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.