The Pandemic Mistake America Can’t Repeat
More, better, and faster testing might have averted the worst of what America faced in 2020.
The coronavirus pandemic may be in its final stage in the U.S. But it will not be the last pandemic of the 21st century.
Since the turn of the century, SARS-CoV-2 is already the second virus to create a pandemic (the first was the H1N1 influenza in 2009) and the third coronavirus outbreak, following the first SARS crisis in 2003 and the emergence of Middle Eastern Respiratory Syndrome, also known as MERS, in 2012.
If the U.S. can expect roughly one global plague every 10 years, it will have to do better than it did over the past 12 months, when it shut down much of the economy to save lives but lost more than 500,000 souls anyway. In the past few weeks, I asked several scientists, epidemiologists, and other experts to tell me what they considered the foundational failure, or “original sin,” of our COVID-19 response. Was it the hemming and hawing over masks? The overly constrictive lockdowns in places that didn’t yet require them, followed by a reluctance to re-impose them when they became necessary? The delusional denials from the Trump administration? All received a mention. But to my surprise, one thing stood out above everything else: tests.
“I don’t think there’s any question that America’s original sin was not having a broadly available test by the time COVID-19 was here,” said Eric Topol, a cardiologist and the founder and director of the Scripps Research facility. “It’s atrocious, egregious, and grotesque. We’re still living with the fallout of not having enough tests. It’s the original sin that has become our daily tragedy.”
Natalie Dean, an epidemiology professor at the University of Florida, agreed. “To me, it all starts with the lack of early testing,” she said. “The process was so bungled, it took so long to set up any kind of testing capacity, and by the time we could properly test people, there was already widespread community transmission.”
Alex Tabarrok, an economist at George Mason University, said the same thing: “If the U.S. government had done everything right with testing, we could still have ended up being screwed. But in any alternative universe in which we succeed, our success would begin with testing.”
Mask ordinances and social distancing (and, now, vaccines) have almost surely saved many thousands of lives. But before any of these remedies came about, America’s inability to track the virus allowed it to establish a base of infection and an exponential trajectory. The testing fiasco was uniquely responsible for launching the U.S. into the national nightmare of an unchecked explosion in cases. More than any other policy failure, it turned what might have been an acute national horror into a tragedy that took more lives than either world war.
America’s testing failure was not a single missed opportunity or bad decision. It was a cavalcade of unpreparedness and hubris that doomed the U.S. to disaster. The federal government neither quickly developed its own working test nor quickly approved effective tests developed by American scientists outside government; it declined to request a diagnostic test from the World Health Organization; it ignored the benefits of cheap “rapid tests”; and it failed to communicate to the public how mass testing would maintain a shred of normalcy by making visible a pathogen whose spooky invisibility had triggered the shutdown of the economy.
Eric Topol divides his blame for America’s original testing sin among three institutions: the White House, the CDC, and the FDA.
Donald Trump’s culpability is so obvious, elaborating on the matter may seem almost gauche. The ex-president denied and downplayed the virus; confidently—but incorrectly—predicted its sudden disappearance; and falsely claimed that “anybody that wants a test can get a test” on March 6. (On that day, the U.S. performed only about 1,500 total tests, or roughly four tests for each metropolitan statistical area.) Trump was wrong about COVID-19 in almost every possible way that a person can be wrong about a thing, and he burdened the entire public-health system with mercurial demands for easy fixes and junk science.
But the U.S. failed in ways that extend beyond Trump’s orbit. “The CDC and [then-Director] Robert Redfield deserve as much blame as anybody,” Topol said. On January 10, 2020, several weeks after the world learned that an unusually contagious virus had shut down the Chinese city of Wuhan, the CDC insisted in calls to local and state public-health officials that it would soon have working tests to distribute throughout the country. Three weeks later, the first kits arrived by FedEx in Manhattan laboratories. They didn’t work—at all. “Oh, shit,” is howJennifer Rakeman, the director of the New York City Public Health Department’s lab, described her reaction. “What are we going to do now?”
Even as U.S. scientists were developing in-house tests to diagnose coronavirus infections, the FDA was dragging its feet on approval. In January, Alex Greninger, a virologist at the University of Washington, designed a more effective diagnostic test than the CDC. But federal regulators put him through the wringer—requiring an online application that would take 100 hours to complete; then requesting a hard copy of that application; then insisting that he obtain samples of other coronaviruses, which the CDC had restricted access to. By the time Greninger’s test was approved, the calendar had turned to March and hundreds of thousands of Americans had probably already been infected.
America’s testing capacity eventually rose to more than 2 million per day. But some observers believe that wasn’t nearly enough. The economist Paul Romer argued that the U.S. needed at least 10 times that—20 million to 30 million daily tests—to open up more of the economy safely in 2020. The best way to hit that figure would have been for the U.S. government to accelerate the production of cheap, rapid antigen paper tests, which could have been distributed en masse directly to residents.
The Harvard epidemiologist Michael Mina has excoriated America’s inability to scale up the development of these rapid tests, which can deliver results in minutes instead of days (albeit with less precision for asymptomatic carriers than the gold-standard PCR tests). “We could’ve at least tried, back in May, to get these rapid tests out,” Mina told New York magazine last month. “We didn’t do it in May. We didn’t do it in August, November, December. We still haven’t done it.”
Other countries adopted an aggressive testing strategy from the start. South Korea knew from experience the value of tracking infections as fast as possible, having grappled with the first SARS, H1N1, and MERS in the previous two decades. A nation one-sixth the size of the U.S., South Korea nonetheless had tested 200,000 people before the U.S. had tested 20,000 of its citizens.
America’s testing fiasco was the seed from which so many other tactical blunders, extreme policy responses, and public-health misunderstandings bloomed. An invisible virus that escapes most detection required that city and state leaders treat all citizens as equally likely to be carriers of the virus. That led to the closure of schools; cancellations of weddings; prohibitions on funerals; and the shutdown of the entire leisure, hospitality, and indoor-retail economy. Widespread tests would have identified carriers with greater speed, making school closures unnecessary and travel less risky. With too few tests to go around, we rationed them for the most severe cases, and let silent spreaders go mostly unidentified, Natalie Dean told me. “We had overly narrow restrictions on who could be tested for weeks, while there was widespread community transmission,” she said. With more tests, we would have learned more, faster about this disease—including that it was circulating through asymptomatic infection and super-spreaders. That would have suggested an airborne virus, which would have strengthened the case for masks in March, when even public-health leaders like Anthony Fauci were wavering on everyday mask use. With more and faster tests, the U.S. would have benefited, at least a little bit, in almost every capacity: We would have had greater and faster epidemiological knowledge, less stringent lockdowns, a more open economy, and fewer overall deaths.
Perhaps you’re not convinced. Perhaps you think testing wouldn’t have made a big difference. If that’s how you feel, consider this hypothetical. Imagine a parallel universe where Americans were tested massively, constantly, without care for cost, while those who tested negative continued more or less about their daily life.
In fact, that parallel universe exists. It’s the National Football League.
When the NFL season started, in September, I was deeply pessimistic that it would end in anything other than mass infection and cancellation. This is, after all, a league with a deplorable public-health record, whose players spend large amounts of time in indoor facilities and locker rooms, when they’re not smashing their helmeted faces into one another on the field. But somehow, the NFL played all of its 256 games with no coronavirus-related deaths reported among its thousands of players and employees.
How did the league do this, even as the U.S. faced a surge in the winter? After an October outbreak, the NFL moved to daily testing of all its players and instituted new restrictions on player behavior and stricter rules on ventilation and social distancing. The league also used electronic tracking bracelets to trace close contacts of people who tested positive. Throughout the season, the NFL spent about $100 million on more than 900,000 tests performed on more than 11,000 players and staff members. In January, the CDC published an analysis of the league that concluded, “Daily testing allowed early, albeit not immediate, identification of infection,” enabling the league to play the game safely.
You could write off the NFL’s season as the idiosyncratic achievement of a greedy sport with nearly unlimited resources. But I can think of another self-interested institution with nearly unlimited resources: It’s the government of a country with a $20 trillion economy and full control over its own currency. Unlike the NFL, though, the U.S. never made mass testing its institutional priority.
“The NFL was almost like a Korea within the United States,” Alex Tabarrok told me. “And it’s not just the NFL. Many universities have done a fabulous job, like Cornell. They have followed the Korea example, which is repeated testing of students combined with quick isolation in campus dorms. Mass testing is a policy that works in practice, and it works in theory. It’s crazy to me that we didn’t try it.” Tabarrok said we can’t be sure that a Korean or NFL-style approach to national testing would have guaranteed Korean or NFL-style outcomes. After all, that would have meant averting about 500,000 deaths. Rather, he said, comprehensive early testing was our best shot at reducing deaths and getting back to normal faster.
At this moment in America, deaths and hospitalizations are plunging as the U.S. vaccinates millions of people a week while tens of millions more retain some form of immunity from previous infections. The basis of vaccination is immunological memory—the immune system’s ability to recognize and respond to pathogens that would otherwise ransack our bodies.
Just as important as immunological memory is institutional memory. A nation can learn from its mistakes: South Korea did better against COVID-19 in part thanks to a national familiarity with airborne viruses. The U.S. can use the brutal experience of 2020 to recognize and respond with greater speed and precision to the next dangerous pathogen. In this pandemic, testing was America’s original sin. In the next pandemic, and there will be a next pandemic, it can be our first step.
“The indignity of being Asian in this country has been underreported,” the poet and essayist Cathy Park Hong writes in Minor Feelings: An Asian American Reckoning. Hong, 44, is the daughter of Korean immigrants and was raised in Los Angeles. Although she has written about race in her poetry, Minor Feelings is her first nonfiction book, a blend of memoir and cultural criticism. Her essays explore the painful and often invisible racial traumas that Asian Americans experience—traumas that have become impossible to ignore over the past year, as reports of anti-Asian racism and violence have increased.
Yesterday, a gunman killed eight people, six of whom were Asian women, at massage parlors in the Atlanta area. Hong told me by email that she was grateful to see an outpouring of sympathy from people outside the Asian American community, but also expressed the concern that police and commentators would downplay the significance of the event. “I’m already seeing media trying to whitewash this incident,” she wrote, “saying it’s not racially motivated, taking words of the police over the stories of these women.”
Earlier this year, several attacks on elderly Asians in the San Francisco Bay Area were captured on videos that went viral. One victim, 84-year-old Vicha Ratanapakdee, died from his injuries. While authorities in many cases have not determined—or are reluctant to say—whether these attacks are racially motivated, the overall pattern of violence is stark. Since March 2020, about 3,800 racist incidents against Asian Americans and Pacific Islanders have been reported to the group Stop AAPI Hate. Last Thursday, President Joe Biden condemned “vicious hate crimes against Asian Americans, who have been attacked, harassed, blamed, and scapegoated”—marking a contrast with his predecessor, who referred to the COVID-19 pandemic as “the Chinese virus” and “kung flu.”
Hong’s work captures the peculiar spot that Asian Americans occupy in America’s racial hierarchy. The political scientist Claire Jean Kim has described this dynamic as “racial triangulation”: Neither Black nor white, Asians are simultaneously stereotyped as model minorities and perpetual foreigners, and thus used as a wedge between Black and white people. But with overt attacks apparently on the rise across the country, Americans of Asian descent are demanding attention to the racism they face.
I spoke with Hong in detail last week, before the Atlanta-area shootings. We discussed why reports of violence and hate have galvanized so many Asian Americans, across ethnicities, in the past year. This interview has been edited for length and clarity.
Morgan Ome: Racism toward Asian Americans is not new. But recently, it feels as though more Asian Americans have been speaking up and protesting. Why?
Cathy Park Hong: A few years ago, David Dao, a Vietnamese doctor, was assaulted and dragged from a United Airlines flight. I remember the media did not talk about his identity. The story was just about him being a middle-class man who was dragged out of the airplane. Whereas when I saw that, I thought, I bet he wouldn’t have been treated that way if he were white. But no one was saying that. A lot has changed between then and now. It’s hard to say exactly what the reasons are. Part of it is because of Donald Trump. There has been a real retrenchment of identities, and people have been much more upfront in talking about race and structural racial inequities in this country. And that has resulted in a lot of Asian Americans speaking up.
When Black Lives Matter [gained force] in 2014—after Ferguson—I saw an increase in Asian American organizing and allyship. And last summer, people really internalized the Black Lives Matter protests and the conversation about social justice. Now, because of the anti-Asian racism that’s been happening, Asian Americans have been more moved to vocalize and organize—from writing commentaries in The New York Times to organizing groups to escort the elderly in Oakland’s Chinatown.
Ome: Has there been a moment like this before? The closest parallel that I could think of was the killing of Vincent Chin in 1982, which led to an outcry among Chinese and Japanese Americans. Other historical examples, such as Japanese internment during World War II, didn’t persuade Asians to protest on a mass scale. The damaging of Korean-owned businesses during the L.A. riots didn’t result in a lot of non-Koreans speaking up for the Korean community.
Hong: It’s true. You didn’t see other Asians coming in to support the Korean community after the L.A. riots. The difference now is that the people who are being attacked run the gamut. Even if they are thought to be Chinese, a lot of times they are Filipino or Vietnamese or Korean. One of the symptoms of racism is that you get all lumped together.
Another historical parallel was after 9/11, when Muslims were being attacked and persecuted. Or when Trump became president, there were talks about detaining Muslims. Americans were attacking Muslims or people who vaguely looked Muslim, including Hindu Indians, Sikh Indians—whoever looked brown. I believe that did galvanize the South Asian community and the Muslim community. We’re seeing that happen now. There is more aggressive activism among East Asians, Southeast Asians, and South Asians. It doesn’t really matter which group is being targeted.
Ome: Do you see any similarities between what’s happening now and what happened after the L.A. riots?
Hong: Similarly to the L.A. riots, there was an economic division between working-class African Americans and working-class Asian Americans. Many Black people resented Korean immigrants for coming into their neighborhood and opening stores they couldn’t open themselves, because they were redlined. At the same time, these Korean immigrants were barely scraping by. They didn’t have any insurance. But they were the next step up [from Black residents on the economic ladder]. There’s still a lot of that resentment from the L.A. riots, and memories of Latasha Harlins, who was killed by a Korean immigrant.
What’s very charged and tricky to talk about today are the optics of a Black or brown person assaulting or attacking the Asian elderly, like the Thai grandfather, Vicha Ratanapakdee. There’s a huge difference between the way second-generation or younger Asian Americans think about race and the way Asian immigrants think about race. Many younger Asian Americans are very sensitive to anti-Blackness in the Asian community, and about policing. With older Asian immigrants, these crimes may reaffirm their anti-Blackness and drive them toward the right.
What I fear is that these crimes are sowing deeper divisions between Black and Asian Americans, and that white people will not hold themselves accountable. Whenever I say on social media, “These attacks are symptomatic of white supremacy,” white people say, “How is it white supremacy when it’s not white people committing the crimes?” Claire Jean Kim has this really great racial-triangulation theory that talks about the relationship between Black, Asian, and white people. You saw that in the L.A. riots, and I see the same kind of dynamics being played out today.
Ome: So how do we move forward?
Hong: I don’t want to overcomplicate this. There are two ways of talking about this. The act of violence itself is wrong. You cannot excuse it. I think many Asian Americans have never talked about it, and so white people still don’t believe that Asian Americans face racism. Because we’re invisible, the racism against us has also been invisible. This is why it’s important that people are speaking up to show: “Actually, this has been happening, and there’s been a spike. But at the same time, this has been going on for a long time. We just haven’t really talked about it. And now we’re talking about it, and you have to pay attention.”
But it gets really tricky when the video [of an assault] becomes viral and we start talking about solutions beyond amplifying it. Part of the reason there’s a spike in anti-Asian violence is that people are angry and desperate. I’m not saying that we should excuse that. I’m just trying to think of the reasons why it’s happening to Asians. Earlier today, I was having a conversation where an interviewer told me that a police officer—who is Asian—said that he doesn’t believe [that recent attacks] are anti-Asian hate crimes.
Ome: The officer didn’t believe they’re racially motivated? What was his explanation?
Hong: Yes—that these assaults against Asians are just part of rising crime. I disagree with him. There have been plenty of incidents where the victims weren’t burglarized—they were attacked for no reason at all—and called racist slurs. I know people who live in Manhattan, specifically Asian American women who live alone, who are scared to go out by themselves, because they are followed and harassed and called all kinds of racial slurs. So this is not just some kind of hallucination.
Ome: Do you think that the events of the past year have forced this country to take racism against Asian Americans more seriously?
Hong: We have far to go. This is typical of this country, to not really focus on racism unless it’s sensationalized in some way, unless there’s a viral video, or someone gets murdered. I wouldn’t be surprised if Americans just forget and think, Onto the next news cycle. It’s great that white people and other non-Asians are picking up on this, but we can’t trust them to continue to train their attention on what’s happening to Asian Americans. We need to continue vocalizing who we are and our role in this country.
Ome: In Minor Feelings, you wrote about the difficulty of using the pronoun webecause Asian Americans are such a diverse population. Do you still think Asian American is a meaningful descriptor?
Hong: It’s what we have right now.
Ome: Maybe I can clarify. The term Asian American was coined in 1968 by radical student organizers who were envisioning a pan-Asian, anti-racist, anti-imperialist movement. Is their notion of being Asian American just an ideal? Or is it a real identity-based coalition that you see forming?
Hong: People forget that history. I forget that too. Asian Americans came together because there was no term for us. Before, we were called Oriental, or by our nationalities. What created the name Asian American was the Vietnam War and the Black Power movement. Keep in mind, those Asian American organizers were second generation, maybe even third generation. They were Filipino, Chinese, Japanese. Quite a few of them had family put in internment camps. They were working-class. So they had a lot to be angry about.
It was really powerful, and it got written out of history. Part of it was because of the immigration patterns in America. After the late 1960s, there was this huge influx of Asians coming in from all different nations. We got way more diverse: Pakistani, Bangladeshi, Indian, Cambodian and Vietnamese refugees, Koreans. A lot of those immigrants now have children who consider themselves American, but realize that they still have secondary status as Americans because of the color of their skin and because their voices don’t have the kind of reach that white people do.
Part of the new awareness and consciousness is because there are a lot more of us. And there are more of us who have been here long enough to demand that we need to be part of this country. More so than when I was in my 20s or even 30s, the younger generation is so much fiercer, so much more involved, and so much prouder of being Asian American. The rhetoric has changed from We want more Asians in Hollywood. It’s not just about representational politics. It’s also about confronting class inequity among Asian Americans and trying to build solidarity with other people of color.
What I like to say about Asian Americans is that if we think of Asian Americans as less of an identity, and more as a coalition, then maybe Asians will feel more comfortable identifying with it, because it allows room for all of our kind of national, economic, and regional distinctions.
Ome: In your book, you wrote, “Since the late sixties, when Asian American activists protested with the Black Panthers, there hasn’t been a mass movement we can call our own.” Why do you think that is?
Hong: Some people disputed that and said there has been a lot of activism since then. I would say that it was more fractured. But I think it’s really important to build a cross-cultural community among Asian Americans, and also bridges between Asian, Black, Latino, and indigenous communities. And right now, we’re not really there yet.
If we want to fix the structural inequities, reform the criminal-justice system and the police, and have health care for all, it’s very important to also talk about our racial identity, because people feel intimately close to that. You can’t just say, like Andrew Yang does, that people are getting too much into identity. If white people are misusing identity or race to pit us against each other, we have to address that. In terms of getting what we want, and being proud of being [in the United States], and speaking out against violence, we need to build community. That means building an Asian American identity that’s beyond loving boba tea and K-pop.
Ome: What do you think about some of the solutions that have been put forth for combatting anti-Asian violence? Last April, Andrew Yang encouraged Asian Americans to show their patriotism. This year, President Biden issued a memorandum to condemn racism and intolerance toward Asian Americans and Pacific Islanders. On the community level, there are calls for neighborhood patrols and other nonpolice safety measures.
Hong: I’m not an organizer. I’m not an activist. So I don’t know if I can tell you exactly what needs to be done. Maybe we should go back to what happened after the L.A. riots, and look at how people tried to rebuild, and see how it failed.
There was a campaign to funnel resources into South Central. There were Korean Americans who called for people to pay attention to the fact that most of their businesses burned down and they had no insurance. There were attempts at interracial community building. And they were abandoned. That’s usually what happens: Whenever there’s a crisis, the media and politicians pay attention. And then they abandon it. Right now, we need to continue amplifying these hate crimes. But I don’t think policing is the answer. Asking for more policing is not going to solve anti-Asian hate crimes and bias incidents. The reason being that the police right now have all the money and are completely militarized, and [violence against Asian Americans] is still happening.
Hong: If you’re the one who has a store or is an employee in Chinatown, and you’re being harassed, and someone’s telling you, “We need to defund the police as a way to protect you,” that kind of language doesn’t work. We have to find a way to talk to each other and with other people of color in our communities. But we also have to figure out a way to talk to our parents and listen to them, because they’re the ones whose lives are most in danger.
I want to listen. That’s really the policy that all of us should have right now: Listen to the stories and the hardships that Asian immigrants are going through, and also listen to the Black and Latinx people who are living in the same neighborhood.
Ome: Is there anything else you want to add?
Hong: As cynical as I sometimes sound, the fact that anti-Asian violent incidents are being documented, and that people are talking about them, is progress. Because that wasn’t happening before, not when I was growing up. A lot of Asian Americans are more vocal, organized, radicalized, and progressive. And we’re not going to go back.
This story was originally published by The Atlantic. Sign up for their newsletter.