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This important WSJ report shows how the CDC labs failed to come with the test after contamination of a component and failure of the third part of the three part test components. In the absence of a working test from CDC where delays cost three weeks of February the private labs all over the country and state labs could have developed their own test, yet HHS and FDA required approval for these labs to develop their own test and use it. From Feb. 8 when state and city public health labs detected problems with the CDC test to Feb 29 when solutions were developed including simply excluding the third part of the three component test, and letting labs around the country do their own test, were 3 crucial weeks that let the virus spread out of control. The CDC, HHHS, and the FDA and their managers and heads of departments bear responsibility for these errors. Week after week the delays continued, instead the two component test which detects if the genetic material in the sample is coronavirus material, could simply have been approved at the outset instead of the approval for this given weeks later. The third component of the test checks if the virus mutated, according to this report. There is no explanation why the labs all over the U.S. were not allowed to go ahead on February 9 itself or within a few days after that to develop their own tests once it was clear the CDC test did not work on that day. CDC officials failed to recognize that there was a possibility that they may not be able to fix the faulty third component of the test and the risks if they gave false reassurances. There is also no explanation of why a German designed test was not used once the CDC test failed on Feb. 9, which would be a proper way for action considering that this pandemic had already shutdown parts of China by this time. Alarming also is the mention in this report that on Feb. 22 a FDA official in charge of lab diagnostics  flies to Atlanta where the CDC Respiratory Diagnostic lab which developed the test is located. His boss FDA medical device center director is cited from later information as describing the lab as "filthy" meaning the lab had the potential to contaminate, and going so far as saying that if it had been any other lab it would have been shut down. Considering that investment in public health has deteriorated over the last two decades and that there has been a massive misallocation of capital in the country away from public infrastructure this is appalling. The thought of critical labs for emergency health needs as not being up to high quality standards in the U.S. as a result of two decades of misspending, that this shows, is very disturbing.  This WSJ report is based on interviews with people who know about the testing crisis, and undisclosed emails, correspondence on the issues involved. Community transmission began in January 2020 in the U.S. These delays were costly in February and could have been prevented either by going with the German design on Feb 10 or asking labs across the U.S. to develop their own test, and letting other labs immediately use the modified 2 component test of CDC that worked instead of doing this action weeks later. Mardi Gras on Feb 25 and other places where large crowds gathered in sports stadiums could have been stopped had testing gone forward and shown the true extent of the community transmission in these critical weeks.  First China delayed a U.S. team of experts coming into the country for weeks, and then the CDC, FDA, HHS, failed to get testing started, creating  a false sense of complacency. Two crucial errors outside and inside the country that caused so much damage to America and the world.   ...

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CDC has given no explanation for its new guidelines that say testing for coronavirus needs to be done only for those with symptoms, not for those exposed to someone within 6 feet who has symptoms. About half of all new cases are from people who are exposed to people with symptoms but have not yet developed symptoms. One of the reasons the virus spread quickly in February is CDC failure in developing of its own test on February 9 and policy that did not let private labs and labs of teaching hospitals develop their own tests and use them for another 3 crucial weeks.  CDC and Health and Human Services Department errors in February, combined with the stalling of an American team for 3 weeks by China to enter Wuhan in January,  have combined to let the coronavirus spread to the wider population. Once it spreads to a wider population the strategy of test and trace cannot be implemented the way it was first in South Korea and Taiwan, and later in Germany. ...

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The head of the U.S. Department of Health and Human Services, Mr. Alex Azar, repeatedly assured the president as early as January 29, that there never had been a better interagency response to coronavirus, says the WSJ. This WSJ report says based on interviews with administration officials and others that Mr. Azar waited for weeks to brief the president on the threat from coronavirus, did not coordinate effectively across the health divisions,  failed to ramp up testing development, and oversold what had been done. Testing is one of the key issues raised at this time about the coronavirus effort. Mr. Trump tweeted on April 12 that Mr. Azar "told me nothing until later." The president was dissatisfied with Mr. Azar's handling of the flavored e-cigarettes ban. This report says Mr. Azar was slow in working with other agencies such as FEMA, and in involving directly the FDA, CDC, and other agencies, to create a strong and effective response to a fast developing public health crisis of enormous proportions. In February White House advisors were critical of Mr. Azar for delays in the testing program. As the delays progressed this report says Mr. Pence and the White House gave more responsibility to FEMA, and Dr. Hahn and CMS's Ms. Verma were made active members of the White House Task Force. FEMA also played a bigger role with greater funding.    ...

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As this report in WSJ shows underreporting of coronavirus cases is a serious problem for Africa, and the figures from Africa's CDC, part of the African Union, do not show the magnitude of the problem. It shows that health workers in places from Yaounde in Cameroon to Dar es Salaam in Tanzania, to cities in Somalia, are reporting a situation quite different from what the CDC shows, with hotspots emerging in some places with little in the way of resources.

Only 1 million tests have been done and half are in SOuth Africa and Ghana. WIthout the testing it is hard to know how many cases there are. Capetown area in South Africa is emerging as a hotspot and hospitals are expected to be overwhelmed within weeks. Officially Tanzania a country with 56 million has 509 cases and 21 deaths, yet this contrasts with reports from health experts. Cameroon and South Sudan are also possible emerging hotspots in addition to Tanzania says this report in WSJ.

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The mistakes  and the right action done in Italy that the world can learn from as Italy tackles the coronavirus. The coronavirus is a dangerous pandemic yet there is one part of it that can be used to take the right action. The timeline of countries affected early in January and February and early March with information from these countries on what worked very effectively and what did not work with bad results is available. The mistakes were made in Bergamo, a town in Lombardy region of northern Italy with the highest number of infections and deaths in Italy. Bergamo had limited testing, no rigorous attitude for quarantining those who had come in contact with people testing positive, and lack of contact tracing. In Vo another town in northern Italy the situation is a complete contrast with resort to mass testing and isolation of clusters which has reduced infections to zero and made it a safe place. Vo is a small rural town 85 miles east of Bergamo in the Veneto region. This was the method used in South Korea, China, Taiwan and other Asian countries that have overcome the virus. Bergamo is an example of what failed in Italy with the worst number of fatalities. The health crisis worldwide has shown this  method of first general quarantine to buy time to build capabilities for testing  and preventing things spiralling out of control,  then mass testing, contact tracing and isolating the people who test positive, and repeating this process again and again till infections are way down,  is the only way to control this crisis. In the early days massive quarantine or stay at home strictly enforced is the best solution till production of tests accelerates to permit mass testing and isolating the clusters of infections. This mass quarantine buys time for accelerated production of tests and building up the capabilities of labs to process these tests, including use of a central national lab centre with national data on computers for microbiologists to monitor the entire country. This was done in South Korea reports in WSJ show. This is vital for everyone involved in the effort to control the virus to understand based on the experience of  countries that have successfully overcome coronavirus. It is the experience in South Korea and Italy that the U.S. White House response coordinator Dr. Brx is looking at and learning from as she and the White House team in the U.S., governors of all 51 states, health officials including CDC, are looking at as they execute their action plan in phases.  ...

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Beijing residents say they began to relax in wearing masks or not wearing them, not wearing masks properly, after 8 weeks with no cases. A vegetable and fruits wholesale market in Beijing, in southwestern district of Fengtai,  which supplies 80% of the fruits and vegetables to Beijing's 21 million people is now seen by health authorites in Beijing as the source of a new outbreak. 79 new cases are traced back to this market on June 15.  In Beijing restaurants and shops had reopened. Primary schools and other schools had reopened. Public health experts are looking at the possibility that the source is a cutting board for frozen salmon imported from overseas possibly Europe-. because of the DNA sequencing of the virus experts say. Contaminated seafood or meat is suspected as a source. China's CDC says the virus can survive on frozen meat or seafood for 3 months. Just when this new cluster was detected in Beijing, the city of Wuhan the origin city of the virus is permitting indoor sports and entertainment facilities reopen, and this WSJ report says Wuhan is making masks no longer mandatory outdoors. Beijing authorites have responded with mass testing, and contact tracing through neighborhood committees. About 100,000 people are organized by neighborhood committees to visit the city's 7000 residential compounds for contact tracing to identify people who visited the market and get them to test for coronavirus. This is the typical response in China to get large numbers of low level officials, workers and volunteers mobilized for contact tracing and testing. By June 14 about 76,000 people were tested - of this 13,000 are from the 29,000 who visited the market since May 30, according to Beijing government statistics. ...

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In a Senate hearing Dr. Fauci, head National Institute of Infectious Diseases, Dr. Redfield, head of CDC, and Dr. Hahn, head of the FDA, answered questions from U.S. Senators including committee chairman Lamar Alexander and Senator Murray. Dr. Fauci told senators that with some states reopening without meeting federal guidelines that include seeing an extended period of falling numbers of cases and deaths, "there is a real risk you could trigger an outbreak ... that could set you back rather than going forward."  Dr Fauci is concerned about the situation in the fall when schools and colleges reopen with possible spread. In other comments Robert Redfield the CDC head told the committee- "timely testing is vital to reopen America, increased contact tracing is critical." Redfield says CDC has created a state by state assessment of contact tracing and was working with states on these surveillance systems. This contact tracing effort is one of the less developed areas in which the focus is being shifted to along with testing capabilities. Admiral Giror who heads testing capability buildup says 40 to 50 million tests should be available by September 2020, so that hotspots could be addressed quickly. ...

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Steep drops in economic activity and loss of so many jobs is the reason why total lockdowns are not the best solution as seen from the experience gained by August. Selective lockdowns are now being applied across France, Germany and Britain in specific areas. About 400 million jobs have been lost, 13 million in the U.S.  Hospitals overwhelmed in northern Italy by March is what made the total lockdowns necessary.  These steps for total lockdown were made with very little known about the pandemic and the need to protect hospital and health systems. These decisions at that time are not questioned today. It is that now  with some treatments found, a vaccine close to being introduced, hospital system protocols established, health ministries and departments organized to respond quickly, and the public awareness at high levels,  it is now possible to impose these selective lockdowns effectively and quickly. As the WSJ now says the CDC had botched the initial development and distribution of tests in February- see WSJ analysis and our Lyrarc links of how 3 crucial weeks were lost in Feb with failure of the CDC and HHS in testing- making test and contact trace strategy window to be missed. China had not cooperated in letting a U.S. team quickly in the early days of February creating more uncertainty and risk. In that situation total lockdown suddenly became the reality to avoid a catastrophe. Today a carefully applied selective application of solutions can be done and is seen as the right way to protect jobs and livelihoods of people. ...