Coronavirus

Is the CDC to Blame for the Lack of Adequate Coronavirus Testing?

Reports from USA Today and ProPublica highlight CDC missteps that set back the United States' Covid-19 response.

|The Volokh Conspiracy |

It is generally accepted that widespread testing will be key to successful control of Covid-19. Identifying where the virus has (and has not) spread, who is infected, and who may be immune are all important. The tracing and isolation of infected and potentially infected individuals is essential if quarantine and containment efforts are to be targeted. Yet as ProPublica reports:

The lack of testing continues to be a source of deep frustration across the country, with worried patients unable to find out whether they have the ordinary flu, the coronavirus or something else entirely. The availability of testing in regions that aren't hot spots still faces an array of bottlenecks, from shortages of cotton swabs to the capacity of the labs processing the tests.

Why isn't there more testing? And why haven't we been able to ensure testing occurs where necessary? Among other things, the Centers for Disease Control & Prevention (CDC) focused on the development of its own test and discouraged the development of alternatives by others. This turned out to be a particularly bad misstep because the CDC's test was not particularly accurate.

A new investigative report from USA Today paints an even more damning picture of a CDC that simultaneously sought to monopolize testing while deceiving state officials about its capacity, As a consequence, parallel efforts to develop and produce tests in private labs were set back, placing the United States well behind the curve of where we needed to be.

From its biggest cities to its smallest towns, America's chance to contain the coronavirus crisis came and went in the seven weeks since U.S. health officials botched the testing rollout and then misled scientists in state laboratories about this critical early failure. Federal regulators failed to recognize the spiraling disaster and were slow to relax the rules that prevented labs and major hospitals from advancing a backup.

Scientists around the country found themselves shackled as the disease spread.

"We were watching a tsunami and standing there frozen," said Dr. Debra Wadford, director of the public viral disease laboratory in California, where some of the country's earliest patients were identified.

The nation's public health pillars — the Centers for Disease Control and Prevention and the Food and Drug Administration — shirked their responsibility to protect Americans in an emergency like this new coronavirus, USA TODAY found in interviews with dozens of scientists, public health experts and community leaders, as well as email communications between laboratories and hospitals across the country.

The result was a cascading series of failures now costing lives.

As they say, read the whole thing.

The reality is that if it were not for some of the actions taken by the CDC, and the Food and Drug Administration, the United States would have had a greater number of more reliable coronavirus tests available for use far more quickly. We might have even been ahead of the curve.

Another report from ProPublica further supplements the picture of a CDC that fumbled some of its key responsibilities, revealing some of the problems of trying to quarterback the nation's entire response from within a few expert offices.

These stories highlight that scientific and technical expertise does not necessarily translate into administrative expertise. Centralized bureaucratic structures face inherent limitations that make them brittle and magnify the costs of failure. No amount of medical expertise can overcome the Hayekian knowledge problem, and the more centralized the government response, the greater the downside risk if someone makes a mistake, such as by underestimating a threat or distributing a botched test.

Institutions such as the CDC and FDA are important, but they also have their limitations. One of the lessons from the Covid-19 outbreak thus far is that giving them to much power and responsibility can have serious negative consequences.

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  1. If it turns out, as I believe, that this quarantine is mostly for nothing because Corona is less dangerous than the annual flu, then the government will and should lose a lot of credibility on this issue and will have a much harder time getting people to comply with the next quarantine order, whenever that may come. They’ve cried wolf.

    1. The interesting question will be the voter backlash — I could see a combination of “throw the bums out” and a Populist wave coming.

      The other thing that is going to happen is a Fourth Great Awakening — the third occurred after WW-II — and we’re not just going to return to our Judeo/Christian roots but religion will have a much greater political role than it does now. (Never forget that the Civil Rights movement came out of the churches, and was lead by Ministers such as the Rev. Martin Luther King, Jr.)

    2. I agree with this. Nobody wants to say it right now but we may find out such a comprehensive lockdown is one of the less effective measures we could have taken. Especially if it turns out everybody and their mother has this virus and just doesn’t know it yet.

    3. “Corona is less dangerous than the annual flu”

      Do right-wing blogs generate overconfident, uninformed dullards, or merely attract them?

      1. Well, it did attract you so… I guess that’s evidence for the latter.

    4. jdgalt1…I’d like to answer you. Becuase you have made a statement that is just wrong.

      The Wuhan coronavirus is less dangerous than the annual flu
      This statement is false. The Wuhan coronoavirus has a higher mortality rate, and transmissability than the flu.

      The fact is, we are now just developing a large enough dataset to make informed, data driven decisions on mitigation and containment. As I write, we have conducted more than 700K tests in record time. Nobody can even approach the speed and rapidity that we deployed testing.

      In the absence of really solid data, what exactly do you propose? Yeah, that is what I thought: Nothing helpful.

      Maybe you should turn on some synapses and consider the following: It is not just about the mortality rate, numbnuts. You might want to think of the percentage of patients who require hospitalization, extensive care (weeks on a ventilator) who then go on to recover partly. Have you considered the cost of that? Nah, did not think so.

      Get your head out of your derriere and use your brain. This Wuhan coronavirus is a new pathogen for which we have no known efficacious treatment, and very high transmissability. Implementing a temporary period of self-isolation is a smart move until we get data to make good decisions.

      1. Take a course in quantitative research methods and you will understand the issue — without testing everyone (or a statistically valid sample of everyone), we have NO IDEA of how lethal this virus is.

        Absolutely no idea.

        And we don’t even know how many actually died from it — and how many people (who had it) actually died from something else. Like the flu — as the actual cause of death is liquid in the lungs.

        And as something like 3/4 of the initial tests came back negative — when they were ONLY testing people whom a qualified MD thought had it, it shows how much other stuff there is out there. It’s like if a victim is both shot & stabbed — a bullet in the arm and a severed aorta means that the stabbing (not the shooting) killed him.

        So all we have is the ratio between those tested and those who died — that’s all we know.

        Hence the Flu becomes relevant — 3% of those who are tested for the flu (and found to have it) die from it. However the death rate from the flu is 0.1%. Note the difference here — most of the people who have the flu are never tested, while the sickest people inevitably are.

        If the same thing holds true here, and it is a reasonable assumption, that means a 2% death rate of those tested will mean an actual death rate of less than 0.1%.

        1. “Absolutely no idea.”

          In your view, are the scenes from hospitals in Italy, and now NY, typical for a run of the mill flu season?

          (it’s a fair, but minor, point that we don’t know if it’s more dangerous than a typical flu year because the virus is more deadly once infected, or just that it’s more transmissible. But some combination of those has resulted in gurneys crowding the hallways. Those aren’t all hypochondriacs reacting to a media oversell)

  2. Yeah, maybe. But we don’t know yet how important it is that Trump appointed a CDC director without any experience managing a public health agency. (https://www.theatlantic.com/science/archive/2018/03/trumps-pick-for-cdc-director-is-experienced-but-controversial/556202/)

    1. Do you honestly think that any CDC director could have turned around the CDC? Betsy DeVos has been ED Secretary for at least three years now, and have the excesses of Higher Education (often discussed here) been abated?

      What’s not mentioned about Andrew Jackson’s “Spoils System” is that in cleaning out the entrenched bureaucracy and replacing it with his people, he created a Federal bureaucracy that would actually implement his policies. Likewise when FDR and LBJ massively increased the number of governmental employees, the entrenched bureaucracy was silenced by becoming greatly outnumbered.

      As both Reagan & Trump have a philosophical objection to further expanding the size of the government, and Civil Service laws prevent the removal of those who have “retired in place”, there really isn’t that much that can be done.

    2. I think the CDC would be just as incompetent as its always been no matter what president they were under, who was in ‘charge’, and how much money they’ve been given. The only difference is since Trump is in change he’s getting blamed for it while the bulk of the criticism would be aimed at the CDC itself if a Dem was president now.

      1. Amen to that.

      2. It’s only been 3 years since Obama. But what the heck; go ahead and blame this whole debacle on him. There’s a decent chance that 42% of the country is idiotic enough to believe it. Can’t hurt to try (non-idiots are going overwhelmingly for the Dem. candidate in November, regardless of what Trump does, anyway.) Hopefully, it will move quickly from the presidential lecture to Hannity, and then quickly on to Rush. We need full saturation, in order to maximize its impact.

        1. lectern, not lecture.
          [sigh]

      3. Amos….Your premise is wrong = …the CDC would be just as incompetent as its always been …

        Look, is there really a way to prepare for what we have happening? The answer is No. I don’t ‘blame’ any POTUS. I mean, if we are going to do the blame game, why not blame every POTUS since 1918 for failing to prepare for a repeat. It is stupid and unproductive.

        Nor do I think the CDC is incompetent. Quite the opposite. The CDC knew very early the Wuhan coronavirus was a problem. It is why they specifically asked to join the WHO delegation to China in early January. China specifically prohibited them. That does not make the CDC incompetent; that action makes China culpable. There will be a reassessment of our relationship with China when this is over. I don’t think they will like the results very much.

        Next, considering the CDC system was a surveillance type testing system, the fact that the CDC has been able to switch over to a mass testing system in less than a month is nothing short of miraculous. Just think about the logistics involved in doing that. No other country in the world can come close to pulling that off. None. Just name one. I’ll wait.

        There is plenty to bash the federal government, the CDC, and POTUS Trump about – the response to the Wuhan coronavirus ain’t one.

        1. I’m wondering if the reason China prohibited them was that the ChiComs knew that the CDC (and/or FBI) are pretty good at getting genetic fingerprints of things and using that to trace them to their source. Case in point, while the FBI accused the wrong man (and had to write a formal letter of apology to him), they did trace back the Anthrax in 2001 — and that was 19 years ago.

          So if this did come out of the Wuhan Institute of Virology, or if the ChiComs think it might have, the last thing is they would want is someone able to determine that.

          1. Jesus, stop with this dime store novel speculative claptrap.

          2. Nobody knows, Dr. Ed. There is plenty of time afterward to sort all of that out. It is a certainty our relationship with China will be reassessed. China’s lying and obfuscation about the Wuhan coronavirus has lead to the deaths of Americans. That will not go unaddressed.

    3. Did you read the article? He was “controversial” for other reasons, not his qualifications.

      “A leading virologist, Redfield has spent more than 30 years researching HIV and other infectious diseases. He served in the U.S. Army Medical Corps for 20 years and later cofounded the Institute of Human Virology at the University of Maryland School of Medicine, where he now acts as associate director. He has overseen a clinical program that treats more than 5,000 patients in the Baltimore-Washington area, and has experience treating people in sub-Saharan Africa.”

      1. AIDs is a political disease — it’s received far more funding and attention than would be appropriate if resources were apportioned on the basis of its *virulence*. You can’t get AIDS from a toilet seat — unlike AIDS, the Wuhan virus can live on that plastic toilet seat for 72 hours….

        In an ideal world, you’d want your CDC director to be an influenza expert because that is the greatest epidemiological risk, but it’s politically incorrect to say that we’ve known how to prevent the spread of AIDS since at least 1986…

  3. It pinpoints once again the difference between government and individuals: government never goes out of business. People are just as incompetent in business as in government; neither government nor business paychecks turn ordinary people into magic competent wise wizards with all the world’s knowledge at their fingerprints. But (a) multiple businesses can simultaneously work on the same goal independently, (b) businesses which screw up go out of business, freeing up their workers and other resources for better, more competent use. Government failures are covered up or doubled down on, but seldom recognized for what they are, and when they are embarrassing, they are used an excuse for blocking private enterprise trying their hand at it.

  4. They were too busy trying to eliminate vaping. And private gun ownership.

    1. You’re definitely right on CDC resources being wasted on attempts to eliminate private gun ownership — last December (while the Wuhan Flu was starting to spread), Congress appropriated $25M for them to study gun violence. Not to control diseases such as the Wuhan Flu…

      All appropriations start in the House of Representatives so the blame for this goes right back to Nancy Pelosi and her Progressive majority. Not to mention the mid-level (civil-service protected) bureaucrats at places like the CDC.

      1. AIDS is and was scary of hell for lots of reasons beyond the political.

        All appropriations start in the House of Representatives so the blame for this goes right back to Nancy Pelosi and her Progressive majority

        This is some major-league buck passing. FFS.

        1. “This is some major-league buck passing”

          In 2003 or so the US created a national stockpile of a little over 100 million N95 masks. That was smart; pandemics of aerosol transmitted diseases are foreseeable in the same sense that earthquakes in California are foreseeable.

          Most of that stockpile (100M) masks from that stockpile were distributed in IIRC the flu epidemic of 2009, never replenished.

          The R’s blame Obama. The D’s blame Trump. But in the interval between 2009 and 2020 both parties have had control of the White House and congress. And nothing was stopping states or even towns from establishing their own stockpiles.

          When I see people pointing fingers of blame, I guess my question is what you did to solve the problem. If you weren’t advocating for pandemic prepping before 2020, you can’t really blame other people for also ignoring the obvious possibility.

  5. “These stories highlight that scientific and technical expertise does not necessarily translate into administrative expertise.” IMO, that’s the crux of the issue Mr. Adler.

    I’ve read elsewhere that CDC’s sterling reputation comes from development of vaccines. That is where doctors, scientists, and engineers can best contribute. I think that CDC being scientifically dominated rather than bureaucratically dominated is its main weakness.

    It is common in recent times to criticize governments for not “following the science”. But in this case, science was not the critical asset. CDC needed clerks to track and organize the messages coming in from outside. CDC needed project managers to envision rapid scale-up of testing.

    What do clerks and project managers do when there’s no pandemic needing their skills? They make trouble.

    In my own field (power), I see public service commissions that regulate utilities staffed with a ratio of 400 lawyers per 1 engineer. Because of that, they are extremely weak in responding to certain needs. IMO, that’s analogous to CDC’s problem.

    1. Re: power industry … I have heard that one of the reasons PG&E in California has such shoddy and old equipment is because the installation of roof solar panels far exceeded expectations … and budgets; because the PUC and/or legislature require PG&E to pay top dollar for excess power fed back in from solar panels, PG&E did not budget enough to pay for it all, and the PUC, reluctant to raise rates to cover the shortfall, told PG&E to cut elsewhere instead.

      It sure sounds plausible to me. I have heard that the PUC is where termed-out legislators go to finish their careers, and it sure can’t be the most exciting way to satisfy political egos.

      Any idea if it is true or not?

      1. Re Solar Power: One thing a lot of people forget to ask is what happens when the sun stops shining (e.g. a thunderstorm comes through). You have to have additional sources of power in reserve to pick up the load, or you have to shed the load — i.e. rotating blackouts.

        You can’t stockpile electricity in relevant quantities so the utility has to either have its own generating capacity waiting in reserve or be able to purchase it from someone else who has a surplus — and do this almost instantly. So solar (and wind) doesn’t always reduce CO2 as much as people think.

        1. One thing a lot of people forget to ask is what happens when the sun stops shining (e.g. a thunderstorm comes through).

          Oh wow. I bet hardly anybody ever thought of that before.

          1. Every engineer thinks of that instantly when asked about solar power – but it’s obvious that the politicians pushing for solar power never did, and ignored those that tried to tell them about it.

    2. ” I see public service commissions that regulate utilities staffed with a ratio of 400 lawyers per 1 engineer.”

      And zero people who have actually gone out in the snow to help replace a pole that’s come down….

      I once had to explain to a bureaucrat that steam pipes operate at a temperature between 300 and 600 degrees (F) and that they need time to cool down before guys can work on them. She’d never even thought about that….

  6. FDA and CDC both failed in a predictable (and predicted) test of their core responsibility to protect public health in a disease outbreak. Trump couldn’t do better to demonstrate leadership in this matter than by demanding the resignation of the directors of these two agencies, and in the case of CDC especially, directing it to terminate any of its activities other than the control of and response to infectious diseases. No more diluting its focus and resources on matters like gun control and workplace safety. Where is the accountability for this immense failure?

    1. Yes, but you fire the coach on Monday morning, not in the middle of the game,

      Not for nothing has Pence been put in charge of this — Pence who fired NSA Michael Flynn. And it’s not the Directors who need to be fired, or just the directors — its the Deputy Directors and Division Leaders that are responsible here. They need to go, and most of them are going to be protected by Civil Service.

      And as to Trump, whom I’m sure that a certain faction would love to do, wouldn’t he have been able to do more last winter had he not been distracted by the Impeachment charade? The problems in Wuhan started last fall, while Nancy Pelosi was doing her thing — which she then delayed for six weeks — and it wasn’t until Februrary 5th that Trump’s people were able to start dealing with other things.

      And then while far more Constitutional than what several Governors are doing, Trump’s initial travel ban which DID help was attacked in a way I don’t see the media attacking the excesses of Democratic Governors.

      1. The coach who should be fired here is Trump.

        I do not expect disaffected anti-government cranks — especially those who love Trump’s bigoted, vainglorious, vulgar, mean-spirited, partisan ways — to recognize this.

        I am confident Prof. Alder understands this.

        1. The coach who should be fired here is Trump.

          What, exactly, would you have personally done differently had *you* been President?

          And then would you have been able to do it? (I doubt it.)

          Remember you can’t fire people, you can only spend the money that Nancy Pelosi is willing to give you, and tenured bureaucrats are almost as independent as tenured professors — they are going to do whatever they want to, regardless of what you tell them.

          At least as of now, you are still free to vote for whomever you wish this fall, and I encourage you to do so, but what powers would you have liked to see Trump assume — and remember that we also don’t want an all-powerful dictator…

          1. A reasonable list for starters:

            1) Refrain from circulating falsehoods, misleading statements, self-serving exaggerations, and the like, especially those that cultivate public resistance to informed, professional opinion. Instead, use the public trust and power of office to promote sound judgment and prudent conduct among citizens. Perhaps even withhold childish whining, silly boasts, and partisan polemics for at least a brief period.

            2) Marshal federal resources earlier, resisting any urge to delay and diminish federal action as part of a ‘don’t worry, be happy’ campaign. In particular, promote prompt production of important equipment, medications, and tests.

            3) Develop a federal response that does not rely on individualized, scattershot efforts by hospital administrators, mayors, governors, senators, non-profit leaders, and the like to scrounge and compete for scarce, scattered tangible goods.

            4) Avoid any impression that other elected officials or citizens are to be rewarded (Florida) or punished (New York) based on the degree to which they or their representatives flatter a president or based on political affiliation.

            5) Avoid suppressing science and scientists; for example, refrain from dismantling pandemic office, alienating scientists in public offices, installing unqualified persons (such as industry mouthpieces) to oversee and control scientists, etc.

            Much of this is simple leadership, selflessness, and decency, although some of it involves respect for science, expertise, credentials, and the like.

            1. How would any of that prevented the CDC’s screwup on testing?

              It well might have created a panic that would have killed people (car crashes, etc) but which item would have addressed the mid-level incompetence at the CDC?

              And your charge of political favoritism is both serious and unfounded — I have no doubt that the anti-Trump media would be broadcasting any of this on an hourly basis were it true.

              1. The CDC is a federal government agency, part of the executive branch.

                Where, in your judgment, does that buck stop during the Trump administration?

                (Spoiler: Obama, RINOs, the Clintons, the “elites,” people with advanced degrees, residents of successful cities, Obama again, mainstream journalists, socialists, transgendered Americans, Clintons again, blacks, CNN, Muslims, Planned Parenthood, agnostics, Justice Ginsburg, scientists, homosexuals, Obama, mainstream academics, atheists, the people who confected that birth certificate, leftists, arugula consumers, and Obama.)

                1. Well, let’s start with Obama not replenishing the stockpile in 2009 after using much of it for Swine Flu. Trump was a TV personality at the time…

                  Obama is responsible for this.

                  1. If there isn’t a drinking game on this website (chug when you hear someone blame Obama for something that happened 3 years after he left office), there sure should be.

                    1. No small number of Obama’s appointees are still serving in the Trump Administration because the Democrats have held up the nomination process. I suspect that you’d find that some of the mid-level CDC appointees are still Obama holdovers.

                      So yes, we blame Obama….

                  2. How is Obama responsible for the decision to choose Redfield, or for Redfield’s conduct in office?

                    How is Obama responsible for failure to replenish the stockpile since he left office?

                    Keep trying to defend Trump on this, clingers. See you in November. Then in January.

            2. Lists of airy platitudes, mostly expressed in the negative, are cheap. What would you have done? For bonus points, how would you have done it? Please be specific. I’ll wait.

              1. I would not have engaged in self-serving, ignorant, dangerous lies, you half-educated bigot.

                Enjoy awaiting your replacement. By your betters.

      2. It’s amazing that you people can come up with excuses such as “Trump could’ve done more about the virus he claimed was nothing to worry about for months, if only he hadn’t been busy refusing to engage in his Impeachment trial in any way, shape or form.”

        Someone who is capable of only focusing on one issue at a time, particularly an issue which they refuse to participate in, has no business being President.

        Your conjecture is bullshit.

        1. So you’re saying he should have been able to handle two tasks at once.

          How many things do you think a President is in charge of, just those two?

          1. A normal president, or this very stable genius?

          2. Effect of the Impeachment on the President and his ability to focus on other issues:
            Trump: “I’m too cowardly to answer questions. And I know that John Bolton’s testimony, Pence’s testimony, Rudy’s testimony, etc, will bring me down. My orders are: Block as much testimony as possible. Hide the truth from Congress and from the American people.”

            There. Done. That was about a 45-second drain on Trump’s time and attention. The hours he spent watching an outcome-never-in-doubt impeachment and subsequent “trial” was his choice on how to waste his time. But both liberals and conservatives do wonder: “What if Trump had taken the 45 hours of wasted Tweeting and had spent 3 of those hours back in Dec and Jan talking with pandemic experts? What would he have done differently?”

            (Impossible to know, of course…we’d need an alternate universe where Trump is still Trump, but that version of Trump happened to believe in science and in the value of [even unpleasant] data.)

  7. We will all die if the people in government takeover all our healthcare and ban our healthcare freedom.

    1. ban our healthcare freedom

      Helluva thing to talk about at this particular juncture.

    2. I think we will all die if govt takes over and infringes any of our freedoms.

      1. I think we will all die sooner or later no matter what the government does.

        1. Replacement seems to be the sole reasonable course with respect to inhabitants of the clingerverse.

  8. “Institutions such as the CDC and FDA are important, but they also have their limitations.”

    Assumes facts not in evidence.

    1. I’d argue the converse…

  9. About three levels deep in the entire FDA and CDC bureaucracies should be impeached for their malfeasance.
    There’s no way that in an emergency situation they should be requiring 6 months of red tape for producing a mask, or a year’s worth of red tape for a ventilator.
    And there’s no way they should have left the national inventory of masks un-stocked for all the years since 2009, in disregard of urgent recommendations from the experts.
    And there’s no way they should be so unprepared for a SARS-like pandemic, given the number of times that warnings experts have given about the likelihood/danger of Chinese markets leading to such outcomes (even by journals such as _Smithsonian_.
    High crimes and misdemeanors…

    1. More nonfeasance, and Obama was warned about the consequences of not replenishing the stockpile….

      OBAMA used it and didn’t replace it. OBAMA….

      1. Why do you keep bringing this up? It has absolutely nothing to do with what President Trump did or didn’t do. Stop misdirecting and defend Trump’s actions and inactions on their own terms. For once.

    2. Agree about the bureaucracies. And add to the list everyone in the administration from the very top to about three levels deep in every cabinet. Which means we’re left with Jared running the show. I feel better already.

    3. That would still leave all the worst problems in place. They need to be cleaned out from the bottom up.

      1. pour encourager les autres…

    4. Replacing those masks took money, and appropriating money is assigned by the Constitution _only_ to the House of Representatives. Nancy Pelosi was the Speaker of the House for most of the last 11 years. The biggest reason those masks weren’t replaced was that Pelosi and the other House leaders had other things they wanted to buy with other peoples’ money.

      But it is worthwhile asking whether the CDC included replacing the masks in their budget requests, and if so, how high a priority they gave it, as compared to political bull@#$% like propagandizing for gun control. Typical Dems and RINOs would want to fund that and not have anything left for the lower priority items. Most Republicans would see that, and want to chop the CDC’s budget off at the item above it. Very few would notice vital items that were being forgotten – and only a handful of Congressmen are MD’s who might be able to recognize those vital items anyhow, if the CDC wasn’t properly prioritizing them.

  10. Lessons long forgotten, or maybe never learned?
    “…in the long run the aggregate of decisions of individual businessmen, exercising individual judgment in a free economy, even if often mistaken, is less likely to do harm than the centralized decisions of a government; and certainly the harm is likely to be counteracted faster.” — — John Cowperthwaite, Hong Kong financial secretary, 1961-1971

  11. I am enjoying those whose lesson from this is that the free market is clearly the way to handle pandemics.

    Hard to imagine a worse place for a market. A deadly free rider problem; lives being on the line; coordination and not competition needed; loads of miss-information.

    1. “Miss-information” being the kind they have in Mississippi?

      1. Erm. Among other things.

    2. “free market is clearly the way to handle pandemics”

      We don’t have a “free market” in health care. Its a highly regulated industry, both as to providers and funding. Among many examples, hospitals need “certifcates of need” to open at all or to add beds.

      Our mixed private/public system is working pretty well right now. Even in NYC.

      1. Our mixed private/public system is working pretty well right now. Even in NYC.

        We don’t have the testing to use epidemiologicaly; we can only use it diagnostically so we have zero power to monitor and mitigate or prevent anything.
        Being reactive doesn’t seem great.

    3. Sarcastr0….I actually see the response of the free market here as nothing short of miraculous. Lets take testing, since you are slamming it – unfairly IMO.

      We went from a ‘standing start’ of having a surveillance type testing system (which worked, BTW) and converted to a mass testing system in under a month. And 700K tests conducted in under two weeks, with 100K day capacity (and growing). That is all because of private industry. I challenge you to name a country that has done as much, so quickly and efficiently.

      America has called on our American businesses to help respond to the Wuhan coronavirus. They have answered in a magnificent way, with few exceptions (GM is a notable exception). I am personally grateful to American businesses who answered our calls in a time of national emergency.

      1. Commenter, I agree that where it’s been properly utilized (drug innovation, manufacturing capacity, etc) the market has been as miraculous as it’s always been – which is indeed pretty badass.

        The issue I’m taking is those who are saying the CDC screwup (here I disagree with you – I think there is plenty of blame to go around, including China and the CDC and Trump with remainder to spare) proves that the government has failed and the market needs to take over. That’s ridiculous – marshaling the resources the market has effectively supplied us with is a center-mass governmental action).

        If it looked like I was generally saying ‘markets bad’ that was not what I meant to say.

        I would take a bit of issue with your invocation of the ‘standing start to 700K tests’ as impressive, since you should look at such capacity on a per-capita basis, not as a bare number. Number of people determines your demand signal, as well as your productivity baseline. By that measure, we’re actually pretty bas.

        And the standing start…well, where was the market anticipating demand? (Unfair, to you – that’s not your thesis. But it is the thesis of many of the more chuckleheaded here)

        1. Sarcastr0, in my ‘heart of hearts’ I do not see a CDC screw-up here at all. I just don’t. Here is why. The surveillance testing CDC had in place absolutely worked; and worked exactly as intended. Our need changed literally overnight from a surveillance testing system to a mass population testing system. This was achieved in less than two weeks; I would call that miraculous. That transformation isn’t a failure of the CDC, it is totally the opposite – an incredible, stunning success. The CDC literally co-ordinated this transformation effort on the fly across thousands of businesses. From the time I wrote my post this morning, we blew through another 125K of tests. Any way you want to look at it, nobody has come even remotely close to us in terms of testing in either speed, percentage of population tested, or the rapidity of innovation.

          This month of March has been the CDCs finest hour. They have accomplished things nobody could ever have imagined as even possible. I am no fan of big government, but the CDC has earned my undying admiration.

          They have been, and are very unfairly criticized.

          1. 1. I don’t think our need changed overnight. – we had warning in January.

            2. The CDC absolutely bobbled the test – their original tests were bad, providing both false positives and false negatives, and then they bobbled the communication that the original test was bad. That lead to not only bad treatment decisions but also a loss of at least a week of data.

            3. Our use of tests is still hobbled to reactive triage levels, not proactive epidemiological levels as South Korea managed.

            I don’t deny there may have been herculean efforts by the CDC, but there is some great evidence that there was a policy failure as well.
            Those blaming the President or top CDC officials are taking the easy way out – we need to study what went wrong and why.

            There’s some serious sociology going on with the mania for blame right now (see above the post about suing hospitals, the rabid speculation about China, this post, even my side blaming Trump). I suspect that will fade as things get real.

        2. “Number of people determines your demand signal, as well as your productivity baseline.”

          If the part after the comma is saying that since the US has a population 10X (or whatever the number is) that of S. Korea, then if they can produce 1M test kits in a month, the US should be able to produce 10M isn’t quite right.

          As Fred Brooks famously said, “the bearing of a child takes 9 months no matter how many women are assigned to the task”. Producing kits take a certain amount of design, testing, and so on, and that time is independent of how many you eventually produce.

          (This is not to say the CDC/FDA can’t be fairly criticized for e.g. shutting down people repurposing lab equipment to do ad hoc testing; the exigency of the situation , IMHO, argues that letting university labs do ad hoc testing if they think they can isn’t the moral equivalent of allowing prescription of thalidomide w/o adequate testing. And we, as a country, have unfortunately developed a culture where you never get in trouble for following the rules, even when the rules are stupid.)

          1. That’s a fair point – that the relationship between population and productivity isn’t a 1-1 proportionality.
            And this is getting deep enough into economics I could be wrong, but it would seem to me that there is enough of a relationship that looking just at the bare number of tests produced is a poor metric of quality of effort.

            As a digression, as a bureaucrat, what I find re: rules following is different from the ‘always safe following the rules,’ but not necessarily better.
            Rules that are set down as requirements are rarely followed because they’re all well-meaning but impractical; you need to know the rule, and then the real way things get done. Rather reminds me of law school versus actual practice.

      2. I may take issue with the proportion of blame you heap on China, but your tone has been better than most here, including myself. And I find the thoughtful engagement you allow and provide a balm in these anxious times.

        Appreciate you!

        1. We Americans are all in this together, Sarcastr0. It really is that simple.

          1. Virus doesn’t see nations. In a bit, it’ll be all humans in this together.

  12. “Another report from ProPublica further supplements the picture of a CDC that fumbled some of its key responsibilities”

    They’ve been too busy with research into violence, obesity, smoking, transgenerism…

    1. And ProPublica leans left….

      1. “Leans”?

        They are fully bent over.

  13. Well you already have governors in Michigan and Nevada, for political reasons, telling doctors what medicine they can prescribe to their patients. Think how much easier that wil be when all the doctors work for the government.

    I have to give Cuomo some credit here, he is acting like a governer rather than just a politician here, unlike a lot of his colleagues, and he’s not going to ban a medication that could work just because Trump suggested it.

  14. “Centralized bureaucratic structures face inherent limitations…”

    In part, the over-reliance on the CDC is due to the defunding of state public health systems over the past 10 years. Those are the people who needed to be on the ground doing the contact tracing and quarantine orders (just like they should have been tracing down cases of gonorrhea and syphilis over the past 10 years).

  15. Say the organic statute of the Department of Administrative Affairs sets out certain areas in which Congress clearly intends for the Feds to occupy the field of administrative regulation of things. The safety of salted wheat crackers and the market for Task-it adhesive notes are specifically singled out. In subsequent decades, a finely reticulated regulatory scheme emerges. Then, crisis–and Congress passes the Triscuit and Task-it Recovery Act of 2097, in which the entire Federal Government swings into action, and of necessity the states are involved to an enormous degree. In the aftermath, states step in to enact massive regulations on the electric-baked salty biscuit market. The manufacturer challenges on grounds of preemption, but the states say that the subsequent Congress, in deploying a massive response to the specific situation that the organic act contemplated, constituted an implied repeal of both the implied and express preemption provisions of the Act.

    Quid juris?

    Mr. D.

    1. I’m thinking the issue will be moot in the massive populist backlash this November.

      1. Like the one that swept Harding and Coolidge into power after 1918?

        1. Was that supposed to be sarcasm? There was no Presidential election in 1918, but you might want to look up who won the next election in 1920.

          1. Harding and Coolidge. Unless someone’s agitating for a recount.

            Mr. D.

  16. See too, James C. Scott, Seeing Like A State on the myriad problems with centralized decision making. https://www.google.com/books/edition/Seeing_like_a_state/W0seMALXWcQC?hl=en&gbpv=1&printsec=frontcover

  17. Usatoday and propublica are not great sources for this. Our pathetic media institutions went after the cdc very early in all this, as yet another way to bash the Trump administration. Are we really going to believe them now after the appalling propaganda we have experienced for the last few decades? Does anyone doubt that is a dem was potus we would be hearing about how much better the cdc has performed compared to foreign efforts?

    I will wait to pass judgement until a year from now, when it is no longer an election year and we can see clear scientific assessments of the history. When we can learn how accurate was the WHO testing protocol really, how much did testing matter, and how was the organization of the relative national responses.

    1. Actually, i take back what i said about usatoday’s article. Its beyond “not great”, it is an outright propaganda hit-piece on the trump administration.
      Notice how they take a critique of the cec/testing, and then immediately quote something Trump said, regardless of relevance? Pure propaganda.

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