When it comes to testing, the states may have to go it on their own.
We have been in a bad way over the past month, but Coronavirus news in the United States has taken a slightly positive turn over the past two weeks: It looks like cases are beginning to plateau in both hot spots and in areas that suffered a more mild outbreak, like Los Angeles. In addition, the New York Times has reported that we’ve made substantial progress on creating a vaccine.
A select number of states are beginning to “reopen” their economies, though some are doing it sooner than any expert would recommend. Georgia, for instance, is still seeing a high number of cases, but Governor Brian Kemp partially lifted the state’s stay-at-home order on Friday, April 24th. Colorado is similarly poised to begin a partial reopening today, but most of the stay-at-home policies will remain in place.
Colorado’s governor, Jared Polis, detailed the reopening process in a press conference last Wednesday and spent a good chunk of his time talking about the next phase of combatting the virus: Testing and contact tracing. Polis said that Colorado was expected to get 150,000 tests by the end of the week (April 24th), with another 150,000 coming in the middle of May.
The focus on testing is incredibly important because most experts say that testing and tracing are how state governments and public health officials will be able to track the disease’s spread and head it off. Picture this: A large program that is rolling out roughly 30 million tests a week, with a contact tracing initiative organized by the government along side private companies like Apple, Google, and Microsoft. Imagine being at home and getting a ping on your phone, telling you that you were in close contact with someone who tested positive for COVID-19, and that you needed to isolate until you were able to get tested (the LawFare podcast had a great discussion on contact tracing and all of its privacy concerns, which can be found here).
This effort will take a wide level of coordination at both the federal, state, and local level, and will require leadership from the Executive branch of government, with the President himself giving daily guidance on how the program will operate. He will need to be calming and reassuring to Americans who are worried about their personal privacy and private corporations having too much access to their personal information. He will have to work quickly and nimbly with the private sector, all while maintaining high levels of competence from the Federal government.
If you can picture this scenario actually happening under President Trump, you should take up screenwriting. Virtually every expert has said that America does not yet have the infrastructure in place to mount such a large scale of testing (or tracing, which will require each state to hire thousands of additional workers) and that we are a long ways off from getting to where we need to be. Andy Slavitt, President Barack Obama’s Administrator for the Centers for Medicare and Medicaid services, highlights the need for testing in a recent piece:
If this were the flu, you get symptoms and you stay home. Even if it were deadly, it would be easier to manage. Since it’s not, if we want to open the economy, testing is the only way to get there. Deaths and confirmed case stats are all over the map, which we know is also a function of poor testing. If having enough testing to contain new outbreaks is one metric that opening up the country is contingent on — and the WH said it is — we’re not ready to open the country.
The reason why it’s impossible to picture such a scenario under Trump is directly related to all of his failures leading up to (and after) the virus’s arrival in the United States. The two essential reads on all of Trump’s failures are this piece from the New York Times and this piece from the Washington Post. The Times noted:
There had already been an alarming spike in new cases around the world and the virus was spreading across the Middle East. It was becoming apparent that the administration had botched the rollout of testing to track the virus at home, and a smaller-scale surveillance program intended to piggyback on a federal flu tracking system had also been stillborn.
In Washington, the president was not worried, predicting that by April, “when it gets a little warmer, it miraculously goes away.” His White House had yet to ask Congress for additional funding to prepare for the potential cost of wide-scale infection across the country, and health care providers were growing increasingly nervous about the availability of masks, ventilators and other equipment.
The Washington Post found similar incompetence:
[Secretary of Health and Human services, Alex Azar, drafted a] supplemental request for more than $4 billion, a sum that OMB officials and others at the White House greeted as an outrage. Azar arrived at the White House that day for a tense meeting in the Situation Room that erupted in a shouting match, according to three people familiar with the incident. […]
White House officials relented to a degree weeks later as the feared coronavirus surge in the United States began to materialize. The OMB team whittled Azar’s demands down to $2.5 billion, money that would be available only in the current fiscal year. Congress ignored that figure, approving an $8 billion supplemental bill that Trump signed into law March 6.
But again, delays proved costly. The disputes meant that the United States missed a narrow window to stockpile ventilators, masks and other protective gear before the administration was bidding against many other desperate nations, and state officials fed up with federal failures began scouring for supplies themselves.
In order for the United States to undertake the testing regimen that is necessary requires an assumption that an Administration that has failed in virtually every way possible will turn on a dime and become as efficient as Chick-fil-A’s drive-thru service. We can all hope that this will be the case, especially given the fact that there are people on the Coronavirus Task Force who are competent and informative, such as Anthony Fauci and Deborah Birx, but every piece of evidence we have so far suggests that the President is incapable of meeting this challenge. Dr. Fauci himself has said that the US is not yet where it needs to be on testing and is not “overly confident” in our ability to meet our needs. At one of his daily press conferences, Trump publicly disagreed with Fauci’s comment, further demonstrating his denial of reality.
It is much more likely that the capacity for testing will have to be driven almost entirely by the States, with funds coming from the federal government. What would that look like? Probably not dissimilar from the steps that were taken by Larry Hogan — the governor of Maryland — which allowed him to secure about 500,000 tests through his wife’s personal contacts in South Korea.
Hogan sarcastically thanked Trump for sending Maryland a boilerplate list of federal labs where testing could be done, but was forced to go around the Federal Government in order to secure the tests he needed. Iowa’s governor — Kim Reynolds — was able to acquire around 500,000 tests (tipped off by Ashton Kutcher, because it’s 2020 and nothing matters) through a contract totaling around 26 million dollars with a medical company based in Utah.
This is probably going to be the method going forward: The federal government providing funds to the states and then the states working on their own — Hunger Games-style, as Kutcher put it — to get the required testing done. States are now starting to make substantial progress on forming regional coalitions to make bids for tests. They will still need funding from the federal government to make these bids, but the ideal scenario is that the states are given money and are then allowed to work together to acquire the tests they need.
There has been a consistent pattern with Trump that his supporters, his opponents, and the media should have all learned by now: He does not change. He is not going to magically become a competent leader in the midst of a pandemic. He has spent over 13 hours speaking at his press conferences, spending much of the time praising himself, and roughly four minutes on condolences for victims of the virus. He will not transition into a Comforter-in-Chief who can assuage people’s fears about the economy or the major privacy invasion that will come along with testing and contact tracing. That will be up to the governor of each state. This might make the Federalists happy, but during a global crisis, the American people will look to their president for leadership. And instead of providing it, Trump seems more content to wax poetic about ingesting disinfectant. We are on our own.