William Hanage (epidemiologist, Harvard University T.H. Chan School of Public Health): “In the United
States, one of the major problems in the response to the pandemic started right at the start with
testing. You cannot tell where the virus is or if somebody’s infected with it unless you test
for it. And even though there were very good tests available and being used, in for instance Vietnam,
since January, the United States developed its own test. And this was being done through CDC.
There were a number of missteps made, notably an issue with contamination meant that some of
the tests that were sent out could not be used in the way that they were intended and so there
was a recall and there was a period of around three or four weeks, maybe, in which the virus
could spread pretty much unchecked. And this was a point when essentially we were flying blind.”
[Music]
Andrew Lo (economist, MIT Sloan School of Management):
“Testing is one of the key issues because once we understand who is actually getting infected,
where they’re getting infected, how they’re getting infected, we can do a lot more to
be able to intervene effectively. We can’t manage what we don’t measure.
And unfortunately, in the early part of 2020, we were doing very little measurement.”
Pardis Sabeti (computational geneticist, Harvard University):
“Problem No. 1 is just that the way a lot of the FDA works during outbreaks. It makes it
more difficult to set up your own test. In January my lab had tests working and
in February they were being used at our sites in Africa. Even though it’s not FDA-approved,
we had working diagnostics in place in Nigeria, Sierra Leone and Senegal before any US hospital.
It’s not hard to do and it’s something that every hospital in this country should be prepped to do.”
[VIDEO CLIP FROM CONGRESSIONAL HEARINGS]
Anthony Fauci (director, National Institute of Allergy and Infectious Disease): “It is a failing
— let’s admit it. We’re not set up for that. Do I think we should be? Yes, but we’re not.”
US Rep. Deborah Wasserman Schultz (D-Fla.): “OK,
that’s really disturbing and I appreciate the information.”
US Sen. Mike Braun (R-Ind.): “The FDA prevented private
and academic development of tests for weeks.”
Pardis Sabeti: “As soon as the FDA unit here in the United States allowed hospitals to engage,
we were able to quickly transition. And we worked with Mass General Hospital and had
working diagnostics there within days of the approval to do so.”
William Hanage: “And of course once testing becomes available, you suddenly
turn on the lights, and you see that there’s a huge problem.
And by that stage it’s a little bit too late to be able to control that problem.”
[VIDEO CLIP OF TV NEWS REPORT]
Newscaster: “After shattering another record for daily infections, tonight more Americans
than ever are hospitalized with Covid.” William Hanage: “It is a matter of scientific fact
that the delays and testing seriously hindered the pandemic response. I think it’s worth remembering
many people don’t recognize a catastrophe until it is upon them. And you cannot escape
the fact that at the federal level in this country, the attitude to the pandemic was
truly to stick its head in the sand, and for a long period of time.”
President Trump: “The testing is not going to be a problem at all.”
Newscaster: “President Trump’s new blueprint for testing does not set specific goals or time frames
and says the federal government should be a supplier of last resort.”
William Hanage: “The federal government brought a rubber chicken to a gunfight.
The situation is that this is the most severe infectious-disease emergency that has
happened in a century, and you need to sit up and recognize this.
“One really interesting thing about the United States health-care system
is its fragmented nature. There are different places that you can get tests done. Tests are
not necessarily done in the state where the sample is taken; they can be shipped off to a company.
That means that it becomes more difficult to take a coherent action, to make any kind of coherent
national plan, and of course over the first year of the pandemic there wasn’t really any
interest from the federal government in terms of coming up with a coherent national plan.”
Anthony Fauci: “What we depend on in the United States is the private enterprise, the various
independent companies that make it and distribute it, and that’s just the system, the way it works.”
Apoorva Mandavilli: “It’s really been shocking
to see how chaotic and disorganized the public health infrastructure in this country is. At an
individual level everybody’s working hard, at an individual level every public health
expert is doing their job, but as a collective? There’s a real failure.”
Pardis Sabeti: “There are 260,000 clinical labs in the United States,
and as of today only 200 of them set up their own tests.
All of the rest of them just waited for commercial tests to become available, and those commercial
tests had huge backlogs. And so everyone was literally just calling and being like,
‘Where’s my test?’ as opposed to just ordering some primers and just running tests yourself.”
Newscaster: “With the death toll rising, experts warn the US is losing the battle over coronavirus
testing. Researchers at the Rockefeller Foundation warn America faces an impending disaster.”
[VIDEO CLIP ENDS]
Pardis Sabeti: “To do it right in the future,
whenever a new viral threat emerges, we have to position the 260,000 clinical labs to be able to
set up testing right away, to be able to be picking up these things as fast as possible
while we kind of hold the line until manufactured kits can be made available to more people.
“As soon as Covid hit, every organization — all professional sports teams,
the White House — everyone’s thinking ‘How do I keep working?’ So a lot of the organizations
that were well-supported started doing a lot of testing on their own members.”
Newscaster: “As long lines form at coronavirus testing sites across the country,
it seems professional athletes are having no trouble getting their results. The
Brooklyn Nets announced four players have tested positive for the virus.”
Pardis Sabeti: “In some extreme examples, people are literally testing healthy
young people every single day; meanwhile, the community around them is burning to the ground,
and people are waiting a week for a result. And you’re getting, you know,
24-hour turnaround on people that are healthy, that are getting tested daily. And
that’s great if that’s something that’s possible, but if you’re looking around you, and
everybody in your community doesn’t have that support, to me it just didn’t make sense.
“We ran a lot of models that modeled these sort of two compartments, an institution and the people
in the community around it, and we said, ‘Why don’t you just take your test and use it outside
the institution?’ — which would go better? We found in every single instance it was better to
at least use some of your tests beyond your walls, and it was more that at least half of your tests
you should use outside of your walls. In some instances you should use nearly 100 percent of
your tests beyond your walls, because if you’re testing yourself you’re not actually
stopping the problem. It’s just a Band-Aid on something that’s continuing to happen.
And so if you really want to stay safe behind your walls, you have to actually test beyond them.
“In general when there is a limited amount of resources, we need to prioritize individuals
who are sick and symptomatic, individuals who are in contact with people who are symptomatic,
do case investigations where we figure out areas where there might be a lot of cases and really
explore there. And so while it’s great that a lot of institutions were able to set up
testing for themselves — and it was a good exercise — it was not the right way to use
the limited amount of tests that we had. We should have had those institutions work
to help to find all cases in a community.
“You know, the best thing we can do to keep ourselves safe is to keep our community safe.
One of the reasons why we had testing for SARS-CoV-2 a week after the virus
was reported is that’s part of our job. If a new virus emerges, we’ve got a new diagnostic
ready to go and they’re going to be implemented in the site immediately. And so that is what we
do for the sites we work in and what we think needs to happen around the world.”
Apoorva Mandavilli:
“I think it’s a real concern as we go into the fall, that Delta has changed the picture.
We’re not doing anywhere near the kind of testing that we could be and should be. There are a lot
of experts who have said that a lot of rapid testing can really help us in this pandemic. I
think they’re right, because we don’t really know where the virus is until it’s too late. A lot of
the time we’re just reacting — “Oh, look, the numbers have gone up very high, now we’re going
to start taking precautions” — instead of knowing where the virus is, where the clusters are.
So this is another place where the federal government really failed this country. I
think there wasn’t enough thought put into how to do testing. We just missed so many opportunities
along the way to make testing really easy and really cheap — really accessible to everybody.
“One very big lesson from this pandemic is that we don’t really have good systems in place to know
when there’s a new pathogen that’s circulating. One thing this has told us is that the world is so
interconnected, that we can’t just take care of surveillance in our own country and forget about
everywhere else. If there is something that is growing somewhere else, it is going to come here.
So the world needs to come together to figure out how to alert each other
to an emerging pathogen — can’t just be left up to the World Health Organization,
which these days is underfunded and really quite beholden to the US and China.
We need so much more surveillance on an international scale.”