Newly obtained emails between states and the federal government highlight the struggles states have faced in dealing with the Trump administration in efforts to boost coronavirus testing capacity.
According to emails obtained by the watchdog group Accountable.US, state officials were pleading with the Centers for Disease Control and Prevention (CDC) and the Federal Emergency Management Agency (FEMA) throughout March and April for more supplies, with limited success.
Without clear federal guidance, state health officials were seeking supplies from the federal government as well as from private vendors on the commercial market.
Many expressed confusion about how to acquire testing materials, because they did not know which federal agency was in charge of distributing supplies.
For example, states were informed in mid-April that only state health labs would be able to request reagents through the CDC. All others, like hospitals and public health authorities, were told they should go through commercial vendors.
"Can you please help us understand ... what ... still needs to go through FEMA and what is through CDC IRR process around testing? This is different and we need a clear understanding to move forward," an Oregon health official asked FEMA and CDC in one email.
"What happens when they can not get what they need?" the official asked about customers that were not public health labs.
An HHS official explained there was a "nationwide shortage on all testing supplies. FEMA and HHS are working with manufacturers to ramp up production."
The HHS official advised states to conduct their own triage to make sure testing materials were not depleted.
"While this may reduce overall capacity in the short term, it will allow vital resources to be concentrated at key locations and maintain testing capability," the official said.
President Trump and top administration officials have boasted about the nation’s testing ramp-up, stating repeatedly that the U.S. is doing more tests than any other country in the world.
“We are the best in the world in testing. We’ve tested much more than anybody else, times two. Or every country combined — we’ve tested more than every country combined," Trump said late last month.
But labs and states across the country have repeatedly dealt with shortages of testing supplies, such as swabs and reagents, hampering their capabilities to ramp up efforts.
Trump has shifted the focus to governors to manage their own testing sites and acquire their own supplies, letting the federal government play a secondary role.
According to the emails, the federal government's system for distributing supplies sent testing kits in “insufficient quantities,” and in one instance, federal officials told a state health department that they were completely out of a necessary reagent, an RNA extraction kit.
On April 11, officials at the Oregon Health Authority asked for help after they said they received just four of 5,000 testing kits requested from the CDC for their Abbott rapid point-of-care test.
"Can you please assist us in figuring out how we can get closer to a requested amount?" officials asked. "[A]t this point we have devices but no test kits to run any tests."
Five days later, they asked again. An HHS official instead offered to help with a workaround.
"At this time there is a critical shortage on the Abbott test kits and the ability to acquire more is very difficult and competitive at the moment ... Since Abbott kits don’t seem to be the answer, I’m happy to assist with developing" a strategy to support rural labs, the official wrote.
At the same time, state health officials in New Mexico were also struggling to obtain a supply of extraction reagents. On April 4, state officials said they were close to running out.
Cases spiked that weekend, and officials said they would likely only be able to continue testing for a little over 3 days. Orders from commercial manufacturers including Roche and ThermoFisher were "trickling in" but the federal government was "out of stock."
Industry representatives said the experiences in those states were common, as the administration left states and labs to compete against each other for critical supplies.
"There was no overarching strategy on how the supply chain conversations had been happening," said Heather Pierce, senior director of science policy at the Association for American Medical Colleges, which runs labs in academic hospitals. "It was not clear how the supply chain was being managed and allocated."
In late April, the White House released a new testing "blueprint" aimed at getting states to the testing level needed to start opening their economies. The plan says that states need to develop their own strategies.
That blueprint has helped, Pierce said, because now governors know they are in charge. Labs have adapted to the situation and there aren't the same concerns about shortages.
"It was so bad in April, the desperation was so palpable," Pierce said. The situation is different now, she said, but the strategy is still emerging and is "murky."
The White House plan made it clear that the federal government will serve as a coordinator between states and the private sector, but critics say the White House needs to lead more.
"Almost exactly two months ago President Trump told Americans that they could have a COVID-19 test if they wanted one. But even as Trump pushes states to reopen, millions of people across the country can’t get one,” Accountable.US President Kyle Herrig said in a statement.
Officials previously promised tens of millions of tests would be available by the end of March. Testing has ramped up considerably since then, but experts say the country has a long way to go before performing enough tests to safely reopen the economy.
Harvard researchers, for example, estimate the country needs at least 500,000 tests per day, up from about 250,000 per day currently.