Health News
, The federal government’s coronavirus actions and failures, Wholesale: Personal Protective Equipment Store

The federal government’s coronavirus actions and failures

By now, it is obvious to everyone seeking to understand the United States’ response to the novel coronavirus (officially SARS-CoV-2) that there were massive failures of judgment and inaction in January, February, and even March of this year. While mistakes are inevitable in the face of such a massive and rapidly evolving domestic and global challenge, our federal government’s response compares unfavorably to a number of other countries, many of whom faced the virus before we did.

Although we will undoubtedly soon find ways to overcome our missteps, it will take years to fully reckon with the failures that contributed to our poor response. No doubt, sometime in 2020 or 2021, Congress will create a well-funded government commission to undertake an investigation similar to the 9-11 Commission or the Financial Crisis Inquiry Commission. Such an investigation will need to grapple with insufficient preparation and capacity, poor leadership and coordination, slowness, and regulatory failures, among many other factors. In doing so, it ought to focus especially on those systemic failures that can be corrected so that they are much less likely to recur in the certain event of future pandemics, whether naturally occurring or deliberately caused.

A number of long-form journalistic pieces offer narrative accounts of what went wrong (including excellent pieces in the New York Times, Reuters, the Wall Street Journal, and The Atlantic). Here, we attempt to present an initial record of the federal government’s important official actions and communications over the past months, with a particular emphasis on the rules, regulation, and guidance related to the public health challenge. We do not claim comprehensiveness—rather, we seek to document new and notable developments and actions during the critical early period of the worldwide spread of the virus. Nor do we attempt to track the extensive actions meant to cope with the economic fallout of the virus. Following the timeline, we briefly outline four phases of crisis response and highlight some of the most important apparent failures.

timeline of federal government actions and communications





January 14, 2020

WHO

First case reported in Thailand.





January 16, 2020

WHO

First case reported in Japan.






January 17, 2020

CDC

CDC implements entry screening at three U.S. airports for passengers traveling from Wuhan.”






January 21, 2020

CDC

First travel-related case in U.S. confirmed in Washington state.





January 21, 2020

CDC

CDC notifies press that screening has increased to five airports.





January 24, 2020

CDC

Second travel-related case in U.S. confirmed in Illinois.





January 27, 2020

FDA

FDA issues first press release related to virus, highlighting its willingness to speed development of “medical countermeasures,” including tests.





January 28, 2020

HHS

Secretary Azar delivers public remarks on coronavirus preparedness, assuring the public that the president is receiving multiple briefings each day and asserting that the readiness of the Strategic National Stockpile is being assessed.





January 29, 2020

White House

President Trump announces formation of White House Coronavirus Task Force that began meeting January 27, led by HHS Secretary Azar and coordinated through National Security Council; statement also asserts that National Biodefense Strategy, signed in 2018, will accelerate response.





January 30, 2020

WHO

WHO declares global health emergency.





January 31, 2020

White House

President Trump issues Proclamation 9984, suspending entry for foreign nationals who had traveled in mainland China in the past two weeks.





January 31, 2020

HHS

Secretary Azar declares Public Health Emergency pursuant to section 564 of the Federal Food, Drug, and Cosmetic Act, triggering requirement that all tests be granted Emergency Use Authorizations (EUAs) by the FDA.





February 3, 2020

CDC

U.S. confirmed cases pass 10.





February 4, 2020

FDA

FDA grants Emergency Use Approvals (EUAs) to CDC-qualified laboratories to test for coronavirus using the test kits developed by the CDC, limited to patients who meet CDC criteria for testing; test validation work begins thereafter.





February 4, 2020

HHS

HHS issues declaration “pursuant to section 319F-3 of the Public Health Service Act to provide liability immunity for activities related to medical countermeasures against COVID-19.”





February 7, 2020

CDC

CDC issues interim final rule to amend its Foreign Quarantine regulations, requiring airlines to collect data on their passengers and crew arriving from foreign countries.





February 10, 2020

White House

In remarks to nation’s governors, President Trump briefly answers a question on the virus by saying, “We’re in great shape though. We have 12 cases — 11 cases, and many of them are in good shape now.”






February 12, 2020

CDC

CDC reveals that its testing kits were flawed, leading many authorized labs to have difficulty validating them because of problems with one of the reagents.






February 22, 2020

CDC

CDC officials tell states that only symptomatic patients with travel histories in mainland China were to be tested.





February 24, 2020

White House

Trump administration sends letter to Congress requesting $2.5 billion in supplemental funding to support vaccine development, other virus responses.





February 25, 2020

White House

At a press conference in India, President Trump briefly remarks that the virus “is very well under control in our country.”





February 25, 2020

CDC

CDC announces that the pandemic is likely to spread to the United States and will make various mitigation measures necessary.





February 26, 2020

White House

President Trump announces that Vice President Pence will now lead the White House Coronavirus Task Force.





February 26, 2020

CDC

CDC emails state and local officials to tell them its “testing capacity is more than adequate to meet current testing demands.”





February 26, 2020

CDC

CDC announces what it believes may be an instance of community spread in California: “the first time this has happened in the United States.” Reporting indicates that the patient sought a test on February 19 but was initially rebuffed because of not matching existing testing criteria.





February 27, 2020

White House

At press conference, President Trump suggests that while Americans hoping to travel abroad may have their plans disrupted, the spread of coronavirus in the U.S. is likely to be cut off, claiming, “when you have 15 people, and the 15 within a couple of days is going to be down close to zero, that’s a pretty good job we’ve done.”





February 27, 2020

White House

Vice President Pence announces that Ambassador Deborah Birx would act as White House Coronavirus Response Coordinator.





February 27, 2020

White House

Additions to the White House Coronavirus Task Force: Steven Mnuchin, Secretary of the Treasury; Dr. Jerome Adams, Surgeon General of the United States; and Larry Kudlow, Director of the National Economic Council.





February 28, 2020

CDC

CDC widens testing criteria to those with foreign travel in Italy, Iran, Japan, and South Korea, as well as those with respiratory failure severe enough to cause hospitalization regardless of travel.





February 29, 2020

White House

President Trump issues Proclamation 9992, suspending entry for foreign nationals who had traveled in Iran in the past two weeks.





February 29, 2020

FDA

FDA announces that public and private labs could use non-approved tests and seek retroactive approval.





March 1, 2020

NYT

First confirmed case of coronavirus in New York state.





March 1, 2020

White House

Additions to White House Coronavirus Task Force: Dr. Ben Carson, Secretary of Housing and Urban Development; Dr. Stephen Hahn, Commissioner of Food and Drugs; and Kelvin Droegemeier, Director of The White House Office of Science and Technology Policy.





March 1, 2020

White House

In remarks at CPAC, Trump says: “As you know, we took in approximately 40 people; they were Americans. And they may have had it. Some had it, but they will put in quarantine, and it’s working out. Many of them are in good shape right now, and they’re better and going home.”





March 2, 2020

White House

Coronavirus Task Force initiates regular discussions about crisis response involving “more than 50 of our nation’s governors.”





March 2, 2020

White House

Additions to the White House Coronavirus Task Force: Robert Wilkie, Secretary of Veterans Affairs; and Seema Verma, Administrator of the Centers for Medicare and Medicaid Services.





March 2, 2020

White House

In Coronavirus Task Force briefing, President Trump announces cooperation with leading pharmaceutical and biotechnology companies to develop a vaccine and treatment.





March 2, 2020

FDA

FDA Commissioner Stephen Hahn says that “by the end of this week, close to a million tests will be able to be performed.”






March 5, 2020

CDC

Confirmed cases in U.S. pass 100.





March 6, 2020

White House

President Trump signs into law the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020, which includes a title to help facilitate emergency telehealth services and provides $8.3 billion in emergency funding to support development of vaccines and treatment, grants for state and local governments, preparedness activities for U.S. government facilities, and humanitarian foreign assistance.





March 6, 2020

White House

After a press conference, President Trump asserts that “[a]nyone who wants a test can get a test.”





March 11, 2020

CDC

Confirmed cases in the U.S. pass 1,000.





March 11, 2020

White House

President Trump addresses the nation in a televised address, saying that “we are marshalling the full power of the federal government and the private sector to protect the American people” and announcing a number of new actions, including a ban on European entries and an agreement with American insurers that copays for coronavirus testing and treatment will be waived.





March 11, 2020

White House

President Trump issues Proclamation 9993, suspending entry for foreign nationals who had traveled in the Schengen Area (continental Europe) in the past two weeks.





March 11, 2020

White House

White House issues memorandum indicating that HHS Secretary will use authority pursuant to section 319F-3 of the Public Health Service Act and Section 564 of the Food, Drug, and Cosmetic Act to facilitate emergency use of respirators; Secretary of Labor will also consider steps to increase the availability of respirators.





March 13, 2020

White House

President Trump declares a national emergency, and also announces close cooperation with private sector leaders to enable mass private testing.






March 13, 2020

HHS

Secretary Azar issues Memorandum announcing that he will seek to accommodate states seeking flexibility in authorizing more labs to develop and perform tests.





March 13, 2020

White House

Administration tasks Adm. Brett Giroir, head of the Public Health Service within HHS, with coordinating testing efforts across health agencies.





March 14, 2020

White House

President Trump issues Proclamation 9996, suspending entry for foreign nationals who had traveled in the UK or Ireland in the past two weeks.





March 14, 2020

CDC

CDC issues No Sail Order for all cruise ships.





March 15, 2020

HHS

Pursuant to the Project Bioshield Act of 2004, Secretary Azar waives parts of the HIPAA Privacy Rule in order to facilitate a more effective response to the virus





March 16, 2020

White House

Trump administration drafts “Executive Order to Save Lives” that would have made it easier to use experimental treatments that have passed Phase 1 safety testing, but is persuaded not to issue it by senior FDA scientists.





March 18, 2020

CDC

Confirmed cases in U.S. pass 10,000.





March 18, 2020

White House

Executive Order 13909: President Trump invokes the Defense Production Act of 1950, enabling the federal government to direct and allocate the production of protective equipment and medical supplies.





March 18, 2020

White House

President Trump signs into law the Families First Coronavirus Response Act of 2020, which provides paid sick leave, free testing, expanded food assistance and unemployment benefits, and which requires additional protections for healthcare workers.





March 20, 2020

HHS

HHS issues a rule that “provides a procedure for CDC to suspend the introduction of persons from designated countries or places, if required, in the interest of public health.”





March 20, 2020

U.S. Customs and Border Protection

USCBP temporarily limits travel of individuals from Canada into the United States to “essential travel.”





March 20, 2020

U.S. Customs and Border Protection

USCBP temporarily limits travel of individuals from Mexico into the United States to “essential travel.”





March 20, 2020

FDA

FDA issues guidance on “Temporary Compounding of Certain Alcohol-Based Hand Sanitizer Products During the Public Health Emergency,” which acknowledges conditions under which hand sanitizer will be produced that will not lead to enforcement actions.





March 27, 2020

White House

President Trump signs the CARES Act into law. The most significant provisions address the economic fallout of pandemic, but Title III includes numerous provisions relating to testing, medical supply chains, drug review, telehealth, and support for healthcare workers.





March 27, 2020

FDA

FDA issues guidance on its enforcement policy regarding facemasks and respirators during the crisis, in order to expand availability.






FIRST PHASE

From the first knowledge of the virus’s spread in Wuhan in early January through nearly the end of that month, the administration publicly treated the virus as a minor threat that was under control, at least domestically, and repeatedly assured the public that the risk to Americans was very low. However, by the middle of January, the virus had clearly spread beyond China, as cases were reported in Thailand, Japan, and South Korea, among other countries. On January 17, the CDC started screening at three U.S. airports those passengers who had been traveling in Wuhan, but by then the virus had already spread to countries other than China. By the end of the month, there were about 12,000 reported cases in China, growing rapidly by the day; at this point, the U.S. had a handful of confirmed cases, but there was almost certainly already significant community spread in the Seattle area.

Second Phase

Beginning with the creation of the White House Coronavirus Task Force on January 27 (publicly announced on January 29) and the declaration of a public health emergency on January 31, the federal government began to put in motion the executive, legal, and regulatory pandemic response procedures already on the books. It also banned foreign nationals who had traveled in mainland China from entering the country.

Most critical for this second phase, it was clear early on that any effective response was going to depend on rapidly scaling our testing capacity. The virus genome was publicly available in mid-January, and the first tests were developed shortly thereafter. The World Health Organization (WHO) sent hundreds of thousands of tests to dozens of laboratories around the world by early February. But the administration and CDC decided to rely exclusively on domestically developed tests, apparently in keeping with past practice. The CDC developed its own test in early February, which was then distributed to labs. But, as became clear roughly a week later, one of the reagents in its kits proved to be faulty, which meant that most labs were unable to proceed using CDC-provided test kits.

Nevertheless, for at least two weeks after the problem became clear, alternative paths to testing were either neglected or stymied by existing regulations. Indeed, although the Emergency Use Authorizations required by the declaration of a public health emergency were meant to facilitate rapid testing, it soon became clear that their required procedures were actually significantly retarding the development of effective testing at scale. CDC was reassuring state and local officials that testing capacity was adequate in late February, although it was reported that fewer than 500 tests had been conducted at that point. (CDC’s own count, which includes its own tests plus those of U.S. public health labs, puts the total number of tests at the end of February at around 4,000.) Perversely, the failure to test at scale kept the publicly recognized number of cases low, which served as a justification for insisting that the existing testing regime was adequate.

This phase lasted through nearly all of February—a lost month during a critical period. As China and other countries took extreme measures to contain the spread of disease, the federal government and most state and local governments took few actions to disrupt normal economic and social life—indeed, some governments infamously discouraged their citizens from altering their behavior. By the end of the month, the United States had two dozen confirmed cases (artificially low because of the low levels of testing), China reportedly had about 80,000 cases, and Italy was already in the early stages of uncontrolled viral spread with nearly 2,000 reported cases.

Third phase

A third phase began in late February, when the CDC and FDA demonstrated a clear shift in their sense of urgency. Beginning with the CDC widening testing criteria on February 28 and the Food and Drug Administration allowing use of non-approved tests (with retroactive approval) on February 29, the federal government signaled that it had begun to recognize and correct for the flaws in its testing regime. Travel bans were extended to foreign nationals who had traveled in Iran. Federal officials worked more concertedly to promote private sector involvement in the crisis response, and Congress passed an $8.6 billion supplemental appropriation bill to promote vaccine and treatment research, emergency telehealth, and preparedness. Although testing was finally expanding during this phase, availability was still severely limited, in spite of administration insistence of adequacy.

Fourth Phase

The fourth phase, dating from President Trump’s nationally televised address on March 11 and his March 13 declaration of a national emergency, finally saw the federal government fully engage in its efforts to hasten mass testing, improve the availability of medical supplies, and encourage all Americans to radically alter their behavior in order to arrest the spread of the virus. Further travel restrictions were placed on foreign nationals who had traveled in continental Europe, and then in the United Kingdom and Ireland. Various emergency powers, including the Defense Production Act, were activated and then later employed. Commercial tests were approved quickly and mass testing finally became a reality—which, in turn, helped reveal the considerably advanced spread in the U.S. Over the month of March, confirmed cases in the United States increased at a rapid clip, passing 100 (3/5), then 1,000 (3/11), then 10,000 (3/18), and by the end of the month 100,000 (3/27), reflecting in part that our testing capacity had begun to catch up with reality on the ground.

, The federal government’s coronavirus actions and failures, Wholesale: Personal Protective Equipment Store


The authors did not receive financial support from any firm or person for this article or from any firm or person with a financial or political interest in this article. They are currently not an officer, director, or board member of any organization with an interest in this article.

All copyrights for this article are reserved to Corona Virus

Leave a comment

Your email address will not be published. Required fields are marked *

Tap to call MyPPE
error: Alert: Content is protected !!