michael barbaro

From The New York Times, I’m Michael Barbaro. This is “The Daily.” Today: It was supposed to be a relatively simple part of preparing for the coronavirus in the United States — testing for it. My colleague Sheri Fink on what went wrong. It’s Wednesday, March 11.

sheri fink

So in 2018, it was the hundredth anniversary of the terrible 1918 flu pandemic. This was called the Spanish flu. And it just killed millions and millions of people around the world. So on that hundredth-year anniversary, many gatherings were held to discuss the lessons of that flu pandemic for today. And there was this one gathering of high-level people in Atlanta, Georgia, where the Centers for Disease Control and Prevention is based. And among the officials there was a group from the National Security Council. It had actually been created, a special unit on global health security that was created after that terrible Ebola outbreak in West Africa.

archived recording So let’s begin with you, Dr. [INAUDIBLE].

sheri fink

So one of the officials with that group, with that unit —

archived recording (luciano borio) Well, it’s a pleasure to be here with so many of my colleagues. And we’ve been working together for more than a decade on these issues.

sheri fink

— she steps up to the podium and she says —

archived recording (luciano borio) The threat of pandemic flu is our number one health security concern. We know that it cannot be stopped at the border.

michael barbaro

So this is a pretty senior health official on the National Security Council warning her colleagues that there is a very predictable threat here — a pandemic flu and —

archived recording (luciano borio) Are we ready to respond to a pandemic? I fear the answer is no.

michael barbaro

— in her words, the country is just not really ready for it. So we should do something about it.

sheri fink

Exactly. And as it happens, the very next day, that global health security unit where she worked was shut down by a senior member of the Trump administration. So fast forward two years. And it’s early January, January 3. It’s a Friday. And the secretary of health and human services, Alex Azar, is at home in Washington. And he gets this phone call from Robert Redfield, this doctor who’s the head of the C.D.C. And Dr. Redfield tells Azar about these reports coming out of China, that there are these clusters of pneumonia cases, and that the likely culprit is a new coronavirus. And Alex Azar, the health and human services secretary, says, this is a very big deal.

michael barbaro

And what does Azar do with this information and this understanding that whatever this is, it’s going to be a big deal?

sheri fink

The Trump administration officials start meeting every day in the basement of the West Wing. And so at first, they say, OK, let’s screen the flights that are coming from China. But there’s an even more serious question that comes up, which is, should we ban flights altogether? And should we deny entry to anybody who has come from China in the last 14 days, to anybody who isn’t a citizen or a permanent resident here? So then that debate got shifted right to the Oval Office. And the top health officials of the nation, at that point, were agreed. A ban from traveling from the center of this epidemic could buy us some time, could help us to prepare ourselves before this came. It could slow that down. The president asked, what could the consequences be on the economy? All logical things that you would probably ask. In the end, he sided with the aides who supported the idea that this could actually help protect our nation’s health. The problem was we weren’t completely prepared. Our government wasn’t completely prepared to use that time.

michael barbaro

What do you mean?

sheri fink

The biggest issue that the government had to face was testing — being able to diagnose somebody who has this illness.

michael barbaro

And what is the problem with testing at this point?

sheri fink

Well, it didn’t seem like there would be a problem. Even though it was a new virus, the Chinese quickly made the sequence of it available. And labs were really quickly able to create a test for that, including the World Health Organization had already approved a test that was developed by some German scientists. But the U.S., which considers the C.D.C the world’s premier public health agency, they decided to make their own test. But it didn’t actually get F.D.A. approved until the first week of February. And at that point, it could be distributed to public health laboratories across the country. But, you know, now we’re already over a month into this scary new outbreak by that point.

michael barbaro

So this is already off to a pretty slow start at a moment where every single day counts.

sheri fink

That’s right. So now, we’re like a month into this thing. And they’re finally able to mail out the kits to public health laboratories around the country — state health laboratories, some big city health laboratories, this network of labs that our public health system has. And the next day — the first step that the labs have to do is they have to check that test. They have to what’s called “validate it,” make sure it’s working. And right that next day, the C.D.C starts getting reports from some of these public health labs, saying, we’re not able to validate this test. We’re having problems. We’re getting some inconclusive results. And that’s the first sign that something may have gone wrong.

michael barbaro

This test is not working?

sheri fink

Well, the C.D.C says it was definitely working in their lab. So they’ve told all the labs across the country, if it’s not working for you, of course, don’t use it. Just send samples to us. Of course, that adds time. You have to collect a sample in your local area and then send it to Atlanta, and then wait for that result to come back.

michael barbaro

So what impact does this testing snafu have at this point on our understanding of the epidemic?

sheri fink

It just means that we don’t know. We actually don’t know. We say we have a low number of cases in this country at that point. But if you don’t test, how can you know?

michael barbaro

OK. And for these weeks where it seemed like we had cases in the low double digits in the United States, and there was a sense that things were quite stable and the danger was pretty low, the virus very well could have been spreading and spreading widely, and we wouldn’t have known. Because we weren’t doing the testing that would have told us that.

sheri fink

Exactly. And here’s why. Because only a small proportion of people who get the virus get really, really sick, fortunately. But by the time that they get into a critical care bed at a hospital — and the doctors there are scratching their heads, and they’ve tested for all the known things that cause like pneumonia and severe, severe respiratory distress — weeks have gone by since that person was infected. So you’re actually looking at history. If you finally get a positive test at that point, then, yes, it has been spreading in the community. And that’s all that time that you lose.

michael barbaro

Right. So this time that the Trump administration had bought the American people with that dramatic step — with shutting its border to Chinese travelers — is kind of being squandered.

sheri fink

Yeah, there were so many people who were starting to feel, at this point, like this time is being squandered. And we needed to get eyes on this. There were travelers coming from parts of the world where we didn’t have a travel ban that now had a large number of cases. And they weren’t being screened at the airports. They were going out into the communities. And there was just this urgency of being able to test more. And that’s when this one group of doctors and researchers took matters into their own hands.

michael barbaro

We’ll be right back.

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michael barbaro

Sheri, who is this doctor?

sheri fink

So her name is Helen Chu.

[phone dialing] helen chu Hello? This is Helen. sheri fink Hi, Helen. How are you doing? helen chu I’m doing well. How are you? sheri fink I’m well. Thanks.

sheri fink

She’s a physician and a researcher in Washington state, which is where the first case of coronavirus was detected in the U.S. back in January. And she and her colleagues see a potential solution to this testing problem in their own work.

helen chu We had a study in place that was set up for detection of respiratory viral illnesses in the community —

sheri fink

She specializes in studying how viruses pass from person-to-person within that same community. And she and her colleagues have this big study where they’re collecting all these samples.

helen chu — from people who are sick, and then testing them in the lab for flu and other respiratory viruses.

sheri fink

And through collecting hundreds and hundreds of samples every week, they’re trying to track the spread of viruses.

michael barbaro

And she was in the middle of collecting samples when the coronavirus arrives in Washington?

sheri fink

That is right.

helen chu

So we had this infrastructure in place already, essentially, in the Seattle area to be able to detect early entry of a virus into the city and then to understand how it spread.

michael barbaro

And that sounds like it would make her very well positioned to do the same thing for the coronavirus.

sheri fink

Exactly. She thought of that. The state health officials knew about their project. And they immediately thought about the potential of this project to help with this issue of testing.

michael barbaro

And so what happens?

sheri fink

They make their own coronavirus test really fast. And they’re ready to go to help the state by the first week of February. But there’s one hitch.

helen chu We had to go through regulatory clearance, essentially. We had to talk to C.D.C. We had to talk to F.D.A..

sheri fink

They don’t have the approval to test and then give those results out for two reasons. One is they’re not a clinical lab, so they don’t have the regulatory approval for that. And number two is they’ve just created this new coronavirus test, which isn’t yet F.D.A. approved.

helen chu And so we were at a point where we could test thousands and thousands of samples at very high throughput. But we didn’t know what to do when we found a positive.

sheri fink

So there’s good reason to have some of those regulations in place. But they figure, this is a public health emergency. And they feel like there’s got to be some way around this bureaucratic red tape, where they could at least screen these samples and get that information out to the public health authorities to confirm that test, whatever it is. But —

helen chu Everybody felt very hesitant about us being able to provide results or to do the testing at all.

sheri fink

— the C.D.C doesn’t seem to find a way around it. Weeks go by. And they’re getting more and more frustrated. And they’re seeing the outbreak is growing in China, and it’s spreading to other countries. So we know there’s a potential for it to be an outbreak not just in China.

helen chu We had the information. We had the data there sitting in our lab where we could actually answer the question. And that was frustrating, that we could answer it. We had the capacity to answer it, but we couldn’t move forward, because we didn’t know what to do.

sheri fink

They feel like they’re sitting on a gold mine. And they feel like the virus very well could be out there. After all, there had been this case in Washington state more than a month earlier, and nobody’s had eyes on it. Nobody’s been doing surveillance in the community, testing samples. So they’re getting more and more nervous. Is there something we’re not seeing? Because we’re not really testing very widely.

michael barbaro

So what did they end up doing? Just kind of keeping those samples on ice and doing nothing?

sheri fink

Well, at first, that’s what they did. Because they thought they could speak with these officials and find out some official workaround, so that they wouldn’t be violating regulations and get in trouble.

helen chu Everyone wanted to be able to do this the proper way — to go through C.D.C and state labs and have them have the high capacity to do the testing of all of these patients who really needed a diagnosis. But it just couldn’t be done.

sheri fink

And then it gets to February 25. I mean, the month is almost gone. It’s more than a month since that first case. And they finally just said —

helen chu What we would do is move forward with research testing only.

sheri fink

— we’re going to start using this unapproved coronavirus test that we have, and that we believe is very reliable, and start testing these samples.

michael barbaro

Wow. So they’re just going for it?

sheri fink

Well, they’re just going for it. And technically, they can test, right? But the issue is, they can’t report the results.

helen chu So what we would do would just be to go ahead and test the samples for coronavirus, but not to associate that with the information from the sample. So the clinical information.

michael barbaro

So they have a plan to test for the coronavirus. And if they find it, that would mean that they’re sitting on information that they’re not supposed to have.

sheri fink

They’re sitting on information that they’re not supposed to communicate because of these regulatory issues. It’s all going to be fine as long as they don’t find a case.

michael barbaro

OK, so once they decided to do that, what happened?

sheri fink

What happened was, one of the very first days that they started testing —

helen chu February 27, we got the first positive.

sheri fink

— they found a case.

helen chu What I thought was, oh, no. If it came up that early in our testing, that meant that it had probably been here for a while and that we just didn’t know that it was there. And so the questions racing through my head at that point where, what is the right thing to do right now? And so what happened at that point was that we rapidly convened a meeting of the investigators.

sheri fink

The group just convenes. They all get on the phone. And they talk about ethics at this point.

helen chu We talked through the ethics of the different options — keep it to ourselves, tell public health, or tell the participants. And what we are allowed to do was to keep it to ourselves. But what we felt like we needed to do was to tell public health. And so that’s what we did.

sheri fink

They decide that the most ethical thing is to report the result to the local health authority. They confirmed the result. And it’s this local teenager in the very same county as that first positive case, but no known link to that person and no travel history. And that next morning, the public health lab went out and they found this teenager, who was feeling better by that point. Because he had had a mild form of this illness, which is most common, especially in young people. And they get to him just after he walks into his school, because he’s —

michael barbaro

Oh, wow.

sheri fink

Yeah. And they end up shutting the school down to make sure that nobody else will catch the virus.

helen chu I mean, that was a good moment for our team, I thought. You know, we did something that didn’t follow the rules, but we were able to prevent spread in a high school. And that seemed really important.

michael barbaro

So because of the doctor’s actions, they catch him, basically, in the nick of time.

sheri fink

They do. And they also realize that they may have a big problem on their hands. Because if this case descended from that first case, if that person potentially had infected somebody without knowing it, and then there was mild illness going on, and nobody caught it, there could be hundreds of cases in the area. And so that gave them the information that they needed to start acting, to start looking more seriously for the virus in the community.

michael barbaro

I wonder. Had Dr. Chu not broken the rules in this case, how that would have changed how we understand the coronavirus in the Seattle region?

sheri fink

Well, we wouldn’t have known, until the people started dying, that there was a problem. And unfortunately, the really sad thing is that that happened really soon after that. And so if Dr. Chu and her colleagues had been able to test sooner, they would have been able to alert the authorities earlier. And that’s the real tragedy here.

michael barbaro

Sheri, on the one hand, the story that you have just told — it’s a pretty heroic story of a doctor willing to go against the rules, the instructions, because she felt that it was needed in the moment, in the midst of a public health crisis. On the other hand, it feels risky for the lesson here to be that medical professionals should go rogue in the middle of a crisis. I mean, what in your mind is the lesson here?

sheri fink

I mean, I’m somebody who’s reported on disasters for many years and used to do some disaster response myself. And I’ve always seen in crises that thinking outside the box can really solve problems and it can save lives. And I think we generally accept that already, that the rules do have to bend, that people need to think creatively. And one of the reasons they have to do it — and it was so evident here — was that the larger system, the official responders, the official system in place couldn’t do everything and was faltering.

michael barbaro

But I wonder, how much would things potentially have been different, Sheri, if, thinking back to the start of our conversation, those government programs — the National Security Council’s health program, for example — hadn’t been cut? I mean, how much does that reflect an overall approach to this epidemic from the people currently in charge from the Trump administration?

sheri fink

I think you can trace it back further than that. It is a pattern that these programs, when there’s a crisis, they get really well funded. And as soon as Ebola recedes into history, we start cutting those parts of government. You can look back after the anthrax attacks and 9/11. And there was all this money that went into bioterrorism preparedness and hospital preparedness. And then you look at the numbers, and they go down over time. This is a reaction of humanity and society and government, is to sort of like — when it’s in the news and it’s fresh in our minds, we invest in it, and then we turn away. So I feel like this is a pattern. And when this happens, and we have these gaps in our preparedness that the government always seems to have, what I have found over and over again as a reporter is regular people step in and fill some of those holes. And I’m thinking — right now I have this image of Hurricane Katrina and government officials not being able to rescue everybody who needed help all at once. People waving towels off of rooftops and people stuck in hospitals. And then it was these regular people who had airboats, who were fishermen from western Louisiana. And they show up, and they just take people to dry ground. I’ve seen examples like that over and over. In this case, we saw Dr. Chu and her colleagues doing something like that. But, what I found out today on the phone with Dr. Chu was that —

helen chu Yesterday, the Washington state regulators called their lab and asked us to shut down.

sheri fink

— the project got shut down again. So the state regulators told them they can’t keep doing this. So it looks like the government isn’t going to allow this to continue to fill that hole. And so that hole remains.

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sheri fink

The question is whether this will be one of those lessons that comes out of this particular outbreak. And of course, there will be a tomorrow. There will be a day where we’re not in the midst of something so frightening that we’re in right now. And the question is, will this fit that same cycle where we say, we’ve learned the lesson, we need to kind of innovate and come up with new systems that will ensure that we’re on a better footing, that we can have some backup system so that we can roll out testing as a country much more quickly? Or will this fit that same cycle, where once the immediate danger goes away, we stop investing, or we just forget?

michael barbaro

Sheri, thank you.

sheri fink

Thank you.

michael barbaro

A few days ago, my colleague Peter Baker asked President Trump whether he regrets eliminating the global health unit of the National Security Council in light of the coronavirus epidemic.

donald trump I just think this is something, Peter, that you can never really think is going to happen. I’ve heard all about, this could be a big deal, from before it happened. Something like this could happen.

michael barbaro

The president claimed, despite past warnings from federal health officials, that such an epidemic was previously unimaginable.

donald trump But who would have thought? Look, how long ago was it? Six, seven, eight weeks ago, who would have thought we’d even be having this subject? We were going to hit 30,000 on the Dow like it was clockwork, right?

michael barbaro

We’ll be right back.

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michael barbaro

Here’s what else you need to know today. On Tuesday, public and private institutions across the United States took their strongest measures yet to limit the spread of the coronavirus. Dozens of colleges and universities, from the University of California, Berkeley to Harvard, are closing their doors or asking students to attend classes remotely. Major airlines, including Delta and American Airlines, said they would drastically cut back on international flights. And the nursing home industry issued a recommendation to bar visits from family and friends after deadly outbreaks inside of five nursing homes around Seattle. In New York, officials have created a containment cell around the source of a major outbreak in the city of New Rochelle, north of New York City, ordering schools, community centers and houses of worship within the zone to close for the next two weeks and deploying the National Guard inside the containment area. And in California, a cruise ship with at least 21 infected passengers docked in Oakland, where it was met by workers in protective gear, who took those on board to a nearby military base in the largest quarantine operation so far on American soil. For the results of Tuesday night’s Democratic primaries, which were held in six states, listen to this morning’s episode of “The Latest.” You can find it on “The Daily” feed or by searching for “The Latest,” wherever you listen.

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