There's a clear path out of this crisis, and Donald Trump isn't taking it.
Journalists should be demanding to know why not.
Public health experts, if you ask them, will tell you that the only way life will return to something like normal is if the government initiates widespread, quick-turnaround, publicly-reported testing for the coronavirus — not just of the sick or scared, but of cross-sections of every community.
That's the only way we'll know if it's safe to come out again.
Almost everything that happens in the short term should be measured against that goal.
Especially with Trump expressing growing impatience and denial — hinting that he'll encourage many Americans to venture out again by Easter Sunday, with possibly cataclysmic consequences — the questions reporters should ask at every White House briefing, and of every official and public health expert, are these: How can we know when it's safe to come out again? When will that happen? And what are you doing about it?
Where things stand
To understand how we end this crisis, we have to start at the beginning. As soon as COVID-19 landed on our shores, the government should have responded by testing anyone who might have been infected, and isolating those who tested positive.
Instead, the virus was left to spread entirely out of control.
Now, it's out there. We don't know precisely where, so it feels like it's everywhere.
We have a pretty good idea where it's most concentrated — at least so far — but we don't know where it's absent. So we don't know how to stay away and stay safe.
Public health experts say they hope our current social distancing regime will slow the spread of the virus and buy us enough time to do what we should have done in the first place: Test and isolate, albeit on a much bigger scale than would have been necessary if we'd caught it early.
But is the government even working toward that goal? There are few signs.
What needs to be done? And what are the metrics for success?
That's what we need to know — and that's what journalists need to be asking, every day.
We have a playbook
We recently learned that Trump failed to follow the "pandemic playbook" left to him by the Obama administration, with obviously disastrous consequences.
Imagine if the media had found a copy of that playbook early on, and could have held Trump accountable to it! The coverage would have been vastly better and more effective.
Now, of course, what we need is a "once you've screwed up the pandemic here's what to do" playbook, so the media can use that to hold Trump accountable.
Well, guess what? A recent Atlantic article by Aaron E. Carroll, a professor of pediatrics at the Indiana University School of Medicine, and Ashish Jha, a professor of global health at Harvard University, is a reasonable substitute.
The way to stop the spread is actually quite simple, they wrote:
To achieve this, we need to test many, many people, even those without symptoms. Testing will allow us to isolate the infected so they can't infect others. We need to be vigilant, and willing to quarantine people with absolute diligence.
But there's a problem:
Because we failed to set up a testing infrastructure, we can't check that many people. At the moment, we can't even test everyone who is sick.
So here's how we avoid a choice between "millions of deaths or a wrecked society," Carroll and Jha wrote:
We could develop tests that are fast, reliable, and ubiquitous. If we screen everyone, and do so regularly, we can let most people return to a more normal life. We can reopen schools and places where people gather. If we can be assured that the people who congregate aren't infectious, they can socialize.
We can build health-care facilities that do rapid screening and care for people who are infected, apart from those who are not. This will prevent transmission from one sick person to another in hospitals and other health-care facilities. We can even commit to housing infected people apart from their healthy family members, to prevent transmission in households.
So there you have it.
Lots of other experts agree. In a Washington Post opinion piece titled "When will it be safe to go out again?" Tom Frieden, a former director of the Centers for Disease Control and Prevention, said the answer is "widespread testing, rapid and effective contact tracing, isolation of patients and quarantine of contacts," with a particular emphasis on "rapid-turnaround-time tests." He concluded:
The Trump administration squandered the lead time provided by Chinese disease control efforts and its own travel ban. We can't afford to make that mistake again.
New York Times columnist Jamelle Bouie boiled down our current situation particularly well:
If the United States had the strict testing regime of South Korea or Taiwan — if it knew the full extent of the outbreak and had the resources to selectively quarantine the sick and the contagious — then you could imagine a return to normalcy in the next month or so, as most people began to go back to work and the vulnerable stayed home. But that is an unlikely, best-case scenario, more dream world than reality.
What is actually happening is that we don't know how many Americans are sick or how many are asymptomatic. We aren't quite flying blind, but without more tests we can't see very clearly either. What we do know is that we have a fast-growing caseload that implies that there are many more infections than what's in the official numbers so far. To relax restrictions in this environment is to guarantee greater spread of the disease and higher death tolls
The "difficult actions we are taking now," as Carroll and Jha put it, basically just buy us time.
The media needs to push government officials at all levels to stop wasting that time.
A whole new kind of testing
A lot of the reporting on testing so far has been misguided. For one the numerators — in this case, meaning the number of positive test results — don't mean much if you don't know what the denominators are. And the denominators — how many people are being tested, and under what circumstances — are changing faster than the numerators, and differ immensely from place to place. We know things are going very badly, in terms of the overall direction, but that's about it.
Secondly, we're only hearing about diagnostic tests — those that are basically used on sick people to determine what kind of medical help they need.
But in order for us to find out when and where where it will be safe to go out again — we need what is called "surveillance" testing.
In a recent appearance on the Deep State Radio podcast, journalist and pandemic expert Laurie Garrett talked about the bizarre – and insufficiently questioned – lack of emphasis on surveillance testing in the government's current planning.
One problem that we have in the United States is a lot of public confusion and politician confusion about testing, in the sense that there's two different kinds of testing and they actually should not physically be the same tests. One kind is diagnostic: That is, are you infected? Do we need to rush you to the intensive care unit right now? And that diagnostic test has to be incredibly accurate….
America's whole thrust is about diagnostic testing, which is most appropriately executed in a medical setting.
Then there's another kind of test — surveillance testing — that can be a lot sloppier, but it needs to be a lot faster, cheaper and easier to do. And surveillance testing is the sort of key to the gumshoe detective work of tracking any epidemic…. You know, what age group is most at risk, who's spreading it to whom.…
And we don't have a surveillance tool, as far as I know, at this moment. Nobody's really seriously even developing one. There's not a lot of money thrown to it. It's for reasons that absolutely defy my imagination. It seems to have escaped the entire CDC and national government's radar scope.
So what that means is that we're going into this epidemic flying as blind as possible. It's like trying to land a plane when your radar is broken and there's a fog bank ahead. We're heading for the landing strip. We know it's somewhere over there. We just hope we don't hit any buildings as we come down.
Lindsay F. Wiley, who teaches public health law at the American University's law school, explained in a must-read Twitter thread:
The population-level (ideally random-sample) testing of mildly symptomatic & asymptomatic cases we need to ID hotspots before hospitals become overwhelmed & target the public health response is a completely separate thing from clinical screening of the very ill….
To have any hope of getting out ahead of this virus in places where it isn't already too late, to deploy critical healthcare resources to the places they'll be needed most, we have to implement surveillance…
Distancing can be eased slowly, using testing data. We have to continuously test/monitor to detect if/when community transmission returns.
Talk to someone who got it right
With Trump using his bully pulpit to spew drivel, lies and flimflam, it's more important than ever for journalists to give voice to the experts. So let's hear what one has to say.
When I turn to experts, I try to find someone who was right when a lot of other people were wrong. That's why I called Jennifer Nuzzo.
Nuzzo, an epidemiologist and expert in disease outbreak detection and response at the Johns Hopkins Center for Health Security, testified to Congress on Feb. 5. That was just a week after Trump blocked some travel from China — the singular achievement he clings to as having proven his mettle as a "wartime president," earning him a 10 out of 10 (according to him) for his response to the coronavirus crisis.
These measures are unlikely to keep the virus out of our country. The virus is spreading too quickly and too quietly for us to possibly know where all cases are. We do not have a complete picture of where in the world the virus is spreading to be able to stop infected people from coming to the U.S. It is also possible that unrecognized infections are occurring in the U.S.
She was correct on all counts, and then explained that the travel ban was a distraction from more necessary measures:
Instead of trying to implement measures that likely will not work to prevent the virus from entering our country, we should focus on efforts that we know will help to lessen its impacts, such as ensuring that federal, state and local health agencies, and hospitals and health clinics, have the resources they need to diagnose, isolate and safely treat cases, and to promote feasible approaches to community mitigation that are most likely to mitigate disease spread. For this we will need government leadership and additional investments.
None of those things happened. Exactly as she suggested, Trump's actions made us less safe.
Now, Nuzzo is focusing on how we get out of this mess.
The most urgent problem, she told me in a phone interview, is getting sufficient personal protective equipment for the doctors, nurses and other medical workers who are putting themselves on the line.
But almost as urgent, she said, is the need to expand testing. "We need to do a better job of finding cases," she said. "We have no idea where we are in the curve."
Singapore, she pointed out, was able to avoid the kind of shutdown we're experiencing here because authorities there acted quickly to find people who had the virus, trace their contacts, and isolate the sick so the healthy could continue to go about their business.
It's too late for us to do that now, Nuzzo said. "But if we get our case numbers down through these various measures that we're taking, then we maybe have a hope of starting to do that again."
Nuzzo added that although state and local officials have taken the lead in so many areas, this is one area where the White House needs to lead. "We can't take a federalist approach to this," she said. "We need a national approach."
What other countries can teach us
Nuzzo mentioned Singapore because what we didn't do — in comparison to countries that responded quickly and successfully — informs what we still have a chance to do, going forward. Journalists should constantly keep that in mind.
As Helen Branswell wrote for STAT News:
Singapore … quickly developed a much-needed serology test — a blood test used to look for antibodies in blood that are a sign of previous infection. Getting a handle on how many people have been infected is critical to understanding how deadly this virus really is, experts stress.
Matt Apuzzo and Selam Gebrekidan wrote in the New York Times:
Australia, Korea and Singapore turned to networks of public and private laboratories to develop tests. On Feb. 4, the South Korean government granted fast-track approval for a company's coronavirus test and began shipping kits. A second company was approved a week later. Two more soon followed….
When Australia identified its first coronavirus patient in late January, political leaders made clear that testing would be widespread. ….
South Korea opened nearly 600 testing clinics, including dozens of drive-through stations.
For now, one of the few places in the U.S. where people can get a quick serology test is in Southern California's Little Saigon. Scott Schwebke and Teri Sforza wrote in the Orange County Register about a local doctor offering a finger-prick test that provides results in 10 minutes.
Where did they come from? This doctor imported thousands of the tests from South Korea.
Blood tests spot antibodies in people who have had the virus, while the cotton-swab-up-the-nose tests detect active disease. So they serve different purposes. But to help officials ascertain the extent of the virus's spread, for surveillance testing, the quick and easy one has huge advantages.
Meanwhile, at the White House
To say that Trump doesn't get any of this would be a dramatic understatement.
Back on March 6, in one of his most dazzling displays of ignorance, deceit and delusion, Trump insisted, repeatedly, that "Anybody that wants a test can get a test. That's what the bottom line is." He called the theoretically omnipresent test kits "beautiful" and said they were as "perfect" as the phone call with the Ukrainian president last summer that got him impeached.
In fact, there were almost no test kits to speak of.
I wrote at the time that it was incumbent on the media to step up and enable our nation's smartest people to set the agenda, rather than waiting for the White House to do it.
When it became clear even to Trump that there weren't nearly enough tests, he urged people who weren't showing symptoms not to get one.
These days — now that the U.S. has finally tested more people than South Korea (although not even close to more people per capita) — he is bragging again. On Wednesday, he said: "We have tested, by far, more than anybody. We're testing more than anybody right now. There's nobody even close. And our tests are the best tests."
A freelance reporter named Doug Christian asked Trump a great question that day. Citing comments by Ashish Jha, the coauthor of the Atlantic article referenced above, Christian asked Trump whether he agreed that "the key to getting this economy open as soon as possible is to test everyone who needs testing so we can quarantine all infected individuals and allow everyone else to go back to work immediately."
Trump, who probably didn't understand the question, came out against testing everyone, which wasn't what Jha called for. "We have some big problems, but it's confined to certain areas, high-density areas," Trump said. "So why would we test the entire nation — 350 [million] people?"
Trump on Thursday sent a letter to governors, claiming that federal officials are gathering testing data that will suggest guidelines categorizing counties as "high risk, medium risk or low risk" for the virus.
In the letter, he promised "robust surveillance testing, which allows us to monitor the spread of the virus throughout the country."
But there's no sign of that happening — and no sign of a clear plan to make it happen — so don't believe a word of it. As Philip Bump put it, somewhat more gently, for the Washington Post:
What Trump's letter implies is that a robust testing regimen and subsequent assessments of the country are required to relax the distancing restrictions — a goal he says he'd like to see in effect to some extent in 16 days. That seems unlikely. The question, then, is which gives: the testing regimen or the timeline?
Big Journalism is finally doing a better job of calling out Trump's lies and ignorance, but too many reporters and editors are still letting him determine what they cover. Perhaps even more important, the pace and rhythm of Trump's reality-show presidency – where it's all about the moment, and maybe, just maybe, about what's on tomorrow — has gotten them out of the habit of looking ahead, in this case to how the season ends.
Reporters could and should change that by relentlessly asking questions at Trump's briefings and elsewhere about how we will know when it is safe to come out again. They should demand answers. They should put that crucial context in every story. And we should measure everything that he and his administration do relative to that goal.