WASHINGTON, DC - Today, U.S. Senator Rob Portman (R-OH), Ranking Member of the Senate Homeland Security and Governmental Affairs Committee, questioned witnesses during a hearing to examine the federal response to the unprecedented COVID-19 pandemic. Senator Portman asked the witnesses why the federal government struggled in its initial preparedness efforts leading into the COVID-19 pandemic, especially problems the Centers for Disease Control and Prevention faced with surveillance systems and inaccurate tests. As Portman discussed during the hearing, CDC’s defective tests resulted in a lack of in-state testing in Ohio from February 7, 2020 until March 5, 2020.
Portman highlighted the need to identify what reforms need to be made to improve federal preparedness for future pandemics and other public health threats.
Excerpts of the exchange can be found below and a video can be found here.
Portman: “Thank you Mr. Chairman and thanks to all of the witnesses. I’m going to start with the surveillance issues. We talked a lot this morning already about CDC, but what happened? You know, why didn’t the CDC have the ability through the surveillance systems that we had in place to be able to detect this sooner? Seems to me they were relying on incomplete and outdated public health information among other things that I said in my opening. Some of you have talked today about the need for digital monitoring and that there were early warning signals that were not picked up. Dr. Gerberding, you’ve focused on that. What sort of surveillance indicators was the CDC relying on at the outset of the pandemic to inform the public health response?”
Dr. Julie Gerberding, Former Director of the CDC: “I think first and foremost was to take a look at what was going on globally. We had some information about the extent of the spread in the Wuhan province, we had examples of pretty well documented spread from travelers into work settings in other parts of the world. I think the clues were there that this was a very transmissible infection, unlike SARS was in 2003, so that was the first thing was to lean into the threat that exists.
“The second thing is testing and I think that it was unlikely even under the most rehearsed scenario that we would have been able to immediately deploy a test for a brand new pathogen to 300 million people on short order but we certainly could have utilized the tests that were available elsewhere in the world and had proven to be useful. And we could have worked much faster to bring a scale of testing up to speed with better cooperation and earlier engagement of the academic sector as well as the private sector. So the first thing that needs to happen is case detection and then the isolation of the cases and the quarantine of their contacts.
“Now, that’s a problem in the United States because finding contacts is basically shoe leather right now which means you have to go out, more or less, door to door and try to track down the people who might have been exposed. And our workforce is way too thin to be able to accomplish that once we had so many cases. It became almost impossible.
“I think a third case of this is to use our epidemiologic common sense and recognize that with a respiratory pathogen there are going to be certain congregate settings – confinement, high degrees of contact - where there is likely to be transmission and to get into those settings first, do the testing and the epidemiologic assessment so that we’re ahead of the curve, rather than waiting until cases were hospitalized and then find the hotspots in retrospect. So, a lot of things, our combination of testing, workforce scarcity, and I think, again, just the inability upfront to imagine how bad it was going to be.”
Portman: “I would like to dig a little deeper on the testing with you and Dr. Lurie and anybody else who wants to jump in, but backing up on surveillance for a moment, because it’s not just about testing, as you indicated its also about the World Health Organization telling us what’s going on, which they did not. China being more transparent, we know that. But what type of fixes do you think we need to make, beyond additional funding, which I appreciate and I appreciate the fact that you said the personnel are needed. You mentioned, for instance, using technology better in your testimony and digitizing some of this. Just quickly, if you could, what can we do on the surveillance system in addition to testing to make it more effective?”
Dr. Gerberding: “Well one really important point that I think is implied in your question is that this is a global challenge and if we had really actualized the promise of the global health security agenda, we would have had much better insight into where this disease started and how fast it was spreading internationally. So, we do need to come back to that global network of surveillance, not just a U.S. network. In the U.S., I agree with you on the digital tools, and the application of our technology in new and exciting ways but at the end of the day it boils down to case detection as the first step.”
Portman: “Yeah, well let’s talk about testing for a second then and, again, anybody is free to jump in here. I’ll tell you my frustration on testing was that CDC, and some of you have been involved with the CDC over the years, and there’s plenty of blame to go around here, but CDC had lousy tests. And in Ohio, we were given a bunch of CDC tests and that was the only place to get tests, as we understood it, and you know they didn’t work. There were defects in them. And it prevented our labs from being able to validate the tests, rendering them basically useless.
“I don’t know if you know this but in Ohio, the result of this was that some of the private sector jumped in, particularly the Cleveland Clinic developed its own test. To give you some dates here, we got our first botched test from CDC on February 7, we didn’t get a working test kit from CDC until March 5. So virtually a month went by, and talk about a wasted opportunity to save lives. And Cleveland Clinic developed their own test and put it online on March 13. That test I took, by the way, early on. But why were we so reliant on CDC, shouldn’t we have been encouraging the private sector to be involved all along? And again, Dr. Lurie, you should jump in here but how did the legal and regulatory landscape at the time help or hinder institutions, like the Clinic, to use them as an example, but there are groups all across the country doing this, from developing their own tests? Can you respond to that, Dr. Lurie?”
Dr. Nicole Lurie, Former Assistant Secretary for Preparedness and Response at HHS: “Yeah sure. So what I would say is, is early on when it was clear very early on that we were going to need an awful lot of tests. And tests were developed around the world. As Dr. Gerberding said, some of them worked quite well and we could have used them. And when CDC was struggling with its test, or even before, BARDA should have exercised its authorities and gotten in early on to stimulate the development of diagnostic tests across the private sector and in the academic sector so that you would have had a variety of tests earlier. No one, there was no entity that took responsibility for pulling samples together to validate diagnostic tests. And so all of the test developers really struggled and so FDA gave an awful lot of them a pass and said well you’re not going to need any UA, we’re going to go ahead and assume things. You know, assume a number of things and then it turned out that we had diagnostic tests that didn’t perform well at all and had to come back off the market. So the failure to get in early as the private sector to develop tests, agree to work with them, provide the support that they would need for validation and then be able to scale, I think were really significant failures stemming from the failure to want to recognize that this was happening. The authorities were clearly there.”
Portman: “Thank you, we have to learn from that, clearly, and, you know, it just amazes me that we were so ill-prepared in terms of our diagnostics. My time is coming to an end. Admiral Nimmich, I had planned to ask you some questions about the BENS Commission. I appreciate the work on that. Senator Hassan was involved, who’s on the panel today, and Senator Cassidy. But we really have appreciated that and we’re using some of your work. I guess the planning and the exercises were not adequate in this case and one question I want to just leave with you as I end my time is, is FEMA the right organization to head up something like this? You know there’s a difference in opinion on whether it should have been HHS or FEMA and was FEMA the right entity? So, I’ll sort of leave that question out there and hope somebody follows up on it who has some more time available. Thank you, Mr. Chairman.”