious approach. He was not proactive in reaching out to manufacturers, and instead deferred to his scientists, following the F.D.A.’s often cumbersome methods for approving medical screening."

WHY?

5/ I mean: of course he should defer to scientists on scientific questions. But the head of the FDA should also have tried to figure out how to fast track the approval process, and/or get it changed if necessary.

No hint of that.

6/ The general picture is of a bunch of different people, many of whom didn't get along, and none of whom seem to have understood how urgent it was to ramp up production of testing asap.

This is just bewildering.

7/ I am a philosophy professor. I teach bioethics, so I read health policy, and took courses in epidemiology and biostat. So I know more than your average lay person, but I am not by any means a professional. The need for LOTS of testing was clear to me from the outset.

8/ Why? Is it because I have the gift of prophecy? No -- it's because this is basic, basic stuff. Once you grasp that a novel virus has the potential to become a serious problem -- which follows from its severity and contagiousness (R0) -- the net step is surveillance.

9/ Sorry, got cut off: surveillance and containment. You watch everyone coming into your country from the affected area, see whether or not they have the disease, and if so keep them isolated and trace their contacts.

This is textbook stuff. And it obviously requires TESTING.

10/ You also try to watch out for community spread in areas where it seems likely to occur. Again, this requires TESTING.

This is not hard. It is not public health arcana. It is obvious.

But this article does not reveal any sense of urgency among decision-makers, except ...

11/ ... for Dr. Fauci: "By Feb. 26, Dr. Fauci was concerned that the stalled testing had become an urgent issue that needed to be addressed. He called Brian Harrison, Mr. Azar’s chief of staff, and asked him to gather the group of officials overseeing screening efforts."

12/ That was pretty late, though. It's not too much to expect that a catastrophe like the failure to get tests in quantity would have created a similar sense of urgency in the people who were actually in charge of making those tests available.

13/ We really do have a stellar scientific community. But we also need good managers at CDC, FDA, and HHS, and it really does not seem that we had them.

Needless to say, we also don't have a President who either knows or cares about such things.

*weeps*

/Fin.