The US is on course to be severely ravaged by the coronavirus outbreak due to a delayed and dysfunctional testing regime and misleading messaging from the Trump administration, public health experts have warned.
As of Friday, there were more than 1,600 confirmed cases of the Covid-19 virus across the US, with 41 deaths, according to the Centers for Disease Control. However, the actual number of infected Americans is certain to be far higher, with the true toll obscured by a calamitous lack of testing.
A lack of planning and restrictions that barred testing people without symptoms, even though the virus can be asymptomatic for some time, or those not arriving from overseas virus hotspots has needlessly worsened the situation, critics said.
Related: Why has coronavirus testing in the US been such a disaster?
In the period from last Sunday until Wednesday morning, the CDC tested just 77 people in the US. By stark comparison the Utah Jazz basketball team alone managed to test 58 people as the NBA, along with scores of schools, Broadway shows and various other cultural and sporting events were shut down. Even in Washington state, where 31 people have died, health officials have had to ration test kits.
On 31 January the Trump administration restricted travel from China, where Covid-19 originated, but then efforts to ramp up testing and ensure containment stalled. In a key setback, the administration rejected World Health Organization testing kits in favor of developing its own, which turned out to be faulty.
"The response has been frustrating and disappointing," said Thomas Chen-chia Tsai, a surgeon in Boston and faculty member of the Harvard Global Health Institute. "The strict quarantine measures in China bought the rest of the world a few weeks of time but in the US we were on the sidelines rather than reacting. It was a missed opportunity. If there was a targeted response we'd be in a very different position now.
"The US government didn't want to cause panic but Americans panic when there they sense there's no plan. That vacuum creates panic."
This muddled response was exacerbated by Donald Trump who, reportedly fearful of the impact upon the stock market and his own re-election prospects, initially dismissed fears over the coronavirus as a " hoax " before stating that infections were "going very substantially down, not up". The administration promised millions of testing kits would be easily available to Americans.
All of these pronouncements have proved untrue, leading to sharp criticism of Trump.
In an unusually stinging editorial, Holden Thorp, a chemist and editor-in-chief of Science, said the president's "distortion and denial is dangerous and almost certainly contributed to the federal government's sluggish response. After three years of debating whether the words of this administration matter, the words are now clearly a matter of life and death."
The worsening situation has been acknowledged even by allies of the president. "We probably lost the chance to have an outcome like South Korea," said Scott Gottlieb, a former Food and Drug Administration chief under Trump, referencing a country that has helped curb the outbreak by testing nearly 20,000 people every day. "We must do everything to avert the tragic suffering being borne by Italy."
Anthony Fauci, who heads the National Institute of Allergy and Infectious Diseases, admitted in testimony to Congress this week that authorities had failed to respond swiftly to the spread of coronavirus.
"The idea of anybody getting [testing] easily the way people in other countries are doing it, we are not set up for that. Do I think we should be? Yes. But we are not," he said. "It is a failing. I mean, let's admit it."
The US is now bracing itself for a huge wave of new infections without a coherent federal government response.
Hampered structurally by the country's lack of paid sick leave and a for-profit healthcare system that makes going to the doctor prohibitively expensive for millions of Americans, states and cities are falling back on "social distancing" measures such as shutting down large gatherings and promoting good hygiene.
Belated actions by Trump, such as banning travel from much of Europe, have done little to tackle a virus that has already raced across the American continent, with experts now predicting that tens of millions of people will become infected.
Andy Slavitt, former head of Medicare under Barack Obama's administration, tweeted that there were expectations of "over 1 million deaths in the US since the virus was not contained & we cannot even test for it. This will be recorded as a major preventable public health disaster."
Even a sudden surge in testing, combined with accurate, sober advice from the Trump administration, won't prevent a huge strain placed upon a fragmented American healthcare system that delivers wildly different outcomes for people depending upon their financial means. Ominously, there are far fewer hospital beds per capita in the US compared to the Lombardy region in Italy, where the coronavirus has overwhelmed the healthcare system.
"We don't have all the beds we need and if this thing hits us full on we are going to be up the creek," said Georges Benjamin, executive director of the American Public Health Association.
"We started with a very crippled public health system that has been underfunded for many years and we knew that something like this would cause us huge challenges. We are seeing that now. We are planning for the worst but hoping for the best."
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