In January 2020, the worst public health emergency in over a century was brewing. By January 30, the World Health Organization recognized it as such. But the United States struggled with one of the most basic tenets of controlling a pandemic: knowing who is infected. Unlike in other countries and despite having the know-how and the technology, tests for Covid-19 were not widely available for weeks, with the FDA only approving private labs to use their own tests by the end of February of that year. By that time, the SARS-CoV-2 virus had already spread. That head start, and a continuing deficit in access to frequent, rapid testing, is one reason the US has since recorded over 700,000 pandemic deaths.

In interviews with experts, this video explores what went wrong with testing early in the pandemic, why that was a problem and the testing strategies that could be put in place now to slow down the spread of Covid-19.

“In the United States, one of the major problems in the response to the pandemic started right at the start with testing — you cannot tell where the virus is, or if somebody is infected with it, unless you test for it,” says Bill Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health. “Once testing becomes available, you suddenly turn on the lights and you see that there’s a huge problem. And by that stage, it’s a little bit too late to be able to control that problem.”

Genomicist Pardis Sabeti, whose lab at the Broad Institute of MIT and Harvard developed its own diagnostic test soon after the SARS-CoV-2 genome was published, concurs. “There are 260,000 clinical labs in the United States,” she says. But more than a year into the pandemic, only about 200 of these had created their own tests, choosing to wait for commercial options instead. “To do it right in the future, whenever a new viral threat emerges, we have to position the 260,000 clinical labs to be able to set up testing right away.”

A more robust national plan for Covid-19 surveillance, including greater access to rapid testing, is still a key strategy for curtailing the pandemic.


This video is part of Reset: The Science of Crisis & Recoveryan ongoing series exploring how the world is navigating the coronavirus pandemic, its consequences and the way forward. Reset is supported by a grant from the Alfred P. Sloan Foundation. Watch more videos from Knowable Magazine.

Video Transcript:

William Hanage (epidemiologist, Harvard University T.H. Chan School of Public Health): “In the United States, one of the major problems in the response to the pandemic started right at the start with testing. You cannot tell where the virus is or if somebody’s infected with it unless you test for it. And even though there were very good tests available and being used, in for instance Vietnam, since January, the United States developed its own test. And this was being done through CDC. There were a number of missteps made, notably an issue with contamination meant that some of the tests that were sent out could not be used in the way that they were intended and so there was a recall and there was a period of around three or four weeks, maybe, in which the virus could spread pretty much unchecked. And this was a point when essentially we were flying blind.”

Andrew Lo (economist, MIT Sloan School of Management): “Testing is one of the key issues because once we understand who is actually getting infected, where they’re getting infected, how they’re getting infected, we can do a lot more to be able to intervene effectively. We can’t manage what we don’t measure. And unfortunately, in the early part of 2020, we were doing very little measurement.”

Pardis Sabeti (computational geneticist, Harvard University): “Problem No. 1 is just that the way a lot of the FDA works during outbreaks. It makes it more difficult to set up your own test. In January my lab had tests working and in February they were being used at our sites in Africa. Even though it’s not FDA-approved, we had working diagnostics in place in Nigeria, Sierra Leone and Senegal before any US hospital. It’s not hard to do and it’s something that every hospital in this country should be prepped to do.”


Anthony Fauci (director, National Institute of Allergy and Infectious Disease): “It is a failing — let’s admit it. We’re not set up for that. Do I think we should be? Yes, but we’re not.”

US Rep. Deborah Wasserman Schultz (D-Fla.): “OK, that’s really disturbing and I appreciate the information.”

US Sen. Mike Braun (R-Ind.): “The FDA prevented private and academic development of tests for weeks.”


Pardis Sabeti: “As soon as the FDA unit here in the United States allowed hospitals to engage, we were able to quickly transition. And we worked with Mass General Hospital and had working diagnostics there within days of the approval to do so.”

William Hanage: “And of course once testing becomes available, you suddenly turn on the lights, and you see that there’s a huge problem. And by that stage it’s a little bit too late to be able to control that problem.”


Newscaster: “After shattering another record for daily infections, tonight more Americans than ever are hospitalized with Covid.”


William Hanage: “It is a matter of scientific fact that the delays and testing seriously hindered the pandemic response. I think it’s worth remembering many people don’t recognize a catastrophe until it is upon them. And you cannot escape the fact that at the federal level in this country, the attitude to the pandemic was truly to stick its head in the sand, and for a long period of time.”


President Trump: “The testing is not going to be a problem at all.”

Newscaster: “President Trump’s new blueprint for testing does not set specific goals or time frames and says the federal government should be a supplier of last resort.”


William Hanage: “The federal government brought a rubber chicken to a gunfight. The situation is that this is the most severe infectious-disease emergency that has happened in a century, and you need to sit up and recognize this.

“One really interesting thing about the United States health-care system is its fragmented nature. There are different places that you can get tests done. Tests are not necessarily done in the state where the sample is taken; they can be shipped off to a company. That means that it becomes more difficult to take a coherent action, to make any kind of coherent national plan, and of course over the first year of the pandemic there wasn’t really any interest from the federal government in terms of coming up with a coherent national plan.”

Anthony Fauci: “What we depend on in the United States is the private enterprise, the various independent companies that make it and distribute it, and that’s just the system, the way it works.”

Apoorva Mandavilli: “It’s really been shocking to see how chaotic and disorganized the public health infrastructure in this country is. At an individual level everybody’s working hard, at an individual level every public health expert is doing their job, but as a collective? There’s a real failure.”

Pardis Sabeti: “There are 260,000 clinical labs in the United States, and as of today only 200 of them set up their own tests. All of the rest of them just waited for commercial tests to become available, and those commercial tests had huge backlogs. And so everyone was literally just calling and being like, ‘Where’s my test?’ as opposed to just ordering some primers and just running tests yourself.”


Newscaster: “With the death toll rising, experts warn the US is losing the battle over coronavirus testing. Researchers at the Rockefeller Foundation warn America faces an impending disaster.”


Pardis Sabeti: “To do it right in the future, whenever a new viral threat emerges, we have to position the 260,000 clinical labs to be able to set up testing right away, to be able to be picking up these things as fast as possible while we kind of hold the line until manufactured kits can be made available to more people.

“As soon as Covid hit, every organization — all professional sports teams, the White House — everyone’s thinking ‘How do I keep working?’ So a lot of the organizations that were well-supported started doing a lot of testing on their own members.”


Newscaster: “As long lines form at coronavirus testing sites across the country, it seems professional athletes are having no trouble getting their results. The Brooklyn Nets announced four players have tested positive for the virus.”


Pardis Sabeti: “In some extreme examples, people are literally testing healthy young people every single day; meanwhile, the community around them is burning to the ground, and people are waiting a week for a result. And you’re getting, you know, 24-hour turnaround on people that are healthy, that are getting tested daily. And that’s great if that’s something that’s possible, but if you’re looking around you, and everybody in your community doesn’t have that support, to me it just didn’t make sense.

“We ran a lot of models that modeled these sort of two compartments, an institution and the people in the community around it, and we said, ‘Why don’t you just take your test and use it outside the institution?’ — which would go better? We found in every single instance it was better to at least use some of your tests beyond your walls, and it was more that at least half of your tests you should use outside of your walls. In some instances you should use nearly 100 percent of your tests beyond your walls, because if you’re testing yourself you’re not actually stopping the problem. It’s just a Band-Aid on something that’s continuing to happen. And so if you really want to stay safe behind your walls, you have to actually test beyond them.

“In general when there is a limited amount of resources, we need to prioritize individuals who are sick and symptomatic, individuals who are in contact with people who are symptomatic, do case investigations where we figure out areas where there might be a lot of cases and really explore there. And so while it’s great that a lot of institutions were able to set up testing for themselves — and it was a good exercise — it was not the right way to use the limited amount of tests that we had. We should have had those institutions work to help to find all cases in a community.

“You know, the best thing we can do to keep ourselves safe is to keep our community safe. One of the reasons why we had testing for SARS-CoV-2 a week after the virus was reported is that’s part of our job. If a new virus emerges, we’ve got a new diagnostic ready to go and they’re going to be implemented in the site immediately. And so that is what we do for the sites we work in and what we think needs to happen around the world.”

Apoorva Mandavilli: “I think it’s a real concern as we go into the fall, that Delta has changed the picture. We’re not doing anywhere near the kind of testing that we could be and should be. There are a lot of experts who have said that a lot of rapid testing can really help us in this pandemic. I think they’re right, because we don’t really know where the virus is until it’s too late. A lot of the time we’re just reacting — “Oh, look, the numbers have gone up very high, now we’re going to start taking precautions” — instead of knowing where the virus is, where the clusters are. So this is another place where the federal government really failed this country. I think there wasn’t enough thought put into how to do testing. We just missed so many opportunities along the way to make testing really easy and really cheap — really accessible to everybody.

“One very big lesson from this pandemic is that we don’t really have good systems in place to know when there’s a new pathogen that’s circulating. One thing this has told us is that the world is so interconnected, that we can’t just take care of surveillance in our own country and forget about everywhere else. If there is something that is growing somewhere else, it is going to come here. So the world needs to come together to figure out how to alert each other to an emerging pathogen — can’t just be left up to the World Health Organization, which these days is underfunded and really quite beholden to the US and China. We need so much more surveillance on an international scale.”