From 2009 to 2017, throughout the entire Obama administration, the Centers for Disease Control had a single director. That director was Dr. Tom Frieden. Frieden was the former head of the New York City Health Department, a former medical officer for the World Health Organization, and a former “Epidemic Intelligence Officer.” Since 2017, Donald Trump has gone through three CDC directors, or four, if you count two acting sessions by Assistant Surgeon General Anne Schuchat.

Trump’s first full-time CDC director was Georgia obstetrician Brenda Fitzgerald who, in addition to having the “right” views on abortion, boasted a failed congressional bid. As a candidate, she joined Newt Gingrich in a historic reenactment by throwing crates of tea into the Chattahoochee River. So she was clearly perfectly qualified.

In 2018, Trump appointed Dr. Robert Redfield as the new CDC director. As a virologist, Redfield might seem like the perfect person for the role at this time … except for the part where he made his name by making premature claims about what proved to be an ineffective vaccine against HIV. And the part where he become a conservative favorite through his association with a group that considered AIDS the “wrath of God.” Redfield also apparently has an ability to flatter Trump into believing he understands science—which might be why he got $375,000 a year as CDC director, when previous directors made $219,700.

It’s not clear how much Redfield added to bringing the CDC from the world’s go-to resource on epidemics to an organization unable to find its own ass with both hands. But clearly Trump’s whole philosophy of loyalty over competence has been heavily at work in the agency. As ProPublica reports, notes retrieved from the CDC show an agency that was in self-admitted confusion about how to respond to the coronavirus outbreak.

The confusion extended to testing, where despite claims of first thousands, then millions of tests, the CDC seemed set on making sure an absolute minimum number of people were able to get tested. That including instructing state authorities that it wasn’t enough to have all the symptoms of COVID-19, and it wasn’t enough to have known contact with someone who had been confirmed to have the disease. It took both to warrant one of the precious tests.

The result was that tests were reserved for those rare few with direct connections to those who had already been tested. And cases that seem like obvious needs were ignored. These restrictions so limited the range of Americans who could be tested, that the nation still hasn’t come close to catching up to the need—and the same confusing requirements are still being used to deny a test despite obvious needs.

Originally, these limits were supposed to be confined to “phase one” testing done by the CDC, but as test kits failed to appear, and phase two testing by states slowly ground into gear, the limits on testing persisted. Patients are still entering emergency rooms and being told they don’t meet the qualification for testing, even if they are clearly in need for critical care. Even healthcare workers who are known to have been exposed are still being denied because no one has provided hospitals and regional authorities with better guidelines for expanded testing.

For weeks, Redfield insisted that the agency was completely prepared, while insisting that the coronavirus was not circulating in the United States. Except it was. The failure to provide tests in time, and to make those tests available at a doctor’s discretion, meant that COVID-19 likely circulated for weeks in the United States before the first case of “community spread” was detected … by someone who ignored the recommended restrictions on testing.