There's a high likelihood that community spread of coronavirus has been going on for weeks: Outbreak expert

There's a high likelihood that the community spread of coronavirus has been happening in the upper west for weeks, according to Jeremy Konyndyk, who served the WHO Advisory Group on Reform of WHO's Work in Outbreaks and Emergencies with Health and Humanitarian Consequences from July 2015 to January 2016.

"Now seems highly likely that there has been undetected community transmission ongoing in parts of the upper West Coast for weeks, at least," Konyndyk explained in a Twitter thread Sunday. "How did we end up with major surveillance failure on par with Italy and Iran? Let's talk about how that happens."

He said that it would likely get spun as a flaw in the test kits, but it isn't.

"It's an interconnected communications, strategy, process, and execution failure, reflecting a serious breakdown of crisis management," he explained. There's a direct line from that failure to those elderly people now infected with the disease in a nursing facility in Washington state. Two are now dead from there.

"Recall how, in the run-up to the Iraq war, the White House signaled preferred policy outcome so heavily that it skewed the analysis and advice it received," wrote Konyndyk. I "can see similar alignment between preferences Trump and his team were signaling, and strategic posture of his crisis managers. Trump wanted to calm markets, avoid threats to his reelection, and keep the disease out of the country. He and his team made those preferences very clear. And got angry at those who deviated."

In a Washington Post tick-tock, the timeline shows Trump's focus on the markets and not the spread of the virus.

"That inevitably colored - both overtly and subtly - the strategic emphasis of the crisis task force," said Konyndyk. "They operated from presumptions that containment was possible, the risk to the US was low, and transmission was not happening here yet. They repeated those things like a mantra. And those assumptions set the frame for the testing failures. The key question is not 'why didn't CDC's test kits work?' It's 'why were flawed CDC test kits allowed to bottleneck all US testing capacity when alternatives were available?'"

Other nations have managed to make it work, and tens of thousands have been tested. In fact, the province of British Columbia in Canada has tested more people than all of the United States.

"That's a strategic process failure. A good crisis mgmt process doesn't put all its eggs in one strategic basket - it looks for vulnerabilities in strategy, red-teams those, and either falsifies or addresses them," he wrote. "That doesn't seem to have happened."

He explained that during the Ebola response, Ron Klain drove people crazy with requests demanding contingency plan after contingency plan.

"I remember spending a weekend working a briefing paper on what we would do if all air travel to West Africa shut down," he explained. "My team thought that very unlikely, and so it drove us slightly nuts at the time (again, Ron, love). But I have come to appreciate it because it achieved two things: it forced the agencies to recheck our assumptions and meant the White House could be sure we were doing so. That kind of check-your-math mentality doesn't seem to be present in the current management of the US response."

It isn't just the CDC or FDA failing in the response, he said. It's also the White House that failed to focus on it.

"It's that sequence of interlinked optics, messaging preferences, strategic assumptions, and execution breakdowns that leaves the USG with a blind spot this big," he wrote. "And that, in turn, is how ongoing transmission in the US can be missed even as the govt assures us it isn't happening.

And all that is why competent governance is actually pretty important."

Read the full thread.