"Tremendous" as in the 3rd definition on dictionary.com. That is:
"dreadful or awful, as in character or effect; exciting fear; frightening; terrifying."
The administration took no effective action for the first seven, most critical, weeks. It wasn't just a "misstep" or two because no system is perfect. It was wrong choice and incompetent action upon wrong choice and incompetent action that multiplied the "tremendous" effect.
For the past three weeks, a number of states have been moving at lightening speed in an effort to deal with the fallout of the seven weeks of tremendous failures. (Tragically, too many states -- including CA -- continue to struggle on the testing front, making very little headway, but that is a different
issue/post. On the "bright side" at least almost every state has now ordered appropriate closures and quarantines.)
Timeline
1/13
Test developed by the department of virology at Berlin’s Charité university hospital with help from experts in Rotterdam, London and Hong Kong available.
CDC inexplicably declines to develop and use this test, opting, instead, to come up with their own.
1/19
Virus is already circulating, undetected, in WA state, and probably elsewhere. (Based on analysis of genetic samples from a 1/20 case and a later case, researchers at Fred Hutchinson Cancer Research Center and the University of Washington found the virus had probably been circulating undetected for
at least 6 weeks prior to 3/1 -- finding announced 3/1)
1/31
Azar (DHS) declares public health emergency. Among other things, this triggers FDA emergency use authorization (EUA) power. This should have come at least two weeks earlier. In an interconnected world, the grim reality of what we would face if we did not make preparations to act, and act quickly, was obvious as soon as it was clear how readily it was transmitted in China and how high the mortality rate was.
In re: EUA power. Normally, hospitals and labs need FDA permission to use their own laboratory developed tests (LDTs). EUA power allows labs to move forward with test distribution and processing while the FDA reviews information about the test they submitted.
If the FDA had started exercising its EUA power immediately upon declaration of a public health emergency, as they should have, labs at university medical centers, hospitals, private labs, etc., could have moved forward with their own tests or a version of the reliable test that was available on Jan 13. (FDA did not exercise this power until 2/29, as noted later in the timeline.)
2/3
China travel ban
After not testing anybody, and doing no screening on anybody for 3 weeks, DT issues a travel ban on China 2/3. Only returning Americans and foreign nationals with "pre-clearance" are allowed entry.
Selected airports are designated to receive planes and screen passengers as they come in. Anyone who visited China in the past two-weeks is screened. If they have symptoms they are told to go home and quarantine. No testing to determine actual status (because we don't have a test). Everyone else on plane already exposed. (More to it than that -- re-routing to original destination and whatnot.)
2/5
CDC finally begins distributing their own test.
Shortly after distribution begins, recipients find problems with the test. Apparently it has been distributed without proper quality control checks. Testing by states put on hold. States are directed to send samples to CDC. CDC has very strict criteria for testing to limit number of tests and resultant backlog. The number of people tested is extremely limited.
(Precisely how incredibly limited in the month of February is made clear in the original post.)
2/23
First community transfer confirmed in CA. (Virus has therefore been circulating, undetected, there, too.)
2/27
CDC has fixed the test issue. Most states still not getting kits. They continue being directed to send samples to CDC for testing with overly strict criteria. Even with limits and test "rationing" there are backlogs.
2/29
FDA
finally begins to use its EUA power to empower labs to distribute/process tests independent of the CDC. A crucial four weeks has been lost.
2/29
DT expands travel ban to include Iran.
2/29
Governor Inslee declares state of emergency in WA (first state)
2/30
Cuomo declares disaster emergency in NY
3/1
With extremely limited testing, 42 cases in the US are confirmed. 2 deaths are attibuted to COVID-19.
People who have symptoms are directed to "self-quarantine."
3/3
Newsom declares state of emergency in CA.
3/8
497 cases have been confirmed. 22 deaths have been attributed to COVID-19. Test capacity continues to be so severely limited we really have no idea how many COVID-19 cases there are. Most states are still being directed to send tests to the CDC for processing. Backlog.
3/15
3,497 cases have been confirmed. 62 deaths attributed to COVID-19. Some states are ramping up testing, but a vast majority continue to face severe sample collection materials shortage and/or extremely limited test processing capacity. The limitations are so severe there is no way to estimate likely incidence per capita in most regions, or to create region-specific data-driven models. In absence of anything else, preparations are necessarily based on worse case scenarios everywhere.
Statewide closure orders begin with Inslee in WA ordering closure of all bars, restaurants, recreational and entertainment facilities. NY follows March 16, and CA follows March 17, with even more restrictive "Shelter in Place" orders. More detailed state-by-state action summary
here.
3/22
29,046 cases. 300 deaths attributed to COVID-19.
3/23
Worldmeter as of 2 am ET 3/24
46,145 cases confirmed. 582 deaths attributed to COVID-19
It didn't have to be this way. Related post
here.
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