Much has been written about President Trump’s fragile ego in the context of his malignant narcissism; in fact, I have expressed my opinion that the extent of his psychopathology is a topic that the mainstream media is deliberately and inexcusably avoiding. I believe that a word now is in order about the ego of Dr. Deborah Birx, the coordinator and now de facto chief scientific spokesperson for Trump’s pandemic task force.

Pundits have conjectured that Dr. Birx’s awkward excuses for and obsequiousness toward Trump are tactical in nature, that she is heroically sacrificing our own reputation to preserve a relationship to Trump so that she can steer him away from his most destructive impulses. Maybe in part, and maybe it started that way, but she has gone way too far and is now one of Trump’s enablers.

Somewhere inside she must realize that she is now doing more harm than good. There is more to her relationship with Trump than just tactics.

I believe that Dr. Birx’s own ego may not be strong enough to withstand the thought of being summarily dismissed by Trump. There is nothing obvious in her life that would prepare her for that kind of rejection and disapproval; in fact, the contrary is true. Dr. Birx’s life story has been one success after the next, following a steady uphill course.

She carries herself with dignity and pride, clearly conscious of the image that she presents to the public, down to the fashionable scarves. I emphasize that I am not saying that there is anything wrong with that; far be it from me to take issue with someone as genuinely accomplished as Dr. Birx. I am saying, however, that she may be vulnerable to being exploited by a powerful and malignant narcissist like Trump.

Dr. Birx’s military background conditions her to a certain deference to authority. That deference simply makes it more difficult to contemplate being punished unfairly by someone in authority, especially by being publicly kicked to the curb and humiliated.

I want to also stress that this discussion is appropriate only for one, important reason: Dr. Birx is allowing herself to be used by Trump and in my opinion, despite what she may believe, she is helping to endanger lives. She is lending credibility to Trump’s leadership of the pandemic response, and that troubles me for a particular reason right now: Her tacit support of Trump’s self-serving refusal to embrace the idea that an expanded regime of testing must be implemented before society can safely be reopened.

My training and experience as a psychiatric social worker are helpful in understanding human behavior. On the other hand, I have applied my lawyerly training to evaluating expert opinions on the need for a much more expansive program of testing for COVID-19, including testing of potential symptomatic carriers, as a precondition for restarting the economy. What the research reveals is that, although opinions vary as to the scope, all credible experts believe that a comprehensive regime of testing and contact tracing is necessary to identify and isolate carriers, and to protect vulnerable places like hospitals and nursing homes.

Trump repeatedly has pushed back on this idea, for the obvious reasons described in another post. Dr. Birx has been non-committal about such testing, refusing against all prudence to be more specific – or to tell us if or when the CDC will be issuing its own guidance on a testing program, which the CDC should have done by now.

As a consequence, many states are drifting toward restarting their economies without such programs, or even without any ideas what such programs should look like. It is the next big storm cloud/pandemic screw-up on the horizon, and Dr. Birx has not prevented it. She is helping to enable it.

I hope that friends, family members, or respected colleagues will have a heart-to-heart with Dr. Birx, explaining to her what she is doing to herself – and to the country. Tell her that we appreciate her efforts, but that a constructive relationship with a malignant narcissist on the order of Donald Trump is not possible. Ask her to give you an example of one such relationship in Trump’s life. And have her read the recent interview with Dr. John Gartner in Salon.

Plead with her to follow the example set by her older colleague, Dr. Fauci, and maintain an arms-length professional relationship with the president. Implore her to stop the fawning. And if she gets fired for doing and saying the right things, so be it. She will have nothing to be ashamed about and will feel much better about herself in the end. And the rest of us will be safer.

Where is the CDC’s guidance for the expanded program of COVID-19 testing and contact tracing necessary to allow states to safely relax restrictions on public gatherings and “reopen” their economies? If the CDS has issued such guidance, I sure cannot find it – any help would be appreciated.

My theory: Despite its clear obligation to do so, the CDC will not issue such guidance because to do so would expose how inadequate the current supplies of test kits are to do the testing necessary to implement such a program. And the inadequate number of test kits would in turn underscore the greatest single mistake of the Trump administration’s generally inept pandemic response – the failure to adopt a national strategy to produce, acquire, and distribute critical medical supplies, including test kits and PPE.

The CDC is the repository of the nation’s expertise in how to establish a program of surveillance testing, widespread screening, and contact tracing customized to COVID-19 that would allow states to safely reopen their economies. It is nothing less than a gross abnegation of its core mission for the CDC not to get out in front of  this key step in controlling the pandemic.  

I discussed what such an adequate testing regime would look like in a prior post, referring to an article  in The Atlantic.  It involves much more widespread  testing than called for by the CDC in its current guidance.

The goal of surveillance testing, done by sampling, is to determine rate of infection in a given population. The use of tests for screening is done to accomplish a specific goal, such as making sure that only virus-free nursing home employees have close contact with residents. And it involves testing asymptomatic people – a subject that the CDC has avoided.

Controlling COVID-19 is particularly challenging because it can be transmitted by asymptomatic carriers of the disease, the so-called “silent spreaders.” These silent spreaders can be pre-symptomatic, spreading the disease in the days before symptoms appear, or they can be carriers of the virus who never have any signs or symptoms of the disease. Estimates now are that as much as 40% of the transmission of COVID-19 is from asymptomatic carriers.

The authors of the Atlantic article point out that a widespread testing program designed to make it safe to reopen society must focus on potential asymptomatic carriers of the disease, interdicting transmission of the disease at the points at which it is most likely to be spread and at which it is most dangerous. They recommend widespread periodic screening for COVID-19, and they group people into four general categories in order of testing priority.

The first priority for screening is health care workers, including nursing home workers, and medical first responders. The second includes people who also interact with many other people and are vital to keeping the country going, such as grocery and postal workers and police officers. The third group is for anyone who routinely comes into contact with large groups of people either in the course of their employment or family life. The final group includes everyone returning to their workplaces.

The authors suggest that testing of people in these groups would occur about once a week. That is a lot of testing and estimates of the number of tests necessary to carry out an adequate program of testing range from 500,000 into millions per day.  Any plan similar to the one described in the Atlantic would have to be phased in, beginning with the high priority groups.

It is fair to add that many experts believe that the plan proposed in the article is too ambitious and is unrealistic. To my knowledge, however, none have said that a comprehensive testing program that includes testing of asymptomatic people is unnecessary, and that social distancing alone will be sufficient to safely reopen society. The risk simply is too high that the pandemic will come roaring back if the virus is allowed to spread undetected.

California apparently will be the the first state to adopt its own program of more widespread testing that includes asymptomatic people, beginning with screening of health care workers. It is limited (including by shortage of test kits), but it is a start. And it is an absolute sin that states have been left to their own devices on this. That does not mean that there would not be deviations from a CDC-designed program to account for local conditions, but the basic program must be based on scientific and public health best practices – in other words, an undertaking that is in the wheelhouse of the CDC.

Finally, this note to Robert Redfield, head of the CDC: Dr. Redfield, I don’t care if it highlights the failure of the federal government to take charge of making adequate number of test kits available and embarrasses the president, you have a duty here. And that duty is to render your best advice on a program of comprehensive testing and contact tracing that will protect citizens as the economy is reopened. Think of us as your patients, doc. Don’t we deserve your best medical advice?

*****************************************************************************

A footnote on my earlier post about the failure of the president to use the Defense Production Act (DPA): To reprise, I pointed out that the greatest single dereliction of federal responsibility (among a whole host of screw-ups in the federal pandemic response) was the failure by the Trump administration to design and implement a national strategy to produce, acquire, and distribute critical medical supplies, including test kits and PPE. Claims by the Trump administration that it was not a federal responsibility are wrong, and reprehensible.

Only the federal government has the power, through the Defense Production Act (DPA), to ensure production of sufficient quantities of supplies and equipment, control and stabilize supply chains, eliminate price gouging, and make sure that distribution is made to where it is most needed. If the DPA had been used in a timely manner, the shortages of PPE and test kits would not exist.

There is an excellent article in Politico titled “Inside America’s unending testing snafu.” It is worth reading if a bit overwhelming in its description of a complex problem. Suffice it to say that the “snafu” that test kit availability has become is the best evidence of why federal officials should have taken charge of this task as soon as they knew that the pandemic was headed our way.

A task of this magnitude and complexity can only be managed centrally. And that means the federal government. And I am absolutely certain that people with relevant expertise and experience told that to the president or his staff at the outset of the pandemic. As I said before, only a congressional investigation will find out why this ball was dropped.

The problems described in the story sound complicated, and they are. But they are the type of problems that logisticians spend entire careers training for and working on. There are about 26,000 employees and a lot of expertise in managing supply chains, interoperability of equipment, and ensuring that multiple moving parts work together to produce the desired results in the Defense Logistics Agency (DLA). There is similar expertise in FEMA.

The president decided to let all of that skill and experience sit on the sidelines and to make acquisition of test kits a “state responsibility,” meaning that he made availability of test kits subject to the vagaries of a market in chaos. There is considerable suspicion that his decision was influenced by manufacturers and suppliers who benefit from such dog-eat-dog sellers’ markets, where states and even individual hospitals are bidding against each other. In any case, it was a horrifically stupid, unjustifiable decision that is costing many lives and will force lengthy delays in safely reopening the economy.

Brian Williams of MSNBC quoted someone whose name I do not recall as referring to the failure of the federal government to adopt and implement an effective national strategy for diagnostic testing of the COVID-19 coronavirus as soon as the pandemic was on the horizon as the “original sin” of the federal response. The term fits perfectly, and it is a sin that continues to haunt us. This post updates and expands upon my post last week captioned “Trump is rushing us headlong toward disaster for his own political benefit.”

As I described in detail in last week’s post, the Trump administration stumbled badly at the starting gate in addressing the need to quickly mass produce test kits. That failure still haunts us. To make matters far worse, President Trump wants to wash his hands of a problem that he created and has refused to solve, and to pressure governors to restart the economy without adequate testing capacity. His insistence that establishment of testing programs necessary to safely reopen society is a state responsibility not only is maddeningly wrong, it is criminal nonfeasance of his own duties in this national emergency, in my opinion.

I was prompted to write this new post by an article published in the Atlantic titled “Without more tests, America can’t reopen – And to make matters worse, we’re testing the wrong people.” The article describes what an ideal testing regime would look like if we are serious about making it safe to return to anything resembling business as usual in this country – and states that we are nowhere near the point of being able to implement such a regime.

The article takes direct aim at current CDC guidance, which gives priority first to hospitalized patients and symptomatic health-care workers, and then to high-risk patients (people over 65 or suffering from serious health conditions) displaying COVID-19 symptoms. Under the CDC guidance, asymptomatic individuals are not tested, even if they had contact with people who tested positive.

In possible defense of the CDC, I will make a point that I have made in the past about CDC guidance and the standards of other federal agencies: They are not “aspirational” in nature. They are based on what reasonably can be required under the circumstances. It is not reasonable to require a broader testing program when tests are not available to implement it.

To my knowledge, the CDC has not stated that its current guidelines are adequate for reopening society. If it has done so, then I stand corrected. If it has not done so, then when is it going to issue updated guidelines for a broader testing program? If the CDC is waiting for more testing capacity to come online before updating its guidance, then maybe Dr. Redfield, head of the CDC, should just say so, no matter how much it annoys Trump.

The authors point out that a testing program designed to make it safe to relax restrictions must focus on potential asymptomatic carriers of the disease, interdicting transmission of the disease at the points at which it is most likely to be spread. They recommend widespread use of testing for screening purposes, and they group people into four general categories in order of testing priority.

The first priority is health care workers and medical first responders. The second includes people who also interact with many other people and are vital to keeping the country going, such as grocery and postal workers and police officers. The third group is for anyone who routinely comes into contact with large groups of people either in the course of their employment or family life. And the final group includes everyone returning to their workplaces.

I offer an oversimplified explanation for people, like our president, who seem to have trouble understanding the importance of the widespread testing described in the Atlantic article. I will use an analogy to a vector-borne disease, the bubonic plague, which is spread from infected rats to humans by flea bites.

If there was an outbreak of bubonic plague in a United States city, one thing that would be done would be to try to eradicate as much of the rat population as possible. The more rats running around infected with the disease, the higher the risk of spreading it to humans – the more infected rats, the more infected people. You would not interview the rats, take their temperatures, or test them to determine which ones were carrying the plague bacteria, and then isolate them from their peers. You would just kill them.

That approach does not work with people, but the problem is the same: The more undiagnosed asymptomatic carriers of COVID-19 there are in the community, the more the disease will spread. You can’t kill the carriers of COVID-19 (despite what Trump or Dr. Oz might think), so what you must do is try to identify those carriers and then prevent them from spreading the disease by isolating them until the disease runs its course.

We currently are testing about 120,000 – 145,000 people per day for COVID-19. According to some experts, that number will have to triple to around 500,000 tests per day for society to safely reopen. Other experts cited in the Atlantic story put the number much higher, into the millions.

Ever since Trump disclaimed federal responsibility for the testing, accurate information has been hard to come by on the status of test production; Vice President Pence talks in generalities, and there is no one at the briefings able to be more specific. I believe that we must assume the worst and that plans are not in place to assure production of sufficient tests.

I described in last week’s post how the Defense Production Act should have been used to assure production by manufacturers of an adequate number of test kits on an expedited basis – only the federal government has the legal power to do that. The news media must press Trump or Pence on how they intend to make sure that we have the capacity to test 500,000 per day or more as necessary to reopen the country for business as they have stated they want to do. If they do not believe that making the necessary number of test kits available is the job of the federal government, then force one of them to put that on the record.

As the Atlantic article also points out, we also must do contact tracing to identify other people to whom carriers may have transmitted the disease. The authors estimate that we will need to hire and train 100,000 to 200,000 additional health care workers to do the contact tracing. Where are we on that task? Has that become another “state responsibility”?

 Misconduct in office

The failure of the federal government to adopt and implement an effective national strategy for diagnostic testing of the COVID-19 coronavirus as soon as the pandemic was on the horizon was the “original sin” of the federal response. It continues to haunt us today and will do so for the foreseeable future. Trump already is on thin ice in terms of his conduct, but in my opinion if he continues to abrogate his responsibility to increase test production and pushes states to reopen before adequate testing capacity exists he has crossed a line to the point where his conduct clearly can be described as common law misconduct in office, an impeachable offense.

Misconduct in office can be committed by misfeasance, malfeasance, or nonfeasance. I am not going to belabor the issue, because there is virtually no chance that Trump will be held accountable by Congress for his misdeeds, no matter how serious. But I believe that it is worth keeping in our minds just how callously indifferent Trump has been to the health and safety of Americans, reckless in both words and actions. If his conduct hasn’t been criminal, then it should be.

Trump has a duty to oversee an appropriate federal response to a national emergency. He cannot just refuse to perform that duty because he finds it politically uncomfortable. In a court of law, Trump would be held to the knowledge that he is not “liberating” the people of Michigan, Minnesota, Virginia, etc. He is sending them to their deaths.

 

President Donald Trump has made a truly cynical and potentially deadly calculation. Fearing political harm from a continuing economic downtown more than he fears causing unnecessary loss of lives from the COVID-19 pandemic, he is determined to push an early re-opening of businesses, stores, and institutions regardless of the risks.

He repeatedly has been advised by experts that the economy can be safely be re-started only when there are sufficient rapid-result test kits available to do much more widespread testing than is now being done. Such testing is needed so that the extent of the virus in the community is known and that people with COVID-19 can be identified and isolated. He also knows that there still are nowhere near enough test kits to do that.

Instead of accepting the obvious federal responsibility for the shortage of tests, however, he alternatively denies the shortage and seeks to thrust the responsibility for it onto the states. I.e., there is no shortage, but if there is a shortage it is the states’ fault. Two days ago, he tweeted this:

“Governors, get your states testing programs & apparatus perfected. Be ready, big things are happening. No excuses!”

Trump is fully aware that he is pressing for actions that will kill people. He believes, however, that by creating the false narrative that states are responsible for any failure to do sufficient testing he can blame the loss of life attributable to a premature relaxing of restrictions on the governors. Even for Trump zealots, this may prove to be one big lie too many.

 The approval, manufacture, and distribution of a sufficient number of diagnostic test kits to bring the pandemic under control is and always has been a responsibility of the federal government.

Assuming an argument can be made about state and local responsibility for having sufficient numbers of ventilators, masks, and other ordinary medical supplies on hand to meet a national emergency (it can’t, by the way), there is no argument about the approval and production of sufficient diagnostic tests for a newly-discovered disease. It is a process controlled by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) and is unquestionably part of the necessary federal response to a pandemic that has been declared a national emergency.

Trump’s general dithering as the pandemic evolved has been well-documented by the New York Times, Washington Post and other news sources. The lack of urgency in the federal response was especially problematic when it came to the approval and production of test kits. It is worth reviewing how the the test kit problem began, because it illustrates just how outrageous it is for Trump to suggest that he is going to hand over to state governors a problem that his administration created and still has not solved.

 A superb, detailed account of how the federal government fumbled the testing ball, and how we made mistakes that South Korea avoided, was published by Reuters on March 18^th. It’s absolutely essential reading for anyone interested in understanding where we went wrong with the testing. I’ve summarized the highlights of the missteps below.

The CDC runs into a problem, and the delays begin.

Chinese authorities first detected an outbreak of a “novel,” or new type of, coronavirus in December 2019 in Wuhan province. On January 11, 2020, Chinese scientists posted the genome of the new virus on an open website.

Within a week, German virologists produced the first diagnostic test. It was approved by the World Health Organization (WHO) and by February 6^th the WHO had shipped 250,000 diagnostic tests to 70 laboratories around the world.  By the end of February more than 1.4 million tests had been sent to nearly 60 countries, not including the United States.

The CDC did not authorize the WHO test for use in the United States, following its standard practice of producing its own test for a new virus to ensure accuracy and reliability. Unfortunately, shortly after the CDC began distributing its own test kits on February 5^th, local labs reported that the CDC tests were producing inconsistent results. It turned out that the test kits were faulty and had to be replaced. Valuable time was lost.

The FDA compounds the problem, and the delays continue.

The first confirmed case of COVID-19 in the United States was diagnosed in Washington State on January 20^th. By February 24^th, still lacking usable tests from the CDC, health officials in Washington and elsewhere grew desperate. The Association of Public Health Laboratories sent a letters to Dr. Stephen Hahn, the FDA commissioner, asking him to use his legal discretion to waive standard approval protocols and allow state and local public health laboratories to create their own tests for the virus. He initially declined to do so.

On February 29^th, however, the FDA relented and announced a new policy to make it easier for hospital laboratories to develop their own tests. We now know that many public and private laboratories had been chomping at the bit since early January to develop tests.

Olfert Landt, head of the German lab that developed the first diagnostic test for COVID-19, believes that the United States waited too long before using private companies to develop the tests. He stated that the pandemic was too big and moving too fast for the CDC to develop its own test in time. “There are ten companies in the U.S. who could have developed the tests for them,” Landt said. “Commercial companies will run to an opportunity like this.”

South Korea has a regulatory system similar to ours. During the outbreak of another coronavirus in 2015, MERS, it had learned a deadly lesson about the need to get test kits in the hands of clinicians quickly. The lesson, of which American epidemiologists were aware, was that routine approval procedures were too slow to deal with a coronavirus. The South Koreans were determined not to repeat the mistake with COVID-19 that they made with MERS in 2015.

South Korea had its first diagnosed case of COVID-19 on the same day as the United States, January 20^th. On January 27^th, South Korean officials met with representatives of 20 medical companies at a train station, urging them to begin work on developing tests for COVID-19, promising quick regulatory approval.

A week after the meeting, South Korea’s CDC approved one company’s diagnostic test. An approval process that normally takes up to a year-and-a-half in South Korea took one week. Another company soon followed. By the end of February, South Korea had drive-through screening centers and the ability to test thousands of people daily.

South Korea used its ability to do quick and widespread testing, along with an extensive program of contact tracing, to identify and isolate those in the community infected with the virus. It’s ability to slow the spread of the virus through those measures dramatically decreased the incidence of and death toll from the disease and allowed officials to avoid severe restrictions on businesses and schools, softening the impact of the pandemic on the economy.

Why did we fail where South Korea succeeded?  

South Korea acknowledged that its expedited approval of testing sacrificed accuracy for speed, but correctly believed the need for speed was paramount; using reasonably accurate tests was better than forcing public health officials to fly completely blind. As manufacturers developed more accurate tests, the early test kits were replaced with the more accurate ones.

The FDA eschewed South Korea’s approach, and erred on the side of caution. Alberto Gutierrez, who led the FDA’s office overseeing diagnostic testing from 2009 to 2017, explained that the agency proceeds with caution because it sees itself as the last line of defense against opportunistic companies looking to cash in on threats to public health, claiming that “the FDA had good intentions.”

“There is money to be made in an emergency, and a lot of people try to take advantage of that,” Gutierrez told Reuters. “The problem the FDA faces is, do you let it become the Wild West?”

Good intentions are one thing, the bigger picture in controlling a pandemic caused by a deadly and rapidly spreading virus is quite another, and it’s hard to believe that the Wild West was worse than what is going on now. In defending the FDA’s slow, cautious approach, Dr. Deborah Birx, the State Department official coordinating the White House COVID-19 task force, stated last month that a less reliable test can result in “false negatives,” meaning test results erroneously indicating that people with the disease do not have it.

That is true, but having no test means that far more people with the disease will go undiagnosed. Did the FDA simply let the perfect become the enemy of the good, somehow failing to recognize that time was of the essence and that waiting for the “perfect” test would cripple efforts to contain the pandemic? It seems doubtful; I believe that there is more to it than that.

Dr. Robert Redfield, head of the CDC, made clear that it was the FDA that called the shots on approval of testing by private labs. A lot of the blame for the slow roll out of test kits therefore fell on Dr. Stephen Hahn, Trump’s appointee who took over as commissioner of the FDA on December 17, 2019.

Dr. Joshua Sharfstein is a former principal deputy commissioner of the FDA as well as a former Secretary of the Maryland Department of Health. Although he agreed that the FDA should have moved more quickly to authorize public and private labs to develop and use their own tests, he did not put all of the blame on the FDA. “The FDA can design an approach to support the public health strategy, but someone has to tell FDA the public health goal,” he said.

Scharfstein also referred to the pandemic response team on the National Security Council under the leadership of Admiral Timothy Ziemer that Trump eliminated in 2018 when discussing how a lack of leadership from the White House may have affected the FDA:

“People talk about, like, why does it matter that they closed the White House office on pandemic preparedness? This is one reason.”

It is not clear that the absence of Ziemer and his team, competent and experienced as they were, would have made any difference. Since Scharfstein made his comments we have learned from the New York Times the extent to which Trump’s stubborn refusal to take the pandemic more seriously, despite the pleas of advisers and other experts, delayed the federal response.

Trump was heavily invested in his boast that the partial ban he placed on travel from China on January 31^st had succeeded in preventing a serious outbreak of COVID-19 in the United States. On February 24^th, the same day that the Association of Public Health Laboratories sent its frantic letter to Hahn urging him to green light approval of test kits because the window was closing on the opportunity to contain the outbreak of the virus in the United States, Trump tweeted the following:

“The Coronavirus is very much under control in the USA. We are in contact with everyone and all relevant countries. CDC & World Health have been working hard and very smart. Stock Market starting to look very good to me!”

The Trump administration received its first formal notification of the outbreak of the coronavirus in China on January 3^rd and within days United States intelligence agencies were warning about the threat in the President’s Daily Brief. Seventy days later, on March 13^th, Trump declared the pandemic a national emergency. The Washington Post described in detail how the intervening 70 days, which could have been used to ramp up the federal response, largely were squandered.

In summary, I find it hard to believe that it was nothing more than the failure of the FDA to recognize the urgency of the situation that caused it to move so slowly. We may not know until Trump leaves office, or at least until subpoenas are issued and testimony taken under oath, whether Trump had a personal hand in the FDA’s laggardly response to the pandemic, but the agency’s actions seem remarkably consistent with Trump’s own lackadaisical approach to the emergency.

We do know that Trump has never even acknowledged the need for widespread testing, for reasons at which we can only guess. And we also know that the delay in making tests widely available already has caused many deaths, and will cause many more.

Why is the distribution of test kits still lagging behind need?

Given the almost universal agreement among experts that society cannot safely be “re-opened” until testing is much more widely available, you might think that 1) there would be specific production goals for additional tests based on the number of tests needed to lift restrictions, and 2) a concrete plan for meeting those production goals, with a timeline.

 If you think that, then you haven’t been watching Trump’s pandemic briefings. One of my many frustrations with those briefings is that reporters have not been pressing Trump on this issue.   

Trump has consistently denied that there is a test kit shortage. That denial pretty much rules out Vice President Pence and his task force initiating a discussion on the extent of the shortage and how to address it, even though the shortage of test kits remains the biggest impediment to bringing the pandemic under control, short of a vaccine.  

And it also means that there is a conspicuous absence on the stage during the pandemic briefings: Someone with knowledge of the scope of the test kit problem, and the expertise to know how to solve it. Drs. Fauci and Birx are experts on the control of the disease, not on the logistics of manufacturing and distributing test kits. The closest thing to a medical logistics expert that we’ve heard from so far is Jared Kushner. Need I say more.

I believe that one of the reasons that Trump is ducking this issue is that closer scrutiny will reveal another major mistake involving the failure to use the Defense Production Act. As noted above, Olfert Landt, head of the German lab that developed the first diagnostic test for COVID-19, believed that commercial American companies would have jumped at the opportunity to develop and manufacture tests if the FDA had authorized them to do so from the start.

We don’t know if that ultimately occurred, but even if it did, I believe that it would have been prudent for the federal government to step in via the Defense Production Act to do the procurement. That would have assured a specific level of production, stabilized the supply chain, eliminated price gouging, and enabled distribution of the tests where most needed.

Using the Defense Production Act may still prove to be necessary. We have received so little useful information on the test kit shortage that it is hard to know. I believe that we are being kept in the dark by design.

Is Trump serious about exercising powers that he doesn’t have?

Today Trump doubled down on his incorrect claim that he has the power to overrule state governors and lift restrictions on public gatherings, workplace closures, etc., tweeting:

“For the purpose of creating conflict and confusion, some in the Fake News Media are saying that it is the Governors decision to open up the states, not that of the President of the United States & the Federal Government. Let it be fully understood that this is incorrect…It is the decision of the President, and for many good reasons.”

I doubt that even his slimy Attorney General, William Barr, has told him that this is true. The president has no such power under our federalist system.

Trump wants it to appear as if he is the one trying to save the economy, but without accepting responsibility for the consequences of reopening schools, stores, and businesses too early. If governors push back on reopening, he will accuse them of promoting an economic downturn to hurt him at the polls. If they do reopen, and it turns out that they did so too soon, he will blame them for being unprepared with their “testing programs.”

I may be wrong, but I believe this time Trump is being too clever by half. His mistakes and the mistakes of his administration are too well-documented to bullshit his way out the mess he has made of the federal pandemic response. People are dying, and that tends to make us finally sit up and pay attention.