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THE SUMMER OF DISASTER
It soon became clear that ceding testing responsibility to the states was a recipe for disaster, not just in Democratic-governed areas but across the country.
In April, Phoenix, Arizona, was struggling just to provide tests to its health care workers and patients with severe symptoms of COVID-19. When Mayor Kate Gallego reached out to the federal government for help, she got an unmistakable message back: America’s fifth-largest city was on its own. “We didn’t have a sufficient number of cases to warrant” the help, Gallego told Vanity Fair.
Phoenix found itself in a catch-22, which the city’s government relations manager explained to lawyers in an April 21 email obtained by Vanity Fair through a public records request: “On a call with the county last week the Mayor was told that the region has [not] received FEMA funds related to testing because we don’t have bad numbers. The problem with that logic is that the Mayor believes we don’t have bad numbers because [of] a lack of testing.”
In June, Phoenix’s case counts began to rise dramatically. At a drive-through testing site near her house, Gallego saw miles-long lines of cars waiting in temperatures above 100 degrees. “We had people waiting 13 hours to get a test,” said Gallego. “These are people who are struggling to breathe, whose bodies ache, who have to sit in a car for hours. One man, his car had run out of gas and he had to refill while struggling to breathe.”
Gallego’s own staff members were waiting two weeks to get back test results, a period in which they could have been unwittingly transmitting the virus. “The turnaround times are way beyond what’s clinically relevant,” said Dr. James Lawler, executive director of international programs and innovation at the Global Center for Health Security at the University of Nebraska Medical Center.
By July 5, Gallego was out of patience. She went on ABC News, wearing a neon-pink blouse, and politely blasted the federal response: “We’ve asked FEMA if they could come and do community-based testing here. We were told they’re moving away from that, which feels like they’re declaring victory while we’re still in crisis mode.”
Three days later, at a press conference, the White House’s testing czar, Admiral Giroir, blasted her back by name. Claiming that the federal government was already operating or contributing support for 41 Phoenix testing sites, he said: “Now, two days ago, I heard that Mayor Gallego was unhappy because there was no federal support…. It was clear to me that Phoenix was not in tune with all the things that the state were doing.”
Gallego recounted how her mother “just happened to catch this on CNN. She sent me a text message saying, ‘I don’t think they like you at the White House.’”
Despite Giroir’s defensiveness, however, Gallego ultimately prevailed in her public demand for help: Health and Human Services agreed to set up a surge testing site in Phoenix. “The effect was, we had to be in a massive crisis before they would help,” said Gallego.
And that is where the U.S. finds itself today—in a massive testing crisis. States have been forced to go their own way, amid rising case counts, skyrocketing demand for tests, and dwindling laboratory capacity. By mid-July, Quest Diagnostics announced that the average time to turn around test results was seven days.
It is obvious to experts that 50 individual states cannot effectively deploy testing resources amid vast regulatory, financial, and supply-chain obstacles. The diagnostic-testing industry is a “loosely constructed web,” said Dr. Pellini of Section 32, “and COVID-19 is a stage five hurricane.”
Dr. Lawler likened the nation’s balkanized testing infrastructure to the “early 20th century, when each city had its own electrical grid and they weren’t connected.” If one area lost power, “you couldn’t support it by diverting power from another grid.”
Experts are now warning that the U.S. testing system is on the brink of collapse. “We are at a very bad moment here,” said Margaret Bourdeaux. “We are about to lose visibility on this monster and it’s going to rampage through our whole country. This is a massive emergency.”
THE PLOT TO SAVE AMERICA
In late January, Rajiv Shah, president of the Rockefeller Foundation, went to Davos, Switzerland, and served on a panel at the World Economic Forum with climate activist Greta Thunberg. There, he had coffee with WHO Director-General Dr. Tedros Adhanom Ghebreyesus, whom he’d known from his years working in global public health, first at the Gates Foundation and then as director of USAID, an international development agency within the U.S. government.
Shah returned to New York, and to the Rockefeller Foundation headquarters, with a clear understanding: SARS-CoV-2 was going to be the big one.
The Rockefeller Foundation, which aims to address global inequality with a $4.4 billion endowment, helped create America’s modern public health system through the early work of the Rockefeller Sanitary Commission to eradicate hookworm disease. Shah immediately began to refocus the foundation on the coming pandemic, and hired a worldwide expert, Dr. Jonathan Quick, to guide its response.
Meanwhile, he kept watching and waiting for what he assumed would be a massive federal mobilization. “The normal [strong] federal emergency response, protocols, guidance, materials, organization, and leadership were not immediately taking form,” he said. “It was pretty obvious the right things weren’t happening.”
As director of USAID from 2009 to 2015, Shah led the U.S. response to both the Haiti earthquake and the West African Ebola outbreak, and knew that the “relentless” collection of real-time metrics in a disaster was essential.
During the Ebola outbreak, which he managed from West Africa, he brought in a world-famous European epidemiologist, Hans Rosling, and President Barack Obama’s chief information officer to develop a detailed set of metrics, update them continuously in a spreadsheet, and send them daily to 25 top U.S. government officials. When it comes to outbreaks, said Shah, “If you don’t get this thing early, you’re chasing an exponentially steep curve.”
On April 21, the Rockefeller Foundation released a detailed plan for what it described as the “largest public health testing program in American history,” a massive scale-up from roughly 1 million tests a week at the time to 3 million a week by June and 30 million by the fall.
Estimating the cost at $100 billion, it proposed an all-hands-on-deck approach that would unite federal, state, and local governments; academic ins utions; and the private and nonprofit sectors. Together, they would rapidly optimize laboratory capacity, create an emergency supply chain, build a 300,000-strong contact-tracing health corps, and create a real-time public data platform to guide the response and prevent reemergence.
The Rockefeller plan sought to do exactly what the federal government had chosen not to: create a national infrastructure in a record-short period of time. “Raj doesn’t do non-huge things,” said Andrew Sweet, the Rockefeller Foundation’s managing director for COVID-19 response and recovery. In a discussion with coalition members, Dr. Anthony Fauci called the Rockefeller plan “music to my ears.”
Reaching out to state and local governments, the foundation and its advisers soon became flooded with calls for help from school districts, hospital systems, and workplaces, all desperate for guidance. In regular video calls, a core advisory team that includes Shah, former FDA commissioner Mark McClellan, former National Cancer Ins ute director Rick Klausner, and Section 32’s Mike Pellini worked through how best to support members of its growing coalition.
Schools “keep hitting refresh on the CDC website and nothing’s changed in the last two months,” Shah told his colleagues in a video meeting in June. In the absence of trustworthy federal guidance, the Rockefeller team hashed out an array of issues: How should schools handle symptomatic and asymptomatic students? What about legal liability? What about public schools that were too poor to even afford a nurse?
(Last week, the CDC issued new guidelines that enthusiastically endorsed reopening schools and downplayed the risks, after coming under heavy pressure from President Trump to revise guidelines that he said were “very tough and expensive.”)
Through a testing-solutions group, the foundation is collaborating with city, state, and other testing programs, including those on Native American reservations, and helping to bolster them.
“They came on board and turbocharged us,” said Ann Lee, CEO of the humanitarian organization CORE (Community Organized Relief Effort), cofounded by Lee and the actor Sean Penn. CORE now operates 44 testing sites throughout the U.S., including Dodger Stadium in Los Angeles and mobile units within the Navajo Nation, which also offer food and essential supplies.
It may seem impossible for anyone but the federal government to scale up diagnostic testing one hundred-fold through a painstaking and piecemeal approach. But in private conversations, dispirited members of the White House task force urged members of the Rockefeller coalition to persist in their efforts. “Despite what we might be hearing, there is nothing being done in the administration on testing,” one of them was told on a phone call.
“It was a scary and telling moment,” the participant recounted.
A BAD GAMBLE
Despite the Rockefeller Foundation’s round-the-clock work to guide the U.S. to a nationwide testing system essential to reopening, the foundation has not yet been able to bend the most important curve of all: the Trump administration’s determined disinterest in big federal action.
On July 15, in a video call with journalists, Dr. Shah looked visibly frustrated. The next day, the Rockefeller Foundation would be releasing a follow-up report: It called on the federal government to commit $75 billion more to testing and contact tracing, work to break through the testing bottlenecks that had led to days-long delays in the delivery of test results, and vastly increase more rapid point-of-care tests.
Though speaking in a typically mild-mannered tone, Shah delivered a stark warning: “We fear the fall will be worse than the spring.” He added, putting it bluntly: “America is not near the top of countries who have handled COVID-19 effectively.”
Just three days later, news reports revealed that the Trump administration was trying to block any new funding for testing and contact tracing in the new coronavirus relief package being hammered out in Congress. As one member of the Rockefeller coalition said of the administration’s response, “We’re dealing with a schizophrenic organization. Who the knows what’s going on? It’s just insanity.”
On Friday, July 31, the U.S. House Select Subcommittee on the Coronavirus, which is investigating the federal response, will hold a hearing to examine the “urgent need” for a comprehensive national plan, at which Dr. Fauci, CDC director Robert Redfield, and Admiral Brett Giroir will testify. Among other things, the subcommittee is probing whether the Trump administration sought to suppress testing, in part due to Trump’s claim at his Tulsa, Oklahoma, rally in June that he ordered staff to “slow the testing down.”
The gamble that son-in-law real estate developers, or Morgan Stanley bankers liaising with billionaires, could effectively stand in for a well-coordinated federal response has proven to be dead wrong. Even the smallest of Jared Kushner’s solutions to the pandemic have entangled government agencies in confusion and raised concerns about illegality.
In the three months after the mysterious test kits arrived at the UAE embassy, diplomats there had been prodding the U.S. government to make good on the $52 million shipment. Finally, on June 26, lawyers for the Department of Health and Human Services sent a cable to the embassy, directed to the company which had misspelled its own name on the original invoice: Cogna Technology Solutions LLC.
The cable stated, “HHS is unable to remit payment for the test kits in question, as the Department has not identified any warranted United States contracting officer” or any contract do ents involved in the procurement. The cable cited relevant federal contract laws that would make it “unlawful for the Government to pay for the test kits in question.”
But perhaps most relevant for Americans counting on the federal government to mount an effective response to the pandemic and safeguard their health, the test kits didn’t work. As the Health and Human Services cable to the UAE embassy noted: “When the kits were delivered they were tested in accordance with standard procedures and were found to be contaminated and unusable.”
An FDA spokesperson told Vanity Fair the tests may have been rendered ineffective because of how they were stored when they were shipped from the Middle East. “The reagents should be kept cold,” the spokesperson said.
Although officials with FEMA and Health and Human Services would not acknowledge that the tests even exist, stating only that there was no official government contract for them, the UAE’s records are clear enough. As a spokesperson for the UAE embassy confirmed, “the US Government made an urgent request for additional COVID-19 test kits from the UAE government. One million test kits were delivered to the US government by April 1. An additional 2.5 million test kits were delivered to the US government by April 20.”
The tests may not have worked, in other words, but Donald Trump would have been pleased at the sheer number of them.
This article has been updated to include a statement from the White House.
