America’s lost month: How the U.S. fell behind on coronavirus testing.
As the deadly coronavirus spread across the United States between late January and early March, large-scale testing of people who might have been infected did not happen because of technical flaws, regulatory hurdles, business-as-usual bureaucracies and lack of leadership at multiple levels.
The three federal health agencies responsible for detecting and combating pandemic threats failed to prepare quickly enough, a Times investigation found. Even as scientists looked at China and sounded alarms, none of the agencies’ directors conveyed the urgency required to spur a no-holds-barred defense, according to interviews with more than 50 current and former public health officials, administration officials, senior scientists and company executives.
Dr. Robert Redfield, the director of the Centers for Disease Control and Prevention, trusted the agency’s veteran scientists to develop a test for the coronavirus. But when test turned out to have a flaw, it took the C.D.C. much of February to settle on a solution. In the meantime, the virus was spreading undetected.
Dr. Stephen Hahn, the commissioner of the Food and Drug Administration, was supposed to help build national testing capacity by approving diagnostic tests developed by the private sector. Yet he enforced regulations that paradoxically made it tougher for hospitals and laboratories to deploy such tests in an emergency.
Alex M. Azar II, the health and human services commissioner, oversaw the two other agencies and coordinated the government’s public health response to the pandemic. Yet he did not manage to push the C.D.C. or F.D.A. to speed up or change course.
Together, the challenges resulted in a lost month, when the United States squandered its best chance of containing the coronavirus’s spread. Instead, Americans were left largely blind to the scale of a looming public health catastrophe.
C.D.C. issues a travel advisory for the New York region, after Trump backs off his quarantine threat.
President Trump said Saturday night that he will not impose a quarantine on New York, New Jersey and Connecticut but would instead issue a “strong” travel advisory to be implemented by the governors of the three states.
Mr. Trump made the announcement on Twitter just hours after telling reporters that he was considering a quarantine of the three states in an effort to limit the spread of the coronavirus to Florida and other states.
Later Saturday night, the C.D.C. issued a formal advisory urging the residents of the three states to “refrain from non-essential domestic travel for 14 days effective immediately.” The advisory, which was posted to the agency’s website and its Twitter account, does not apply to “employees of critical infrastructure industries,” the agency said. That includes trucking, public health professionals, financial services and food supply workers.
Mr. Trump, when he said he was considering a quarantine for the region, offered no details about how his administration would enforce it. Speaking to CNN, Gov. Andrew Cuomo of New York criticized the idea, calling it “a declaration of war on states.”
He also questioned the logistical challenges, as well as the message, such an order would present. “If you start walling off areas all across the country it would just be totally bizarre, counterproductive, anti-American, antisocial,” he said.
Mr. Trump’s public airing of his deliberations came one day after he signed a $2 trillion economic stimulus package and as cases in the tristate area continued to climb. The specter of a federal quarantine followed a wave of governors who, fearful about the virus spreading further through their states, ordered people who had traveled from New York to isolate themselves for two weeks after their arrivals.
Gov. Gina Raimondo of Rhode Island said Friday that state troopers would begin stopping drivers with New York license plates so that National Guard officials could collect contact information and inform anyone coming from the state that they were subject to a mandatory, 14-day quarantine.
Texas, Florida, Maryland and South Carolina are among the other states that have ordered people arriving from New York to self-quarantine. In Texas, for instance, the authorities said Friday that Department of Public Safety agents would make surprise visits to see whether travelers were adhering to the state’s mandate, and they warned that violators could be fined $1,000 and jailed for 180 days.
Mr. Lamont, the Connecticut governor, this week urged all travelers from New York City to self-quarantine for two weeks upon entering the state, but he stopped short of issuing an order requiring it.
Illinois reports first known U.S. death of an infant with the coronavirus.
An infant who tested positive for the coronavirus has died in Chicago, the authorities said on Saturday. It was the first known death of a child younger than a year old with the virus in the United States, although the authorities in some states do not release details about people who die.
Newborns and babies have so far seemed to be largely unaffected by the coronavirus, but three new studies suggest that the virus may reach the fetus in utero.
“There has never before been a death associated with Covid-19 in an infant,” said Dr. Ngozi Ezike, the director of the Illinois Department of Public Health. “A full investigation is underway to determine the cause of death.” Older adults, especially those in their 80s and 90s, have been viewed as the most vulnerable in the outbreak, but younger people have also died.
By Saturday night, deaths in the United States had surpassed 2,000, at least 50 of them in Illinois. More than 3,500 known cases of the virus have been identified in Illinois.
As deaths mount, Spain and Italy look for signs of a turning point.
Italy and Spain, which have the world’s highest coronavirus death tolls, have reported grim new daily totals: 889 deaths over 24 hours in Italy, and 832 in Spain.
The swelling figures brought the fatality counts in the two countries to about 15,000 — more than half of the deaths reported worldwide.
“We have to reduce to the maximum this mortality,” Fernando Simón, the director of Spain’s national health emergency center, said.
But the health system in Spain, where the government on Saturday further tightened restrictions on movement, is under strain. Dr. Simón warned that some intensive care units had reached “the limit,” while others were approaching their capacities. In the Madrid region, a hub of Spain’s outbreak, about 1,400 patients are now in intensive care units.
The surge in deaths was particularly unsettling in Italy, where it had seemed the fatality rate had begun to slow. More encouragingly to public health experts, Italy and Spain have both reported signs that new infections are becoming fewer, although those rates could wobble as the outbreaks progress.
“We are reaching the peak of this curve that worries us so much,” Dr. Simón said. “In some areas of the country we have probably already passed it,” he added.
Hopes have been more muted in Italy, where the head of the national health institute, Silvio Brusaferro, suggested the country’s outbreak “could peak in the next few days.”
Even so, he said, “We can’t delude ourselves that a slowing down of the diffusion will allow us to slow down social distancing.”
The scale of the outbreak in Italy has unnerved people in France, where President Emmanuel Macron offered a fresh defense of a government response that some have deemed insufficient.
“We have absolutely not ignored these signs,” Mr. Macron said in an interview with three Italian newspapers. “I dealt with this crisis with seriousness from the beginning, when it started in China.”
France has reported 37,575 cases and 2,314 deaths, a one-day increase of 319.
“It’s an unprecedented health crisis in at least a century,” the French prime minister, Edouard Philippe, said on Saturday afternoon. “As I speak, almost half of humanity is under lockdown, it’s literally extraordinary.”
Here is how some other countries are responding to the virus:
Russia will close its borders starting on March 30, a government order published on Saturday said. The measure will come into force at all vehicle, rail and pedestrian checkpoints, and apply to Russia’s maritime borders, the government said. It will not apply to Russian diplomats and the drivers of freight trucks, among others. The country, which has already grounded all international flights, has reported 1,264 coronavirus cases. It closed its longest border, with China, in January.
Turkey halted all intercity trains and limited domestic flights and halted international flights on Saturday. Its number of coronavirus cases jumped by a third in a day to 5,698, with 92 dead.
Brazil’s president, Jair Bolsonaro, continues to cast doubt on São Paulo’s death toll from the outbreak, accusing the state governor, without evidence, of manipulating the numbers for political ends. “I’m sorry, some people will die, they will die, that’s life,” Mr. Bolsonaro said in a television interview Friday night. He said that in São Paulo State, Brazil’s economic powerhouse — which has the most cases and deaths so far of coronavirus in Brazil, at 1,223 cases and 68 death — the death toll seemed “too large.”
Ambulances in New York haven’t been this busy since 9/11.
Even as hospitals across New York become inundated with coronavirus cases, some patients are being left behind in their homes because the health care system cannot handle them all, according to dozens of interviews with paramedics, New York Fire Department officials and union representatives, as well as city data.
In a matter of days, the city’s 911 system has been overwhelmed by calls for medical distress apparently related to the virus. Typically, the system sees about 4,000 Emergency Medical Services calls a day.
On Thursday, dispatchers took more than 7,000 calls — a volume not seen since the Sept. 11 attacks. The record for amount of calls in a day was broken three times in the last week.
Because of the volume, emergency medical workers are making life-or-death decisions about who is sick enough to take to crowded emergency rooms and who appears well enough to leave behind. They are assessing on scene which patients should receive time-consuming measures like CPR and intubation, and which patients are too far gone to save.
And, they are doing it, in most cases they say, without appropriate equipment to protect themselves from infection.
The paramedics described grim scenes as New York City has become the epicenter of the coronavirus pandemic in the United States, with more than 29,000 cases as of Saturday, and 517 deaths.
Reporting and research was contributed by Neil MacFarquhar, Alan Blinder, Michael D. Shear, Jesse McKinley, Abby Goodnough, Sheila Kaplan, Sheri Fink, Katie Thomas and Noah Weiland,