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Sun Mar 29, 2020, 07:39 PM

Timeline and failures -- lost shot at containment

Last edited Wed Apr 8, 2020, 02:52 AM - Edit history (7)

Re-posted as OP by request
___________________________

Actual sequence of events follows "what could have been".

Just imagine...

-- If the CDC had started sourcing and distributing sample collection materials the week of 1/13, and simultaneously moved to develop and distribute tests and testing supplies to public health entities (there are about 3000 of them) as rapidly as possible.

-- If the public health emergency had been declared 1/13 to empower more rapid preparation and response.

-- If the FDA had used its EUA power as soon as the public health emergency was declared to allow labs across the country to develop, distribute, and process tests.

-- If the public health emergency declaration had conveyed the reality of what we were facing. (i.e., Had conveyed a clear picture of what would come if we failed to act, and act quickly. The grim reality was obvious as soon as it was clear how readily it was transmitted in China and how high the mortality rate was.)

-- If, in response to clear warnings, states and and feds had recognized the need to pass funding bills to get critical testing, tracing, and containment programs off the ground and create specialized task forces to coordinate across states and public health entities (A big job that requires dedicated management and staff -- something we still don't have).

-- If federal authorities paid attention to epidemiologists' models and health expert metrics of projected incidence, hospitalizations, actual resources vs. needed resources, and began to source and use powers to order increased production of PPE, ventilators, and put plans in place for how to address possible/probable shortage of beds and other critical resources.

-- If, as soon as testing was available, the power to order tests had been put in the hands of doctors and a public information campaign had been initiated to advise anyone having symptoms, or who suspected exposure, to immediately self-quarantine and seek testing.


Even if it took until the beginning of Feb to get "rolling," we would have been mobilized to detect cases that had been contracted in mid-January. With fewer cases to detect, public health entities would have been able to ramp up efforts to trace source and contacts of every case detected (and have time to bring personnel on board to make it possible to trace if/when numbers increased -- funded by those emergency bills).

Perhaps all this is too much to expect of any government, but I don't think so.

The first "sin" was the inability of the DT administration to confront the grim facts about the probable (if not guaranteed) consequences of failing to act early and quickly. In our interconnected world, it was ridiculous to think the crisis in China would somehow, magically, be be limited to China without action on the part of other nations. Effective containment required coordinated mobilization across national borders. Or, failing that, mobilization within our own borders.

Of course, I could be flat wrong and containment efforts would have failed, however early they had been initiated.

We'll never know because our government didn't bother to try.


____________________________________

Timeline

1/13
Test developed by the department of virology at Berlin’s Charité university hospital with help from experts in Rotterdam, London and Hong Kong available.

CDC inexplicably declines to develop and use this test, opting, instead, to come up with their own.

1/19
Virus is already circulating, undetected, in WA state, and probably elsewhere. (Based on analysis of genetic samples from a 1/20 case and a later case, researchers at Fred Hutchinson Cancer Research Center and the University of Washington found the virus had probably been circulating undetected for at least 6 weeks prior to 3/1 -- finding announced 3/1)

1/31
Azar (DHS) declares public health emergency. Among other things, this triggers FDA emergency use authorization (EUA) power. This should have come at least two weeks earlier. In an interconnected world, the grim reality of what we would face if we did not make preparations to act, and act quickly, was obvious as soon as it was clear how readily it was transmitted in China and how high the mortality rate was.

In re: EUA power. Normally, hospitals and labs need FDA permission to use their own laboratory developed tests (LDTs). EUA power allows labs to move forward with test distribution and processing while the FDA reviews information about the test they submitted.

If the FDA had started exercising its EUA power immediately upon declaration of a public health emergency, as they should have, labs at university medical centers, hospitals, private labs, etc., could have moved forward with their own tests or a version of the reliable test that was available on Jan 13. (FDA did not exercise this power until 2/29, as noted later in the timeline.)

2/3
China travel ban
After not testing anybody, and doing no screening on anybody for 3 weeks, DT issues a travel ban on China 2/3. Only returning Americans and foreign nationals with "pre-clearance" are allowed entry.

Selected airports are designated to receive planes and screen passengers as they come in. Anyone who visited China in the past two-weeks is screened. If they have symptoms they are told to go home and quarantine. No testing to determine actual status (because we don't have a test). Everyone else on plane already exposed. (More to it than that -- re-routing to original destination and whatnot.)

2/5
CDC finally begins distributing their own test.

Shortly after distribution begins, recipients find problems with the test. Apparently it has been distributed without proper quality control checks. Testing by states put on hold. States are directed to send samples to CDC. CDC has very strict criteria for testing to limit number of tests and resultant backlog. The number of people tested is extremely limited.

2/23
First community transfer confirmed in CA. (Virus has therefore been circulating, undetected, there, too.)

2/27
CDC has fixed the test issue. Most states still not getting kits. They continue being directed to send samples to CDC for testing with overly strict criteria. Even with limits and test "rationing" there are backlogs.

2/29
FDA finally begins to use its EUA power to empower labs to distribute/process tests independent of the CDC. A crucial six weeks has been lost.

2/29
DT expands travel ban to include Iran.

2/29
Governor Inslee declares state of emergency in WA (first state)

2/30
Cuomo declares disaster emergency in NY

3/1
With extremely limited testing, 42 cases in the US are confirmed. 2 deaths are attibuted to COVID-19.

People who have symptoms are directed to "self-quarantine."

3/3
Newsom declares state of emergency in CA.

3/8
497 cases have been detected. 22 deaths have been attributed to COVID-19. Test capacity continues to be so severely limited we really have no idea how many COVID-19 cases there are. Most states are still being directed to send tests to the CDC for processing. Backlog.

3/15
3,497 cases have been detected. 62 deaths attributed to COVID-19.* Some states are ramping up testing, but a vast majority continue to face severe sample collection materials shortage and/or extremely limited test processing capacity. The limitations are so severe there is no way to estimate likely incidence per capita in most regions, or to create region-specific data-driven models. In absence of anything else, preparations are necessarily based on worse case scenarios everywhere.

Statewide closure orders begin with Inslee in WA ordering closure of all bars, restaurants, recreational and entertainment facilities. NY follows March 16, and CA follows March 17, with even more restrictive "Shelter in Place" orders. More detailed state-by-state action summary here.

3/22
29,046 cases detected.

300 deaths attributed to COVID-19*

Testing still so limited the actual numbers remain essentially unknown.
Hospital admissions with COVID-19-like symptoms that resulted in death were only counted if diagnosis was confirmed by test (which was not happening with any sort of consistency)

3/29
https://covidtracking.com/data/ 7pm ET

139,061 cases detected

2,428 deaths attributed to COVID-19*

Hospitalized 19,730 (not all states report this so the actual number is probably much higher)

Continued limited testing. Actual numbers higher.
Only 254 tested per 100,000 (US)

Wide range by state. For example:
Approx 800 tested per 100,000 in NY and WA
Approx 90 tested per 100,000 in TX

+++++++++++++++++
April 7th update

3/29

12,709 deaths attributed to COVID-19*

* Underestimate. People with COVID-19-like symptoms who died before testing began to ramp up in mid-March were often not counted as COVID-19 deaths because the diagnosis was never confirmed by testing. People dying at home, and even in the hospital, were not always, and still are not always tested to confirm COVID-19 status, These cases of likely COVID-19 are not counted in reported deaths.



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Reply Timeline and failures -- lost shot at containment (Original post)
pat_k Mar 2020 OP
gibraltar72 Mar 2020 #1
pat_k Mar 2020 #2
gibraltar72 Mar 2020 #3
Hermit-The-Prog Mar 2020 #4

Response to pat_k (Original post)

Sun Mar 29, 2020, 07:41 PM

1. You forgot if doctors and nurses hadn't stolen supplies.

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Response to gibraltar72 (Reply #1)

Sun Mar 29, 2020, 07:49 PM

2. Added an If...

I added this "If..." to what our government could have/should have done.

-- If federal authorities paid attention to epidemiologist models and health expert metrics of projected incidence, hospitalizations, actual resources vs. needed resources, and began to source and use powers to order increased production of PPE, ventilators, and put plans in place for how to address possible/probably shortage of beds.

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Response to pat_k (Reply #2)

Sun Mar 29, 2020, 07:51 PM

3. You've done a lot of study. All I got is my gut and common sense.

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Response to pat_k (Original post)

Mon Mar 30, 2020, 04:44 AM

4. The travel bans were window dressing after community spread began.

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