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What did Dr. Anthony Fauci say about coronavirus testing ‘failing’?

President Trump said he did not have responsibility for a "failing" cited by Dr. Anthony Fauci. But what was Fauci talking about? (Video: The Washington Post)
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Reporter: “Doctor [Anthony] Fauci said earlier this week that the lag in testing was, in fact, ‘a failing.’ Do you take responsibility for that?”

President Trump: “No, I don’t take responsibility at all, because we were given a set of circumstances and we were given rules, regulations, and specifications from a different time.”

— Exchange at a news conference, March 13, 2020

Trump’s response to this question during a coronavirus news conference generated a lot of attention, in part because Trump, as a private citizen, had made it clear he believed whatever happened on a leader’s watch was his responsibility:

Former vice president Joe Biden’s Democratic presidential primary campaign two days later tweeted out a video that included the exchange at the news conference, framed around the question of presidential leadership. It includes a brief clip of Fauci, who runs the National Institute of Allergy and Infectious Diseases, saying: “It is a failing, let’s admit it.”

The implication was that Fauci was referring to the “lag in testing,” as the reporter had framed the question. But is that what Fauci was talking about?

The Facts

A major issue in the U.S. government’s response to the outbreak of a novel coronavirus has been the availability of tests for people who believe they may have covid-19. The administration has been under fire for its failure to quickly expand testing for coronavirus across the United States. A still-unspecified manufacturing problem caused the Centers for Disease Control and Prevention (CDC) to distribute flawed tests to state and local health departments. The lack of tests, compared with countries such as South Korea that have tested tens of thousands of people, has meant the spread of the virus in the United States may have been hidden in the early weeks of the outbreak.

From mid-January until Feb. 28, fewer than 4,000 tests from the CDC were used out of more than 160,000 produced, The Washington Post reported. “In South Korea, more than 66,650 people were tested within a week of its first case of community transmission, and it quickly became able to test 10,000 people a day,” the Atlantic reported on March 7. “The United Kingdom, which has only 115 positive cases, has so far tested 18,083 people for the virus.”

Community transmission means someone is infected even though they have not been in contact with someone who had traveled abroad. The first such case in the United States was reported on Feb. 28. Even as of March 17, according to the New York Times, about 125 people per million have been tested in the United States, far fewer than many other countries. By contrast, Italy has tested more than 2,000 per million and South Korea more than 5,000 per million.

On March 12, the day before the news conference, Rep. Debbie Wasserman Schultz (D-Fla.) at a congressional hearing asked U.S. officials to identify the person in charge of “making sure there were enough tests [so] as many people as possible across this country have access to getting tested as soon as possible.” Robert Redfield, the director of the CDC, had trouble answering the question so Fauci stepped in.

FAUCI: “The system — the system does not — is not really geared to what we need right now, what you are asking for. That is a failing.”
WASSERMAN SCHULTZ: “A failing, yes.”
FAUCI: “It is a failing, let's admit it.”
FAUCI: “The fact is the way the system was set up is that the public health component that Doctor — that Doctor Redfield was talking about, was a system where you put it out there in the public and a physician ask for it and you get it. The idea of anybody getting it easily the way people in other countries are doing it, we are not set up for that. Do I think we should be? Yes, but we are not.”

Later that day, in an interview with ABC News, Fauci was asked who was responsible.

ABC NEWS: “So you testified today that the U.S. testing system is currently failing and that we’re not set up for universal testing. Who’s responsible for this failure?”
FAUCI: “You know, I don’t think it’s anyone that’s responsible. What I was referring to is that the system as it was originally designed was really designed for a patient to doctor relationship in which the CDC would make a test, give it to the public health authorities in a particular state or local section, and if someone needed a test they would get an individual test. What it was not designed for was the broad, more global as it were, screening. Where you could not only get a test for an individual but you could go and essentially blanket the country to find out how many people are actually infected. That was something that was originally worked really very well for the systems that were in place then.”

Fauci emphasized this point at the news conference when Trump was asked if he was responsible — and Trump said he was not.

FAUCI: “So just to reiterate what I said to many of you multiple times, it’s the [inaudible] of a system. The system was not designed — for what it was designed for it worked very well. The CDC designed a good system. If you want to get the kind of blanket testing and availability that anybody can get it or you could even do surveillance to find out what the penetrance is, you have to embrace the private sector. And this is exactly what you’re seeing, because you can’t do it without it. So when I said that, I meant the system was not designed for what we need. Now, looking forward, the system will take care of it.”

On March 17, in an interview on the Hugh Hewitt radio talk show, Fauci again was asked about the testing breakdown at the CDC. (Hewitt is a Washington Post opinion columnist.)

FAUCI: “You know, it was a complicated series of multiple things that conflated that just, you know, went the wrong way. One of them was a technical glitch that slowed things down in the beginning. Nobody’s fault. There wasn’t any bad guys there. It just happened. And then when we realized, when the CDC realized, and the FDA said both the system itself as it was set up, which serves certain circumstances very well, was not well-suited to the kind of broad testing that we needed the private sector to get involved in.”

As you can see, there are two things going on here. The CDC had a testing breakdown because of a flawed test. At the same time, the administration did not move quickly to get the private sector involved — that is the failure that Fauci referred to in his congressional testimony, not the production failure that happened with the test. Fauci went on to tell Hewitt that the test-production failure “has nothing to do with anybody’s fault, certainly not the president’s fault.”

But it’s worth noting that getting the private sector involved was flagged as an urgent issue by two former Trump administration officials in a Jan. 28 opinion article in the Wall Street Journal, titled “Act Now to Prevent an American Epidemic.” Just five days earlier, China had shut down the city of Wuhan to stem the outbreak.

“If the number of cases increases, experience from the 2009 swine flu pandemic and the 2015 Zika epidemic suggests that the CDC will struggle to keep up with the volume of screening,” wrote Luciana Borio, who had been Trump’s director for medical and biodefense preparedness policy at the National Security Council, and Scott Gottlieb, who had been Trump’s commissioner of the Food and Drug Administration. “Government should focus on working with private industry to develop easy-to-use, rapid diagnostic tests that can be made available to providers.”

Not until a month later, on Feb. 29, did the FDA loosen the rules to allow more labs to apply for approval to conduct covid-19 testing. Labs have complained about other bureaucratic hurdles imposed by the FDA and CDC that slowed down the development of tests.

The Bottom Line

Fauci has repeatedly tried to clarify he was speaking about a failure to get the private sector involved sooner, not the flawed tests distributed by the CDC. But his “failing” quote keeps getting cited indiscriminately.

Few would argue that a president is responsible for a manufacturing glitch. Fauci has also said no one is responsible for designing a “good system” for a testing protocol that proved not up to the task posed by the novel coronavirus.

But a president is supposed to manage the government’s response to a crisis — with language that signals to government workers the path forward.

Trump had spent weeks playing down the seriousness of the coronavirus pandemic, even as other nations experienced a surge in cases. Such messages resonate through the government bureaucracy. Would consistent presidential messaging about a global threat to Americans have moved things faster? It’s impossible to know.

But as Trump once tweeted, leadership means “whatever happens, you’re responsible. If it doesn’t happen, you’re responsible.”

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