But that time is not now. We are in the middle of a public health emergency, and we should not waste energy nitpicking the problems when we should be figuring out solutions.
To be sure, the limited number of tests available led to missed diagnoses and missed opportunities to stop community transmission. At least one outbreak cluster could have been detected sooner. And it makes no sense that we have not been able to figure out testing as well as other countries: South Korea has been testing 10,000 patients a day, while the United States tested fewer than 500 people in all of February.
There is a lot of blame to go around. The Centers for Disease Control and Prevention (CDC) sent out tests that had a faulty reagent and had to recall them. The Food and Drug Administration waited weeks before allowing state government and commercial labs to produce their own tests. On Tuesday, the Senate held a hearing to hold the various entities within the Trump administration accountable; on Wednesday, President Trump blamed the delay on regulations passed during the Obama administration (an allegation that was quickly proven to be false).
But let’s all keep in mind that this has been a rapidly evolving outbreak. In under three months, what we now call covid-19 has gone from a cluster of cases in one Chinese city to a near-pandemic affecting more than 70 countries. Public health officials have been working around the clock. A lot has been done rapidly, in extremely time-sensitive conditions, in an effort to contain the novel disease.
Did mistakes happen? Certainly. Mistakes occur in public health responses just as they occur in medical care. Sometimes, they are unavoidable: The best decision was made at the time, but it resulted in an adverse outcome. Sometimes, mistakes are made and should have been prevented. If there are systemic problems that could cause similar mistakes to happen in the immediate future, we need to find them. Otherwise, we need to grant some grace as we acknowledge the extraordinary challenges of this extraordinary situation.
At the very least, let’s not waste anymore time finger-pointing. There are many critical tasks at hand. The CDC says it now has enough of its tests for 75,000 patients. State laboratories are developing the capacity to run their own tests and, within a couple of weeks, commercial labs are expected to ramp up even more capacity. In the meantime, how will the limited number of tests be distributed? The CDC tests themselves are free, but seeing a provider to get the test is not. How can we help patients cover the costs of testing and afford their medical care if they have covid-19?
More testing means that more cases of covid-19 will be detected. The global nature of the outbreak and the presence of person-to-person transmission in the United States means that there are likely many undiagnosed cases of covid-19 throughout our communities. Local officials are being faced with difficult decisions of imposing social distancing measures, such as closing schools and canceling mass gatherings. As medical centers prepare for the surge of additional patients, the public health and medical community must reassure the public and keep the “worried well” from overwhelming hospitals.
These are the issues that we should be discussing and working on together, rather than blaming each other. A good example was set in mid-February after a patient in San Diego was mistakenly released from a hospital after testing positive for covid-19. The CDC, local officials and hospital leadership immediately acknowledged the problem publicly. They isolated the patient and traced her contacts. They figured out that the reason was a labeling and communication error, and all parties worked to remedy the problem and prevent it from occurring again. The episode was reported by the media, and then everyone moved on.
The lack of tests is just one of multiple mistakes that will occur in the course of this outbreak response. Let’s recognize these missteps and then move beyond them. Our ability to face this epidemic depends on our willingness to focus on a common goal: to protect the health, safety and well-being of our residents and our country.