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Tragic Virus Disconnects May Begin to Yield to Phase 3

The sharply different accounts, stories of critical shortages from hospitals and medical personnel versus sweeping assurances from the White House, were in especially sharp contrast Friday while both sides looked to the new rules and mountains of money that finally became available with the day’s signing of Phase 3 into law.

It was a comment from the Corona Virus Task Force Response Coordinator that was buried within a slew of remarks toward the very end of the evening’s latest White House briefing that may have signaled the most significant development perhaps since the virus’s onslaught in the United States began.

First the context. What has coalesced into a consensus of what has been wrong with the US response to the virus by medical experts and other knowledgeable people outside the White House has centred on three elements that have been lacking: speed, testing and contact tracing.

President Trump has justifiably taken credit for his early ban on entrants from China that was crucially important in holding the virus at bay longer than would have been the case otherwise. The ban took effect at 5 pm ET February 2, only 13 days after the first case of Covid-19 was confirmed in the state of Washington.

The Corona Virus Task Force was created January 29 and Trump declared a national health emergency Jan. 31.

So far, so good.

Then, as many graphic presentations available on the Internet show, Trump for weeks made comments that dismissed the threat of the virus, an attitude that seemed to dampen the institutional urgency of mounting a large-scale and immediate federal response.

In late February, Trump did something that had the effect of shocking into near paralysis the government’s medical bureaucracy. He was angered by an interview he heard while on Air Force One returning from his trip to India, several accounts revealed.

Nancy Messonnier, the director of the CDC’s National Center for Immunization and Respiratory Diseases, had told an interviewer that an outbreak of the same virus that was ravaging Wuhan was “inevitable” for the United States.

As Politico later reported, White House advisors learned her brother was Rod Rosenstein, the former deputy attorney general who oversaw the Mueller probe. Conservative talk-show hosts began to beat the drums of a common theme. A virus hoax was being perpetrated by Trump’s enemies. Fox News anchor Trish Regan amplified on the theme in a monologue. Fox announced earlier in the day Friday she was no longer with the network.

Messonnier quickly became persona non grata within the administration, an example to anyone who wanted to say the virus was a big deal. She hasn’t been heard from publicly since.

But Trump did something else that was eventually a positive development. He put Vice President Mike Pence in charge of the Task Force on February 27.

Initially, there was confusion about how to transform a long-standing small-scale CDC testing regime into a large-scale surveillance system. Pence seemed to gradually organise the effort, bringing the advice of the Task Force’s medical professionals forward. In the process, Health and Human Services Secretary Alex Azar and CDC Director Robert Redfield faded into the background.

Faced with a skyrocketing count of domestic virus cases, only in the past few days did Trump’s dismissive tone suddenly become a much more focused “war president” dialogue with America, dominating TV screens with daily news briefings, conference calls among governors, nurses, grocers, airline executives, business leaders, logistics executives and many others.

Without much testing – again, perhaps 40 times less proportionately than in South Korea – and without rigorous contact tracing that lack of early urgency turned Seattle, New York, New Orleans, Cook County, Illinois and other places into unbounded major and minor epicentres. They are now racing at different speeds toward an “apex” of hospitalisations that NY Governor Andrew Cuomo said that in his state will ultimately, under any “reasonable scenario,” overrun the hospital system.

As the case load and death toll grew, those unwitting asymptomatic carriers were taking – and are taking – the virus elsewhere in the country to future epicentres.

That, and much more for which there is no space, takes us to March 27, and the evening briefing.

There were many sideshows, like Trump’s imposing the Defense Production Act on General Motors in what seemed like a fit of pique, his declaration that if governors like those in Seattle and Michigan don’t “treat you right, I don’t call”, and his repeated assertion that no one could have known what, in fact, many people within his administration did know.

Then there was finally that statement from the Task Force Response Coordinator, Dr Deborah Birx.

What she seemed to be saying was while testing has been greatly expanded, most of the results of that testing have stayed out of reach. While streamlined testing procedures are speeding up results, they haven’t been able to be properly analysed because the results were not getting to Washington.

With the signing of Phase 3, now the commercial laboratories doing most of the tests are required to start sending the results starting “tomorrow”. At last it seems, a surveillance regime is being put together that might actually work, more than two months since that first confirmed US case of the virus, almost a month since the first US death.

With so many more test results and a Public Health Service beginning rigorous contact tracing, plus nearly two-thirds of the US population off the job at home, a realistically monumental effort is finally underway to effectively catch up with the leading edge of a marauding virus, those unwitting asymptomatic carriers.

“So testing should be used intentionally as a surveillance tool or a diagnostic tool,” Dr Birx told the briefing, “and I think what we’re going to work on over the weekend is to weave together both a testing strategy for surveillance” and for “strong testing for diagnosis”. Testing allows all that protective gear to be used only for those taking care of the positives by ruling out the negatives.

What about those much more numerous test results from throughout the country, the ones that are crucially important to slow down the virus spread?

“We worked very hard to get it into the first bill,” she said of the directive to commercial labs to report, “but it was changed to state and local labs, and obviously 99% of all the tests are being done in the commercial labs.”

She went on, at the very end of the briefing, to get to the important part. “So in this recent bill, that was just approved, it is mandated that all commercial labs need to report.” That means, “You’ll have that data when we get the data comprehensively from all the commercial labs.”

How soon? “Well, it was passed today,” she said, “so hopefully we’ll expect it tomorrow.”

There were 104,463 confirmed US virus cases by late Friday night, the most of any country, and of those, 1,693 deaths – and counting.

Denny Gulino

Julie Ros

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