Testing debacle

How a 96-hour project helped Trump's team reverse its testing debacle

Public-private partnership sees some results, but can it produce enough Covid-19 tests to reopen the country?

By DAN DIAMOND

Fifty-two days ago, the president vowed to a worried nation: Coronavirus testing is finally coming, and you won’t even have to leave your car.

“The goal is for individuals to be able to drive up and be swabbed,” President Donald Trump said in an address in the Rose Garden on March 13, previewing a network of drive-thru tests in places like Walmart parking lots. “We have many, many locations behind us, by the way,” Trump added. “Stores in virtually every location.”

Trump’s remarks thrilled public health experts, who had been terrified that Covid-19 was silently spreading with no way to easily detect it. The United States had completed a mere 20,000 total tests by that day, they estimated, even as South Korea — which had already launched its own drive-thru testing network — had tested nearly 250,000 people for the coronavirus. But excitement quickly turned to disappointment, as the administration's promised drive-thru sites were limited to a handful of locations in 10 states and the rollout was far from seamless; local officials received just a fraction of the test kits they were expecting.

The Community-Based Testing Site program would end up serving just 116,234 people in its first month, according to an internal tracker obtained by POLITICO. State officials and public health experts lamented the missed opportunity to test more people and slow the virus’ spread. The episode has been held up as a prime example of the White House’s unrealistic coronavirus proclamations, like the president’s March 6 pledge that “anybody that wants a test can get a test” — a promise that remains unfulfilled nearly two months later.

Yet inside the administration, and among its retail partners, the drive-thru effort has been viewed quite differently: as a successful prototype. The team that assembled the drive-thru initiative in about 96 hours — a coalition of administration technocrats, career civil servants and private-sector volunteers who were rapidly thrown together the day before Trump’s Rose Garden remarks — has become the heart of White House efforts to conquer the all-consuming problem of producing enough tests to safely reopen the economy this month.

That unorthodox team, assembled by White House senior adviser Jared Kushner, has achieved real progress: They’ve revamped medical supply chains, solved ventilator shortages and then devised a Covid-19 testing plan that the White House announced last week. National testing numbers have surged from a meager 5,000 tests on the day the team was assembled to more than 300,000 tests conducted last Friday. Even the much-maligned drive-thru program has now expanded to more than 100 sites in 30 states.

Public health experts say the need remains far greater, but acknowledged the improvements. “I think the administration is at a C now because they’re at least meeting the needs in a pandemic,” said a former Trump administration official, noting that the Kushner team had inherited an F after the administration’s lab-testing strategy failed across February. “But they’re not an A or B yet because we’re not getting ahead of the problem.”

Kushner, whom the president tapped two months ago to join the coronavirus response, said his team’s private-public partnerships were intended to supplement the administration’s ongoing efforts in the face of a pandemic. “It just took extraordinary creativity, focus, speed and untraditional approaches to help create an effective response,” he said.

POLITICO spoke with more than 15 officials, volunteers, advisers and private-sector executives directly involved in the White House-backed effort, who described a sprint against time to transform the nation’s Covid-19 response — even as the U.S. outbreak remains among the worst in the world — and insisted that the work was apolitical and shielded from White House pressures.

Officials working with Kushner’s team argue that drive-thru testing taught them the limits of what they could accomplish overnight. “There were tradeoffs,” said one senior administration official. “In the first 48 hours, we calculated that if we ran the [drive-thru] sites full speed, we could burn through 80 percent of the strategic national stockpile of personal protective equipment just on testing.”

The true test of the team’s work awaits in May, as states reopen their economies and millions of Americans head back to work, even as public health officials warn of a “slow burn” of continued infections that could top 200,000 new cases per week and death projections jump as states rush to relax restrictions. In order to contain the ongoing outbreak, there needs to be sufficient surveillance to uncover possible cases — and the White House insists that its rescue effort has secured enough supplies for states to run 8 million diagnostic tests alone in May. There were only about 6 million total tests conducted between January and the end of April.

"We are working with governors to make sure they have all the testing they need to open up safely," Kushner said.

Dan Bartlett, who runs corporate affairs for Walmart, was cautiously optimistic: “It’s definitely been a well-intentioned process that is complicated, and it’s taken time to find its footing,” he said. The retail giant launched two pilot testing sites in the Chicago area within 10 days of Trump’s remarks; now Walmart is up to more than 40 sites and aiming to scale to more than 100 sites by the end of May, Bartlett said.

Like some of its initiatives, the team behind it has been misunderstood and scorned, largely because of the involvement of one person: Kushner, the president’s son-in-law. Democrats have seized on Kushner’s role, clamoring for investigations and warning that the team may have inappropriately leaned on private sector volunteers.

“I don’t remember any Democrats saying it's terrible the private sector is helping save Obamacare,” countered conservative policy analyst Avik Roy, adding that key members of Kushner’s team — like Medicare innovation chief Brad Smith, U.S. foreign-investment czar Adam Boehler and Flatiron Health’s Nat Turner — have proven track records as health care entrepreneurs.

“I think they've made a huge difference,” Roy added. “You take a bunch of dedicated government officials … [and] layer on to that Adam, Brad and Nat are exceptionally talented and capable. You have the workings of a group that can actually move mountains.”

A coronavirus rescue team

That progress began late on March 11, where for the first time Trump appeared to grapple with the nation’s spreading coronavirus outbreak, after weeks of minimizing the risk.

“We are marshalling the full power of the federal government and the private sector to protect the American people,” the president said in a rare Oval Office address to the nation. “This is the most aggressive and comprehensive effort to confront a foreign virus in modern history.”

The president’s remarks were filled with glitches about new travel restrictions — reflecting the rushed pivot to address the virus’ severe threat — and they were partially scripted by Kushner, who off-camera was beginning to pull together the private sector efforts that Trump had just promised. By the next morning, he had recruited his longtime friend Boehler, an entrepreneur who first joined the administration’s health department in 2018 before shifting to a role last year overseeing U.S. investment in developing countries.

In a meeting at the Eisenhower Executive Office Building next to the White House, Kushner, Boehler, national security official Matt Pottinger, Trump policy aide Chris Liddell and other staff walked through the state of the nation's response. Kushner and Boehler then conferred on four key priorities, including the possibility of launching drive-thru testing sites modeled on South Korea’s popular model.

Smith, the newly installed head of Medicare’s innovation center, hadn’t been involved in the Covid-19 efforts to that point. (In fact, having just joined the Trump administration in January, Smith was still learning the many acronyms associated with his job and getting acquainted with his team, which was holding a meeting on social determinants of health that morning.) But Boehler — who had spent months recruiting Smith to the administration, convincing his one-time private sector competitor to walk away from a business startup — summoned him to the White House, where Smith was tapped to be the operations manager for the fledgling coronavirus rescue effort. The two health care entrepreneurs and dozens of other staff soon crowded into the Office of American Innovation, housed in the basement of the West Wing, as Kushner rounded through the office and laid out instructions.

Calls were quickly placed to retailers like Walmart to enlist their support and services, and to Obama administration veterans like Andy Slavitt, who’d helped lead the team to fix the broken HealthCare.gov website six years ago and became an outside adviser to the new group.

Meanwhile, Brett Giroir, a top Trump appointee in the health department, was tapped as the nation’s new testing coordinator — an overdue move to address the badly broken response. Giroir, who had been acting head of the Food and Drug Administration in late 2019, had spent recent days at the Centers for Disease Control in Atlanta, trying to uncover what had gone wrong after the agency’s troubled efforts to produce a coronavirus test. Those stints at FDA and CDC would help him understand the regulatory environment to speed tests to market, Giroir would tell colleagues.

A focus on drive-thru sites

By the morning of March 13, the new team had settled on the drive-thru testing project as its first priority, only a few hours before Trump would make the announcement in the Rose Garden.

But they faced several practical challenges, including one major operational problem: “No one in the government had ever set up something like a drive-thru testing site before,” said Smith. “It turned out that actually doing that was pretty hard.”

The team’s leaders turned to members of the Commissioned Corps — the nation’s uniformed public health team, who work under the Surgeon General — who had recently returned from coronavirus-infested cruise ships in order to figure out the potential workflow of how testing would even work. Across the weekend, the team determined what testing materials and personal protective equipment each drive-thru site would need — and after discovering that the strategic national stockpile only had about half the necessary supplies, conducted its own efforts to locate and acquire them.

Meanwhile, the Kushner team was working to convince retailers to allow them to set up drive-thru sites in their parking lots — a terrifying notion for some executives, worried about the perception of being Covid-19 hubs and the potential risks to their other customers, several executives acknowledged to POLITICO.

“You could imagine all the reasons not to do it. And the lawyers were arguing that case,” said Boehler. “And at one point [Walmart CEO] Doug McMillon said if ‘we’re not going to step up, who’s going to do it?’” Boehler added. “Everything switched at that moment.”

By Tuesday, four days after Trump’s remarks, test kits and other supplies were finding their way to partners in states – though the breathless and chaotic process seemed designed more to meet the White House's announced timeline than test people on a large scale. Seattle officials said they were initially promised 10,000 test kits and staff support from federal agencies, but as the administration's offers changed rapidly from day to day, ended up with only 4,000 kits and local officials had to staff the sites themselves.

“We always appreciate testing supplies. We put a number of them to use,” said Casey Katims, the federal liaison for Washington state. “We were grateful for that. But logistically there were challenges.”

The drive-thru plan would be symbolic of the challenges the team would face. The Community-Based Testing Site program, as it’s known inside the White House, did help several hard-hit cities like New Orleans get a handle on their emerging coronavirus infections — but the drive-thru program only led to tens of thousands of tests per week, generally limited to at-risk populations like first responders or the elderly, and not the nationally accessible program that many Americans were led to believe Trump was creating.

Meanwhile, some federal health department officials not involved in the effort saw it as a Band-Aid on the much larger problem of coronavirus testing shortages. “This was like a PR project cooked up so Trump could have something to tout,” said one official in the health department, whose team was also working to address the Covid-19 crisis and worried that the drive-thru plan was sapping focus from longer-term initiatives.

But the top officials who worked on it, like Boehler and Smith, experienced it as a crash course in the intricacies of Covid-19 testing and described it as akin to their experiences standing up new businesses.

Retailers have echoed the Trump administration line. For instance, Walmart’s Bartlett said that the giant retailer’s two pilot sites in March provided a real-time learning lab, teaching Walmart how to position the sites and its own personnel, figure out how many supplies are needed — even how to deal with complex interplay of local, state and federal regulations, like what to do with the biowaste generated by the testing.

While Walmart’s initial drive-through sites needed as many as 15 staff per location, its sites now require as few as two or three staff. The retailer last week launched mobile testing units too.

CVS, which launched its own pilot site in Massachusetts on March 19, says the public-private partnership prepared it for the massive rollout of self-swabbing tests it’s aiming to make available in up to 1,000 stores this month.

“Our team worked around the clock to open a test site six days after the Rose Garden announcement, then used those learnings – and newly-available technology – to change our strategy and dramatically increase testing capacity,” spokesperson T.J. Crawford said. The company is now moving toward a goal of performing up to 1.5 million tests per month on its own.

Overhauling supply lines

The team’s operations swiftly shifted to the Federal Emergency Management Agency’s squat headquarters on March 19 and began focusing on supply-chain overhauls, such as developing the “Project Airbridge” supply-flights to rapidly bring tens of millions of medical supplies from overseas into the United States, rather than waiting for the products to be shipped by sea, and working to encourage private-sector companies to spin up production of ventilators and other devices.

Team members said that the stakes felt especially dire, as doctors in Italy were reporting shortages that were forcing them to ration ventilators, and New York Governor Andrew Cuomo was insisting that his state needed tens of thousands of ventilators in order to avoid a similar fate.

“You really felt the impact of the work we were doing,” said one team member. “We were making decisions where it felt like hundreds or thousands of lives were at stake.”

That supply work would become even more politically sensitive as the White House battled with states over its role in procurement, and Trump sought to position the federal government as a “backup” to local officials.

“We don’t need a backup. We need a Tom Brady,” Washington Gov. Jay Inslee told Trump on a March 26 conference call with governors. The widely publicized comment, which Trump later addressed in a press briefing, was focused on Inslee’s concerns about a shortage of coronavirus testing swabs in Washington state, said one person with knowledge of the call. Giroir and other officials reached out after Inslee’s complaint, but more than a month later, Washington state officials warn they still have concerns about swab shortages.

“We’ve been disappointed by how slowly the administration has come to the realization that supplies are the key problems with testing,” said Katims, the Washington state liaison. “It spoke to a misunderstanding of where the lab challenges are.”

Other governors decided to take the supply issue into their own hands. Maryland Gov. Larry Hogan and his wife, a native Korean speaker, on March 28 began a dialogue with South Korean officials to acquire hundreds of thousands of tests for his state, a spokesman for Hogan said. The test kits arrived three weeks later — and Hogan had them flown to a Baltimore-area airport and protected by the National Guard, fearing that federal officials would find a way to confiscate them.

Faced with angry governors, administration officials said the rescue team was making a rational choice: it was impossible for the federal government to be the national supplier. “There was an initial reticence to own the issue federally because the capacity was at the state and local level, and we didn’t initially have the federal resources to meet demand,” said an administration official with insight into the plan. “No matter how well you did, we also knew it was never going to be considered good enough.”

Meanwhile, the Kushner team began to draw attention as a “shadow task force,” unfavorably compared to the televised briefings that Trump and his key deputies gave from the White House every day. One watchdog, the Citizens for Responsibility and Ethics in Washington, warned that the group’s use of “private email accounts with no assurance their communications are being preserved” appeared to violate federal records laws.

Democratic skepticism about the group hardened, as members of Congress looked for possible financial conflicts and focused intently on the role of Kushner.

“Our first concern is that Jared Kushner — President Donald Trump’s son-in-law and senior advisor — has been managing a ‘shadow task force’ of key government officials and private sector actors tasked with coordinating the private sector response,” Democratic senators Elizabeth Warren, Tom Carper and Richard Blumenthal wrote last month to the White House’s top ethics official. The Democrat-led House Oversight Committee also has looked into the role of roughly two-dozen volunteers from cancer-technology firm Flatiron Health, private-equity firm Welsh, Carson, Anderson & Stowe, and investment fund Insight Partners.

The growing intense spotlight unsettled some team members, who worried that the role of the private sector volunteers — who some officials had flagged to the media for using personal emails — had been overblown. “They had nothing to do with contracting, and they’d leave the room anytime there was a sensitive conversation,” said one person with knowledge of team operations. Overall, the private-sector volunteers accounted for just 10 percent of all people working on the team’s efforts, estimated two team leaders, who said the volunteers’ work largely focused on analysis and sourcing calls. The team instead was mostly staffed by officials at FEMA, HHS and the White House, including some of Boehler and Smith's own deputies, as well as dozens of federal contractors.

The harsh scrutiny also rankled White House officials, who worry it’s putting politics over public health. “In the face of this unprecedented crisis, these volunteers dropped everything to help our country,” said Boehler. “I’m proud of them.”

“It wasn’t a shadow task force,” Kushner said, adding that he was on the White House’s coronavirus task force led by Vice President Mike Pence, who encouraged him to coordinate innovation efforts between the White House and the health department. “I think people have made this with more mystique than it actually has.”

An April-long push for more testing

At the end of March, Trump had extended the White House’s social-distancing guidelines through the end of April, which team members took as a signal: be prepared for the economy to re-open by May.

“We knew there was a good chance that we’d need to get a lot more testing capacity online in May,” said one official involved in the team’s preparations. “But unlike the drive-thru project, where we had a few days, we had weeks of runway to plan for it.”

Team members on April 1 began working to identify total lab-testing capacity, interviewing dozens of companies to develop projections for how much diagnostic testing would be coming online. The group also met with outside experts like Scott Gottlieb, Trump’s former FDA commissioner who had outlined a plan for re-opening the economy that depended on having sufficient testing available.

A new testing task force then kicked off on Monday April 6, with White House coronavirus coordinator Deborah Birx soon joining the effort to provide more clinical expertise, and team members began reaching out to a slew of firms to identify and source potential products. For instance, U.S. Cotton changed production of its existing Q-tip swabs at an Ohio factory into a swab that could be used for specialized Covid-19 testing, with the coronavirus rescue team working with the FDA to speedily win permission to use the devices.

Officials said that the earlier drive-thru project also laid key groundwork by establishing ties with firms that would be relied on again, such as lab equipment company Thermo Fisher, which can perform mass amounts of automated testing.

“Had we not done that work, there’s no way we would’ve ramped as fast as we did” on the April projects, said Smith. “I don't think we would have that momentum with the manufacturers and with the retailers.”

By the week of April 13, the team had briefed Kushner and Chief of Staff Mark Meadows: the federal government could acquire enough supplies to ensure that states could conduct 8 million Covid-19 tests in May, at the time more than double the 4 million tests that had been cumulatively performed. The team also had drawn up state-by-state lists of unused testing capacity that they believed would allow local officials to multiply the number of tests they performed.

The plan was then brought in front of Trump himself on the afternoon of April 20 — who liked it so much that he asked Smith to present it on national TV at the White House press briefing, less than an hour later. Smith frantically dashed to Kushner’s office to work on his remarks, where he would stress that states needed to take advantage of their existing lab-testing machines.

But the announcements, and the state-by-state list of lab capacity in particular, rankled some governors, who said they needed more supplies immediately — and not instructions from Washington on how to use their lab equipment.

“This does nothing to answer the repeated calls from governors to address the lack of swabs, viral transport media, reagents, and other supplies and personnel needed to take advantage of that lab capacity,” Inslee wrote to Vice President Mike Pence on April 21.

Looking forward

On April 27, the collection of retailers and suppliers from the March 13 drive-thru announcement had returned to the Rose Garden, where Trump touted the work by his rescue team and took a victory lap.

“We’ve launched the most ambitious testing effort … on Earth,” the president said, noting that the nation’s sheer number of Covid-19 tests has well outpaced other countries, although on a per capita basis, the United States still lags behind peers like Canada and Germany.

Some executives agreed with him, noting that more drive-thru sites, use of mass testing machines and even at-home testing options are set to expand in May.

“I think you’re going to see far fewer bigger, centralized testing locations that are trying to accommodate hundreds, if not thousands of people,” Walmart’s Bartlett said, adding that the national effort will shift “to more massly distributed locations that are handling dozens of tests per day that’s just much more ubiquitous.”

The Kushner team officials also said they have been conducting weekly calls since April 22 to discuss each state’s testing goals, and Giroir has told states that the team will be shipping them weekly pallets intended to meet their needs.

State and local officials remain skeptical, saying the White House effort has continued to disappoint them as they lack crucial supplies and continue to face shortages, months after the first Covid-19 cases were detected.

“It seems too good to be true,” said one state official. “After weeks of begging and begging that they’ll finally get all the swabs, now they will?”

“Last week, we needed between 20,000 and 30,000 test kits. We only could get 5,000,” added Patty Hayes, the public health director of Seattle and King County, Washington — the epicenter of the nation’s first outbreak in February.

“It’s been an incredible roller-coaster,” Hayes added. “Promises are made — and then the story changes. To not get our partners’ hopes up, we work on a weekly basis.”

On the coronavirus rescue team, there’s a mood of quiet confidence that they’ve set the nation up for what should be a massive surge in testing across May — one that could exceed the stated goal of 8 million tests this month, if governors fully engage the lab-testing capacity they’ve identified. A key recommendation from the White House: that states use an instrument produced by Thermo Fisher known as a KingFisher, which helps automate part of the process needed to test patients' samples for Covid-19. The team has had conversations with governors about the devices in recent days, with many officials learning about the existence of the equipment in their states for the first time.

“Getting to those bigger numbers is really about the governors, and whether they are going to ramp up the machines in their state to full capacity,” said Smith.

Smith acknowledged that he’d never heard of “Thermo Fisher” or “KingFisher” machines before beginning his coronavirus recovery team — part of the surreal experience of the past two months that's forced him and other officials to become overnight experts on nucleic acids, lab-testing plates and other terminology relevant to fighting the Covid-19 outbreak.

Team leaders also said they regret that the private-sector volunteers who pitched in on the rescue effort — regardless of politics or circumstances — have been so closely scrutinized, politically attacked and investigated.

“Everybody was proud to raise their hand to help,” said one person who helped coordinate a volunteer effort back in March. “I just want everyone to raise their hand next time too.”