New York – The U.S. government’s inability — no, make that its refusal — to take charge of COVID-19 testing is a national disgrace, with profound consequences that will arrive soon. With pressure building to reopen the economy, the lack of meaningful testing means that states and their citizens are going to have to assume risks they can’t see.
The problem is not that there aren’t enough labs able to test for the coronavirus. Private labs, university labs, commercial labs — by now they all have workable protocols for diagnostic tests. Rather, the bottleneck is a severe shortage of materiel, starting with the simplest of tools: the nasopharyngeal swabs that are used to gather genetic material. Reagents — chemicals needed for COVID-19 testing — have also been in short supply.
As part of his effort to place the burden of this crisis on the states (and, of course, the blame if things go wrong), U.S. President Donald Trump keeps claiming that testing is a state responsibility. “We’re the federal government,” he has said. “We’re not supposed to stand on a street corner doing testing.”
What a grotesque remark. Nobody is suggesting the Food and Drug Administration do the actual testing. But states can’t force companies to manufacture swabs, or mass-produce reagents, or loosen regulations to make testing quicker and easier. Only the federal government can do that.
The shortage issue has been obvious since February. Yet it was only on last Thursday that the FDA gave companies approval to make cheaper, easier-to-use swabs. Meanwhile, after more than a month in lockdown, Americans are becoming impatient to end shelter-in-place rules — eager to get their kids back in school, worried about running out of money, terrified of the immense economic damage the virus is causing. Yet the country isn’t close to having enough testing for a relatively risk-free easing of restrictions. It is a tragedy that the most powerful nation on earth finds itself in this position.
On the Sunday morning talk shows, several governors expressed anguish over the situation. Gov. Gretchen Whitmer of Michigan said that her state, which has been averaging about 4,000 tests a day since late March, could double or triple the number “if we had the swabs or reagents.” Gov. Ralph Northam of Virginia said that the country was fighting a biological war “without the supplies we need.”
During his daily press briefings, New York Gov. Andrew Cuomo practically begs the Trump administration to lend a hand. States have the ability to test, he said during the weekend, “but I can’t do an international supply chain, and that’s where the federal government has to help out because no state can do that.”
The U.S. is testing about 150,000 people a day for COVID-19. Scientists say the country needs to be able to conduct 500,000 to 700,000 a day to reopen the country with any assurance of safety.
After someone receives a positive diagnosis — whether showing symptoms or not — researchers are supposed to track down everyone that person has been in contact with over a predetermined number of days and quarantine them as well. That’s called contact tracing; it is critical to slowing the spread of an epidemic. Just a few states have ramped up these efforts so far.
How about antibody testing, which would identify people who have built up immunity to the virus and give some indication of just how widespread it is in the population? Germany is preparing to allow shops to reopen in no small part because it has embarked on a broad antibody-testing program. Among other benefits, Germany expects these tests to identify, as the New York Times put it, “which of the far-reaching social and economic restrictions that have slowed the virus are most effective and which can be safely lifted.”
That is exactly the kind of critical information government officials in the U.S. desperately need as political pressure increases (including from the president) to start lifting stay-at-home restrictions and allow businesses to reopen.
Consider Massachusetts. Boston is the hardest hit city, with 5,516 of the state’s 38,000 cases. But the death toll is comparatively low: 176 people, compared with 590 in Detroit and 329 in New Orleans. Yet Michigan and Louisiana imposed shelter-in-place restrictions a week before Massachusetts.
Why are the Boston numbers so low? Is it because Detroit and New Orleans are denser than Boston? Because the disease hits blacks harder than whites? Detroit and New Orleans have a higher percentage of blacks.
Or could it be that Bostonians have developed some unnoticed degree of herd immunity? On Friday, the Boston Globe reported that 200 residents of Chelsea, a small working-class city that abuts Boston, were given antibody tests. Nearly a third of them tested positive for COVID-19 antibodies. Those results raise the possibility that the virus has infected thousands — if not tens of thousands — of Bostonians without anyone realizing it.
Or consider Florida. The state should have been ravaged: It declined to shut down spring break; it has a large elderly population; and its governor, Ron DeSantis, didn’t order a statewide lockdown until April 1. Yet is has suffered fewer than 4,000 hospitalizations and 774 deaths as a result of the coronavirus. That is 25 percent fewer deaths than Pennsylvania, which shut down in mid-March and has generally taken the virus more seriously.
During the weekend, DeSantis said that beaches could be reopened; by Saturday morning, people were swarming beaches in Jacksonville, gleefully ignoring the social-distancing guidelines. Social media was full of pictures of the crowded beaches with the hashtag #FloridaMorons.
But are their actions really all that moronic? Without sufficient testing, all people have to go on is what they’re seeing and experiencing. And what Floridians are seeing is a situation that doesn’t truly seem all that dire no matter what the scientists say. With the death toll so low, they’re willing to assume the risk of walking on the beach shoulder to shoulder with their friends and neighbors. Maybe their decision will lead to a spike in hospitalizations and deaths. But maybe it won’t. We just don’t know.
The protests during the weekend in Maryland, Texas and elsewhere suggest that plenty of other Americans are willing to assume the risk that they’ll either not get sick or they’ll survive the coronavirus. As we get into May, those numbers will increase, and they won’t all be Trump supporters. You may disagree with those who argue that the cure is worth than the disease — that scientists have overestimated the coronavirus’s lethality while ignoring the deaths that will result from a decimated economy — but it is bound to gain adherents in the weeks ahead. Without adequate testing, however, states and their residents will only be left guessing.
Including, I should note, New York. No governor has been more passionate than Cuomo about wanting to be guided by science. On Sunday, he announced that the state would begin limited antibody testing, which is an important step. But New York still doesn’t have anywhere near enough diagnostic testing.
The current shelter-in-place order is in force until May 15. It will be incredibly difficult for Cuomo to extend it, given New York City’s position as the nation’s financial capital and the citizenry’s need to get back to something approaching normalcy. A federal government that was truly playing its part would make it possible for him to make a science-based decision. Instead, he’s going to have to make the decision based on a risk-reward equation that he can’t realistically calculate.
At the White House press briefing on Friday, Vice President Mike Pence announced that 3.7 million diagnostic tests had been conducted since the crisis began. (The number as of Monday was 3.9 million.) Pence made it sound as if that number was something to be proud of.
It’s not. It is the country’s shame.
Joe Nocera is a Bloomberg columnist.
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