Alex Greninger was watching it all from the start. An epidemiologist and expert in laboratory medicine, Greninger spent the first few weeks of the year paying close attention to China, where a new SARS-like virus was burning through the city of Wuhan at an alarming rate. He watched as Chinese officials struggled to contain the virus, locking down the giant city of 11 million people, going door-to-door to test its citizens. He watched as the virus evaded their grasp. More than most people, Greninger could guess at what was coming for America. And more than most people, he was in a position to do something about it.

The key to getting an outbreak like the current one under control, say medical professionals, is implementing proper testing protocols. Testing for the virus allows doctors to pinpoint and isolate those who are carrying the virus and prevent them from spreading it. Aggressive testing allowed China, eventually, to get the outbreak in Wuhan under control and bring the number of new infections down dramatically. It’s been central to the strategy that Singapore and South Korea have used, too: test and isolate. And yet, two months since the first case of COVID-19 was confirmed in the U.S., tests for the novel coronavirus are still exceedingly hard to find.

How did the U.S. fumble its response to the coronavirus so colossally, even with so much lead time? Why, with the number of diagnosed COVID cases in the U.S. climbing toward 4,000, do we still not have nearly enough tests?

A large part of the blame lies with President Trump, who has not wanted widespread testing, apparently out of an obsession with keeping the number of confirmed COVID cases low. It’s why he waffled so long on whether to let the Grand Princess cruise liner, where COVID infections were spreading rapidly, dock in the United States. “I would rather have them stay on [the ship], personally,” Trump said earlier this month. “I don't need to have the numbers double because of one ship that wasn't our fault.” His administration turned down tests provided by the World Health Organization and instead wasted precious time having the Centers for Disease Control create its own test. While that was underway, the president denounced the spread of the disease as a Democratic hoax, giving the public a dangerously false sense of complacency just as a pandemic was getting underway.

In the meantime, a more prosaic and bureaucratic tangle of frustrations ensnared those on the front lines of the fight—those like Dr. Greninger, whose struggles offer a window into how the rollout of testing has been bungled, and why the situation isn’t likely to improve any time soon.

Back in January, while Greninger was studying the outbreak in China, officials there helpfully published the viral genome of the SARS-CoV-2 virus, which causes the COVID-19 illness. Greninger immediately took the information and used it to start developing a test. He knew that he’d need to get FDA approval to use the test on patients, but if there was an outbreak coming, he hoped that wouldn’t be a problem.

It was. The FDA had granted permission to make testing kits to only one lab: the CDC. Many of those kits had, by early February, been sent to public health labs across the country—and the tests, it turned out, didn’t work. By then, cases of COVID-19 in Washington state were beginning to crop up just north of Seattle. The bottleneck for testing patients began to grow. And those patients fortunate enough to get tested were forced to wait for their results. In the case of a typical illness—say, flu or strep—doctors and nurses can order tests and have the results processed in-house, especially if they work at a big teaching hospital, like the medical center at the University of Washington. Now, mysteriously ill patients, some of them critically sick, had to wait days for doctors to send their swab to their local public health department, which had the CDC tests, and then wait for the result to come back.