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pat_k

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Current location: Seattle, WA
Member since: Tue Nov 23, 2004, 11:22 PM
Number of posts: 8,648

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Timeline and failures -- lost shot at containment

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.



Colossal failures and loss of critical weeks of testing and containment -- we need answers!

Excerpt from informative article (Politico)

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, according to POLITICO interviews with dozens of viral-disease experts, former officials and some officials within the administration’s health agencies.

And this, from an article in The Guardian:

By 13 January – three days after the gene sequence was published – a reliable test was available, developed by scientists at the department of virology at Berlin’s Charité university hospital with help from experts in Rotterdam, London and Hong Kong.

I want to hear that congressional committees are conducting robust inquiries on the effectiveness of efforts going forward, rapidly compiling national and state program recommendations from experts outside the DT admin, and appropriating additional emergency funds to implement. I want to hear they are investigating the stink that surrounds the disastrous actions to date. I want to see the paper trail (emails, memos, meeting notes, guidelines...).

I would also love to see someone like Jane Mayer dig into questions like these:

Why did the CDC decide they needed to produce their own test, rather than use the reliable test already developed by Jan 13? (The CDC effort apparently took an additional 3 weeks.) What process/reasoning, went into that disastrous decision?

Why didn't the FDA immediately trigger a regulatory workaround enabling qualified medical centers to roll out tests that they had designed themselves? (BTW, AP fact check reports that the regulatory limitation was implemented by the Trump admin, NOT Obama's, as DT and other admin officials claimed.)

What failures in process allowed the CDC test "performance issues" to go undetected until AFTER they began distributing their test around Feb 5? (Problems identified by recipients, NOT the CDC.) What the hell happened to quality control?

Why did most states have to continue to send their samples to CDC for an additional 4 weeks (through March 2), causing a "bottleneck"? (A bottleneck that led the agency to put in place extremely restrictive criteria for testing to ease the burden.)


Time will tell how quickly we can put in place the means to collect samples from those who need to be tested,** and have those samples transported to, and processed by, labs with the capacity to produce rapid results. Test kits, by themselves, are of no use. There needs to be a system in place. (And no, it is not "too late." If we fail to put efforts into both containment AND building capacity to treat, we will have many more people to treat, putting an even greater burden on the system.)

Time will also tell how high a price in precious lives this nation will pay for the loss of critical weeks.

One thing we know is that the magnitude of the crisis will be far higher than it would have been if the administration hadn't pursued its lie, ignore, deny, dismiss "strategy" to "protect" the stock market. Of course, their strategy will certainly backfire. As the crisis accelerates as a result their colossal failures, so too will the affect on stocks.

_________
** "those who need to be tested" must include all contacts traced from known cases, as well as symptomatic people, particularly those who live, work, and otherwise have, or have had, contact with vulnerable people. Such testing will likely require staffing of tracing task forces, as well as training, equipping, and deploying people to collect samples "in place."
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