1. Cesar Ruiz – IOL – Michigan – 6′-3″ 307 lbs. – Zone or man, excellent pass blocker, can play OG or OC. Best combo of size/strength and athletic ability in the IOL group. I like him as a Zone scheme OC.

2. D’Andre Swift – RB – Georgia – 5′-8″ 212 lbs. – Bellcow back with excellent footwork and balance, HR speed and can catch passes. Not a between the tackles type.

3. Laviska Shenault Jr. – WR – Colorado – 6′-1″ 227 lbs. – A physical, workhorse that just punishes defenders in the open field. Injuries are a concern.

4. Josh Jones – OT – Houston – 6′-5″ 319 lbs. – Super athlete with great feet, decent anchor that would work best in a zone scheme. Not the dog the top 4 are, but still will get after it.

5. Zack Baun – Edge – Wisconsin – 6′-3″ 238 lbs. – A bit smaller edge, but he is smart, relentless and refined. Will have trouble against the run due to size. I think he works best as a LBer you move around inside early, out late.

6. Lloyd Cushenberry – IOL – LSU – 6′-3″ 312 lbs. – Another OG/OC candidate. Strong and tough, not as mobile as the other top OCs. Really improved over the year.

7. Denzel Mims – WR – Baylor – 6′-3″ 207 lbs. – Big, strong with decent speed. He can go up and get it. A real 50/50 ball stud. Lacks any real route running.

8. JK Dobbins – RB – Ohio State – 5′-9″ 210 lbs. – Inside out back that can catch passes, extremely tough after first contact and can go the distance. I wish he was a tad bigger.

9. Justin Jefferson – WR – LSU – 6′-1″ 202 lbs. – Good route runner, good hands, good speed, good blocker. Not explosive, but gets open, makes catches and scores.

10. Brandon Aiyuk – WR – Arizona State – 6′-0″ 205 lbs. – Another big play waiting to happen. Can take the top off the defense and is slippery in the open field. Not a very nuanced route runner, hands are OK.

11. Terrell Lewis – Alabama – 6′-5″ 262 lbs. – Another high ceiling guy with injury history. Loooong levered. Smooth. Stong. 34 Edge

12. Jonathan Taylor – RB – Wisconsin – 5′-10″ 226 lbs.- A workhorse back with HR speed and excellent vision. Pass catching is his worst trait, and its fine.

13. Tee Higgins – WR – Clemson – 6′-4″ 216 lbs. – a highpoint, catch radius WR that wins at all levels of the field, but is at his best winning 50/50. Good, not great speed.

14. Jalen Reagor – WR – Arizona State – 5′-11′ 206 lbs. – He’s a jittery HR hitter that is electric deep or in the open field. His hands are iffy IMO, or he’d be higher on my list.

15. Clyde Edwards-Helaire – RB – LSU – 5′-7″ 207 lbs. – An easy mover with a powerful lower half. May lack the size to handle a full NFL load.

16. Austin Jackson – OT – USC – 6′-5″ 322 lbs. – Lost time/strength due to helping his sister with a medical issue. He may need a year, but a full toolbox with a good balance of strength and agility.

17. K.J. Hamler – WR – Penn State – 5′-9″ 178 lbs. – Electrifying. In the open field as dangerous as any WR in the draft. Hands can be iffy, and he is small, but a HR hitter and someone a defense needs to plan for.

18. Lucas Niang – OT – TCU – 6′-6″ 315 lbs. – Another nice power/athletic combo blocker that plays with a nice edge. Injury slowed him some, and needs to get consistent.

19. Jordyn Brooks – LB – Texas Tech – 6′-1″ 240 lbs. – An absolute heat seeking missile that is devastating going downhill, lacks pass coverage reps. Sideline to sideline.

20. Van Jefferson – WR – Florida – 6′-1″ 200 lbs. – A route running technician, good hands and is OK in the open field. Not explosive and not what I would call a HR threat.

21. Marlon Davidson – IDL – Auburn – 6′-3″ 303 lbs. – 3T or 34 DE. I like him as a penetrating DE in a 34 that can also hold his own against the run. Big time motor.

22. Michael Pittman Jr. – WR – USC – 6′-4″ 223 lbs – Another physical WR that is starting to put everything together. Not a burner, but a good athlete with a great work ethic. A big Robert Woods.

23. Donovan Peoples-Jones – WR – Michigan – 6′-2″ 212 lbs. – Good hands and an excellent athlete. Underused in that woeful Mich. offense. He is more of a projection due to lack of production.

24. Matt Hennessy – IOL – Temple – 6′-4″ 307 lbs. – A OZS OC that is an excellent mover with great technique. Needs to get stronger, but IQ and skill set are outstanding. Reminds me of Garrett Bradbury.

25. Julian Okwara – Edge – Notre Dame – 6′-4″ 252 lbs. – A 34 Edge with a nice blend of explosiveness and flexibility. Needs to get stronger against the run.

26. Jonathan Greenard – Edge – Florida – 6′-4″ 263 lbs. – I just love his athletic ability, balance against the run and pass and supposedly a hard worker off the field. Not the most flexible, but his length and strength make up for it. high floor, lower ceiling type.

27. Curtis Weaver – Edge – Boise St. – 6′-3″ 265 lbs. – He could either be a 43 or 34. Lacks an ideal athletic profile, but has a hot motor, a good first step, active hands and handles his own against the run. Another high floor, lower ceiling type.

28. Cam Akers – RB – Florida State – 5′-10″ 217 lbs. – Another feature back buried on a horrible offense. Does a little of everything., but he’s a downhill 1 cut style power back at his best.

29. Kyle Dugger – S – Lenoir-Rhyne – 6′-1″ 217 lbs. – Small school kid. Great size and athletic profile that can play free or strong. Excellent blitzer and played really well at the Senior Bowl. Will need some coaching.

30. Jeremy Chinn – S – Southern Illinois – 6′-3″ 221 lbs. – Simmons-lite in a safety body. he could be a LBer a S or an edge rusher with crazy athleticism. Love his physicality and the fact that he is always around the ball.

31. Josh Uche – Edge – Michigan – 6′-1″ 245 lbs. – Smaller edge that will have issues against the run. but he is a flexy, bursty little dude that is also good in space.

32. Zack Moss – RB – Utah – 5′-9″ 223 lbs. – A big, bigtime power back with some wiggle to him. Hard to bring down. I like his footwork. Not a HR hitter and a 1 cut and go type back.

33. Jonah Jackson – IOL – Ohio St. – 6′-3″ 306 lbs. – A technician with decent strength that can play anywhere on the inside. Needs to be more consistent. Plays with an edge.

34. Akeem Davis-Gaither – LB – Appalachian St. – 6′-2″ 224 lbs. – Highly productive WILL that plays fast, can cover and rush the QB. I like him outside in a 43, but maybe a MO in a 34…

35. Chase Claypool – WR – Notre Dame – 6′-4″ 238 lbs. – A big possession WR, that wins contested catches, 50-50 balls and is tough in the redzone. Tested better then he plays, but is still a great athlete.

36. Bradlee Anae – Edge – Utah – 6′-3″ 257 lbs. – Can rush the passer and hold his own against the run, excellent hand fighter, with a top-notch motor. Not the greatest athlete. 43 or 34 compatable.

37. Robert Hunt – IOL – Louisiana-Lafayette – 6′-5″ 323 lbs. – 2nd nastiest OG in the draft. He is a punisher. Needs to be a little more patient, but he will finish on all levels.

38. Malik Harrison – LB – Ohio St. – 6′-3″ 247 lbs. – Old school type MLBer that stuffs the run and plugs gaps. Quick to react, strong and will drop the hammer. Too stiff to contribute in a lot of coverage.

39. Brycen Hopkins – TE – Purdue – 6′-4″ 245 lbs. – Your prototypical new age TE. A mismatch problem in the middle of the field that is a smooth, easy mover. Not an inline blocker, I worry a bit about his hands.

40. Prince Tega Wanogho – OT – Auburn – 6′-5″ 308 lbs. – Surprise, an athletic, raw skilled LT from Auburn. He has elite tools, but needs a year learning and gaining strength.

41. Leki Fotu – IDL – Utah – 6′-4″ 330 lbs. – A monster NT with a little pass rush juice to him. Good motor and is almost impossible to move. Not the athletic freak Lawrence was last year.

42. Ben Bartch – OT – St. Johns (MN) – 6′-6″ 309 lbs. – Small School prospect that held his own at Senior Bowl. TE turned OT. Athletic with a nice anchor, he needs seasoning. Arm length probably moves him inside.

43. Eno Benjamin – RB – Arizona State – 5′-9″ 207 lbs. – Physical for his size, smooth lower half and can be slippery to tackle. Change of pace back only.

44. Matt Peart – OT – Connecticut – 6′-7″ 318 lbs. – An easy moving OT with decent strength that again, could use a year or 2 learning and adding power, but there is no denying the skills are there.

45. Tyler Biadasz – IOL – Wisconsin – 6′-4″ 314 lbs. – OC for any scheme. Excellent mover with a great anchor and good strength. Off season hip surgery slowed him down last season. Followed by shoulder surgery this off season. Could be a heck of a steal.

46. Raekwon Davis – IDL – Alabama – 6′-7″ 311 lbs. – a 34 DE, because he will get out-leveraged on the inside. powerful with a solid anchor against the run, pass rush potential is there, but never developed.

47. Albert Okwuegbunam – TE – Missouri – 6′-5″ 258 lbs. – Big target with enough athletic ability to create issues in the seam. A decent and willing blocker inline. Offense and QB really slowed down his progression.

48. Bryan Edwards – WR – South Carolina – 6′-3″ 212 lbs. – He wins with his size and physicality in the middle of the field. Not a burner, but plays hard and smart.

49. Darnay Holmes – CB – UCLA – 5′-10″ 195 lbs.- Smooth and quick are his calling cards. I wish he was more aggressive. off man or zone scheme fit.

50. Troy Dye – LB – Oregon – 6′-4″ 231 lbs. – Another see ball, chase ball LBer that needs to add strength. But he makes plays all over the field.

51.Kenny Robinson – S – XFL – 6′-1″ 205 lbs. – A ballhawking single high Safety that needs development, but has a real nice athletic profile and flashes elite ball skills.

52. Thaddeus Moss – TE – LSU – 6′-2″ 250 lbs. – Not the freakish athlete his dad was, but is a monster in the blocking game, is a nuanced route runner and knows how to get open. Competes hard.

53. Cole Kmet – TE – Notre Dame – 6′-6″ 263 lbs. – Another size mismatch with decent athleticism. Should be a better blocker then he is. Good hands, decent route runner.

54. Adam Troutman – TE – Dayton – 6′-5″ 255 lbs. – Exciting athlete that is new to being a TE. Extremely productive, but a raw skill set including route running. A plus blocker.

55. Darrell Taylor – Edge – Tennessee – 6′-4″ 267 lbs. – Good athlete, with plenty of flex, decent get off and enough size to hold up against the run. hasn’t put it all together. High upside, high bust potential.

56. Nick Harris – IOL – Washington – 6′-1″ 302 lbs. – Smaller, smooth moving OC that lacks the power to go heads up against any kind of power. Good technique. Zone scheme only.

57. Saahdiq Charles – OT – LSU – 6′-4″ 321 lbs. – A smooth mover with good athleticism, but lacks power. A move inside might be in his future. zone scheme prospect.

58. Logan Stenberg – IOL – Kentucky – 6′-6″ 317 lbs. – Meanest, nastiest OG in the draft. Won’t win on style points and will talk your ear off. Not a great athlete.

59. Ezra Cleveland – OT – Boise State – 6′-6″ 311 lbs. – Absolute athlete for his size/length. Real smooth mover with light feet. Needs to add strength and needs technique work. I’d say an OZS LT right now.

60. Willie Gay Jr. – LB – Miss. St. – 6′-2″ 243 lbs. – Athletic and quick, will pop you in the mouth. And he did punch his own QB in the face, so there is that. Could be a 3 down ILBer with some seasoning.

61. Terrell Burgess – S – Utah – 5′-11″ 202 lbs. – He’s an exciting athlete with good speed and a bigtime motor. Lack of size might be an issue.

62. Larrell Murchison – IDL – NC State – 6′-2″ 297 lbs. – A nose for the ball with a great motor. Not the rangiest 3 tech, but he will apply constant pressure.

63. Brandon Jones – S – Texas – 5′-11″ 198 lbs. – A smaller, tad more rangy version of Brooks. He is a thumper with an all-day motor, and a nose for the ball.

64. Jordan Elliott – IDL – Missouri – 6′-4″ 302 lbs. – Strong and bursty, he can cause havoc in the backfield. Easy mover with excellent hands. Not the fastest off the snap, timing issues slow him down.

65. Tyler Johnson – WR – Minnesota – 6′-1″ 206 lbs. – A nuanced route runner that knows how to get open. Plays with some physicality. I question his speed and he didn’t run so…

66. Netane Muti – IOL – Fresno St. – 6′-3″ 315 lbs. – Skill set, power and movement ability should have him as the top IOL in the draft. he can flat out dominate. And looks to dominate you. Cannot stay healthy. Serious medical red flags.

67. AJ Dillon – RB – Boston College – 6′-0″ 247 lbs. – A bigger bodied back with more speed than one would think. A gap power fit. Loses a lot when stretched out east to west.

68. Ben Bredeson – IOL – Michigan – 6′-5″ 315 lbs. – A LG prospect I love that has played in Gap/man/OSZ at Mich so he is versatile. Decent mover with good balance and very good power that looks to finish blocks.

69. Amik Robertson – CB – Louisiana Tech – 5′-8″ 187 lbs. – slot corner due to his size. But he is a mean, physical little dude that will bring the fight to you.

70. Lamical Perine – RB – Florida – 5′-11″ 216 lbs. – A patient power back with just enough juice to get to the house. Enough wiggle to get outside, but is at his best working north to south.

71. Jabari Zuniga – Edge – Florida – 6′-3″ 253 lbs. – Decent burst, OK against the run, good athlete with range. Another boom bust prospect.

72. Kenny Willekes – Edge – Michigan State – 6′-4″ 264 lbs. – Relentless, tough, strong, try hard with average athletic ability for the position. I think due to that he is a 43 DE.

73. Alex Highsmith – Edge – Charlotte – 6′-4″ 248 lbs. – Dynamic athlete off the edge with plenty of range, good flexibility and a great motor. Not the sturdiest run defender. 34 Edge.

74. Logan Wilson – LB – Wyoming – 6′-2″ 241 lbs. – A easy flowing downhill ILBer with average athletic ability, plays with smarts and under control. Don’t think he has the range to cover on passing downs. 2 Down ILBer.

75. Anthony McFarland – RB – Maryland – 5′-8″ 208 lbs. – An undersized, raw talented HR threat from anywhere on the field. Not a 3 down guy.

76. Shaquille Quarterman – LB – Miami – 6′-1″ 234 lbs. – A real old school MLBer that reads, reacts and then thumps. I think he moves well enough to help in some coverage.

77. Antonio Gibson – RB – Memphis – 6′-1″ 223 lbs. – A wr/rb/do it all back with home run ability. Elusive with a bit of power. A jack of all trades, master of none.

78. Evan Weaver – LB – California – 6′-2″ 237 lbs. – Not the world’s greatest athlete, but he is so instinctual he’s always around the ball. Super productive. Not a hammer and not great in coverage.

79. David Woodward – LB – Utah State – 6′-2″ 230 lbs. -Not fast or super athletic, but he is smart, instinctual and has a big motor. He is everywhere. ILB

80. Ke’Shawn Vaughn – RB – Vanderbilt – 5′-10″ 214 lbs. – Decent vision with good balance and ok speed. Good pass catcher. Lacks wiggle and not explosive.

81. Quintez Cephus – WR – 6′-1″ 202 lbs. – Wisconsin – Big strong physical. Good route runner that can get himself open. Lacks deep speed. Faced 2 counts of sexual assault, case was dismissed.

82. Jason Strowbridge – IDL – North Carolina – 6′-4″ 275 lbs. – A gap jumper that lacks the size to hold his ground against double teams. Once he is into gaps, causes issues for the offense. A 34 DE or 43 DE is his future.

83. Alton Robinson – Edge – Syracuse – 6′-3″ 264 lbs. – A toolbox full of length, athletic ability, bend and explosiveness. Decent against the run. Just needs to put it all together. 34 Edge with a high ceiling.

84. Joe Bachie Jr. – LB – Michigan State – 6′-2″ 230 lbs. – a ILB with good instincts and decent range. Will pop you in the mouth when given the chance. Probably a 2 down ILBer in the NFL. Steroid suspension…

85. Joshua Kelley – RB – UCLA – 5′-11″ 212 lbs. – Strong, tough with good balance and hard to bring down, but lacks wiggle and HR speed. A one cut and go type of back.

86. Lynn Bowden – WR – Kentucky – 5′-11″ 204 lbs. – a gadget WR that can play RB and QB (wildcat) A real team guy that you will need to game plan to get the ball in his hands as he learns to be a slot WR.

87. Colby Parkinson – TE – Stanford – 6′-7 252 lbs. – Big with a big wingspan, he will torture defenders in the middle of the field and the endzone. Not a great blocker and needs to get stronger.

88. Antonio Gandy-Golden – WR – Liberty – 6′-4″ 223 lbs. – Crazy catches are littered throughout his highlights. Outstanding catch radius combined with flypaper hands make him a bigtime contested and 50-50 ball receiver. Not a great athlete or burner.

89. Darrynton Evans – RB – Appalachian State – 5′-10″ 203 lbs. – Lightning in a bottle. His change of direction and lateral jump cuts will have defenders tackling air. HR speed. Narrow frame with little room for growth. Better outside then inside. OZS committee back.

90. J.R. Reed – S – Georgia – 6′-1″ 202 lbs. – An old school SS that works best moving forward as he doesn’t have the foot speed to be ultra rangy.

91. Harrison Bryant – TE -Florida Atlantic – 6′-5″ 243 lbs. – Athletic with good hands and is a good route runner. He isn’t a blocker. His calling card is in the middle of the field.

92. Javelin Guidry – CB – Utah – 5′-9″ 191 lbs. – Quick, oily and super fast. Size is going to limit him to slot/nickel/dime work.

93. Hakeem Adeniji – OT – Kansas – 6′-4″ 302 lbs. – Another smaller LT that moves well and could slide into a zone scheme easily. needs to add power.

94. Jacob Breeland – TE – Oregon – 6′-5″ 252 lbs. – An average at best athlete, but plays with an edge and isn’t afraid of contact. Good hands and can get deep. Decent inline blocker.

95. Geno Stone – S – Iowa – 5′-10″ 207 lbs. – Another kid from Iowa with smarts, instincts and lacks a big athletic profile. Works best in the box or zone coverage.

96. Markus Bailey – LB – Purdue – 6′-1″ 235 lbs. – A Kiser clone in the fact that he is a smart. between the tackles, run stopping machine. Not enough athletic ability or speed to cover against the pass. 2019 knee injury muddies his water. 2 down ILB.

97. Josiah Deguara – TE – Cincinnati – 6′-2″ 242 lbs. – Good inline blocker regardless his size, is also a good route runner and pass catcher. Not a tremendous athlete, but is first team try hard TE. A balanced TE.

98. Gabriel Davis – WR – UCF – 6′-2″ 216 lbs. – Exciting athlete with decent speed and plays with a bit of an edge. hands are meh, and he didn’t run a ton of different routes.

99. D.J. Wonnum – Edge – South Carolina – 6′-5″ 258 lbs. – An above average athlete that can do a little of everything, but isn’t great at any one thing. Perfect size for 34 Edge with a great motor.

100. Justin Strnad – LB – Wake Forest – 6′-3″ 238 lbs. – Smooth moving forward and backward, can run and cover and go sideline to sideline. Would rather run around blockers then stack and shed. Still learning the nuances so his arrow is pointing up. ILBer in an odd front or WILL in an even front.

101. Myles Bryant – CB – Washington – 5′-8″ 183 lbs. – another slot CB, plays faster than he ran, explosive movement skills.

102. Lamar Jackson – CB – Nebraska – 6′-2″ 208 lbs. – Big, long and physical. Speed will give him issues. Press man CB.

103. Julian Blackmon – S – Utah – 6′-0″ 187 lbs. – Fun kid on tape. Plenty of speed and range, great physicality, but at the same time, not a tremendous athlete.

104. Devin Duvernay – WR – Texas – 5′-10″ 200 lbs. – a speed demon that would rather run you over then around you. A RB in a WRs body. A smart OC can do alot of stuff with this kid. Small catch radius.

105. Essang Bassey – CB – Wake Forest – 5′-9″ 191 lbs. – a nickel/slot CB that gets after it and is a smooth enough athlete to mirror really well.

106. Charlie Heck – OT – North Carolina – 6′-8″ 311 lbs. – As Alyo has stated, the son of a coach. Smart, good technique and excellent length. Needs to add some weight and power. Great developmental type of L/RT.

107. James Lynch – IDL – Baylor – 6′-4″ 289 lbs. – Monster sack production from a guy with not a ton of athletic ability. Not twitchy and not explosive. Just average strength. Really just wins on an all-day motor and a give ’em hell attitude.

108. Trevis Gipson – Edge – Tulsa – 6′-4″ 261 lbs. – an easy mover with decent burst and good flexibility. Can get bullied against the run. Developmental 34 Edge.

109. A.J. Green – CB – Oklahoma State – 6′-1″ 202 lbs. – Physical CB, sometimes too physical. Decent speed and a decent athletic profile.

110. Jalen Elliott – S – Notre Dame – 6′-0″ 205 lbs. – Slow, moderate athlete, but man he loves to blow up ball carriers. IMO a box safety or a big nickel LBer.

111. Mitchell Wilcox- TE – South Florida – 6′-3″ 247 lbs. – Hard working combo TE that had good production, but won’t wow you as an athlete. I worry a bit about his hands.

112. Trevon Hill – Edge – Miami – 6′-3″ 248 lbs. – Athletic, bursty edge with a nice pass rush. Needs to add weight to handle the run. Pass rush specialist early. 34 Edge.

113. Josiah Scott – CB – Michigan State – 5′-9″ 185 lbs. – A nickel back with good speed and decent toughness for his size. Good ball skills. Too small to survive on the outside.

114. Myles Dorn – S – North Carolina – 6′-2″ 205 lbs. – A decent all-around S with good work in the box and some solid pass defense stats. His lack of speed may limit his upside.

115. Kendall Coleman – Edge – Syracuse – 6′-3″ 257 lbs. – Average athlete that is really still developing his skill set. Good motor and plays with nice physicality. Needs to be developed. Developmental 34 Edge.

116. Jake Hanson – IOL – Oregon – 6′-4″ 303 lbs. – A zone scheme OC. A technician and good athlete, lacks the strength to trade power with defenders.

117. Mykal Walker – LB – Fresno State – 6′-3″ 230 lbs. – Has played DE, Edge and ILB. So, he is a movable chess pc. I like him as an ILB in an odd front. Certainly knows how to blitz, can drop into coverage and will stick his nose in the fan in run support. Needs development time, due to so many position changes.

118. Lavert Hill – CB – Michigan – 5′-10″ 190 lbs. – A hard-nosed press man. Lacks speed to stay with the fast WRs. Might work inside. Man only.

119. – Michael Warren II – RB – Cincinnati – 5′-9″ 226 lbs. – Decent feet for his build (a bowling ball) with good power and contact balance. Not making you miss and isn’t a HR hitter. Another short yardage back IMO.

120. Tanner Muse – S – Clemson – 6′-2″ 227 lbs. – A big S, maybe a LBer…4.41 speed, can play deep due to his speed and athleticism, can play in the box due to his size. Never put it all together for his profile.

121. Aaron Parker – WR – Rhode Island – 6′-2″ 209 lbs. – A good blend of physicality combines with his ability to go up and get it makes him a contested catch monster. He needs to develop his route running.

122. Kyle Murphy – IOL – Rhode Island – 6′-3″ 316 lbs. – Overpowered FCS competition, needs to add size and power to do that at the NFL level. He’s an easy mover with good footwork. Scheme versatile.

123. Joe Reed – WR – Virginia – 6′-0″ 224 lbs. – A deep threat with good hands and can return in STs. Has some wiggle. Another gadget kid early as he learns to run routes properly.

124. Stephen Sullivan – TE – LSU – 6′-5″ 248 lbs. – Massive seam buster that got lost in the shuffle of an all star offense. Long, middle of the field mismatch. Not a tremendous blocker.

125. Benito Jones – IDL – Ole Miss – 6′-1″ 316 lbs. – a fire hydrant with very good strength. Won’t slide thru gaps but holds more than his own against the run. A true NT with a little pass rush push.

126. Jaylinn Hawkins – S – California – 6′-1″ 208 lbs. – Smart, physical with some range. Not a ton and won’t wow you going sideline to sideline. Decent ball skills, but he has room for improvement.

127. Davion Taylor – LB – Colorado – 6′-1″ 228 lbs. – Late comer to football. Kid is a PAC 12 track star, so he can fly, great athlete, smooth mover. Great motor. Needs to get stronger and needs massive development. WILL or ILB in a 34.

128. Kyahva Tezino – LB – San Diego State – 6′-0″ 235 lbs. – Plays the run well, decent athlete that can get to the sidelines and plays with patience and intelligence. Lacks length and quickness.

129 Devin Asiasi – TE – UCLA – 6′-3″ 257 lbs. – a combo blocker/receiver with good size for the position. Needs technical work in all aspects. Developmental type traditional TE.

130. Dalton Keene – TE – Virginia Tech – 6′-4″ 253 lbs. – Here is your late round, H-back, fullback, TE. He can block and catch but was never really given much opportunity. Decent athlete, but plays like an old school TE.

131. Kindle Vildor – CB – Georgia Southern – 5′-10″ 191 lbs. – Ballhawking athletic CB with the size and footwork to work in any scheme. Not great in run support. Can be over-aggressive.

132. Stephen Guidry – WR – Mississippi State – 6′-3″ 201 lbs. – Long with long arms and decent deep speed. Can go up and get it, or win over the top. Not a great route runner.

133. Justin Herron – OT – Wake Forest – 6′-4″ 308 lbs. – A OG in the NFL. Good pass blocker with decent footwork, has trouble trading power in the run game. Zone scheme OG.

134. Reggie Robinson II – CB – Tulsa – 6′-1″ 205 lbs. – Long with decent athletic profile, does his best work in a zone and things are in front of him. Nice production. Modest athlete.

135. Tyrie Cleveland – WR – Florida – 6′-2″ 209 lbs. – Long and fast. Never ran a diverse route tree, but he can eat up a DB in a hurry. Will need some development.

136. Jon Runyan – OT – Michigan – 6′-4″ 306 lbs. – I think he moves inside to OG. Son of an NFL OT. So he is smart. Good athlete but lacks strength. zone scheme OG.

137. Tipa Galea’i – EDGE – Utah State – 6′-5″ 235 lbs. – An explosive, oily, easy mover. Needs to add mass if he wants to hold up against the run.

138. Nigel Warrior – S – Tennessee – 6′-0″ 190 lbs. – Vols played him everywhere from what I saw. So he can do some of everything. Good athlete, good run defender for hsi size. Lack of ball production is a concern.

139. Nevelle Clarke – CB – UCF – 6′-1″ 190 lbs. – I called him a mini Ramsey. Plays with a swagger and a ballhawks mentality. Great size for a CB. Easy mover. Needs to add strength and some weight to reach his full potential.

140. James Proche – WR – SMU – 5′-11″ 201 lbs. – Natural hands and just catches everything. Smooth athlete, with great college production. Not a burner. Needs to work on route running.

141. Cameron Brown – LB – Penn State – 6′-5″ 233 lbs. – Long for a LBer. Also raw. Can cover a ton of ground quickly and goes sideline to sideline. Not great in coverage. Not sure his position fit. 43 OLB or maybe add 15-20 lbs and make him a 34 edge?

142. Sean McKeon – TE – Michigan – 6′-5″ 242 lbs. – A combo TE that can block in line and be used as a pass catcher. Not the most dynamic route runner, or athlete, but he competes hard. Good 3rd TE for a roster.

143. Quez Watkins – WR – Southern Miss – 6′-0″ 185 lbs. – Will take the top off a defense. No idea how to run a route, gets open from DBs being scared of being ran by. Electric in the open field. Needs to add some good weight.

144. Grayland Arnold – CB – Baylor – 5′-9″ 186 lbs. – Nickel CB with great ball production. Smooth lower body makes him sticky, has a ballhawk mentality. Lacks size to hold up on the outside.

145. Charlie Taumoepeau – TE – Portland State – 6′-2″ 240 lbs. – Literally a move TE. He played H-back, RB, TE, WR for Portland State. So he can block and catch and be a nice depth piece. Nothing athletically extrordinary.

146. Levonta Taylor – CB – Florida State – 5′-10″ 190 lbs. – a CB turned safety, smooth lower half and good speed and lack of strength make him an ideal zone fit, either as a nickel or S. had back problems in the past.

147. Mohamed Barry – LB – Nebraska – 6′-1″ 245 lbs. – A bull in a china shop ILBer with sideline to sideline athleticism. Tough and strong just kinda running around out there hitting things and overrunning other things…

148. John Reid – CB – Penn State – 5′-10″ 187 lbs. – A physical press man CB that due to lack of size will end up being a Nickel Back. Average speed to match his average athletic ability.

149. Jordan Fuller – S – Ohio State – 6′-2″ 203 lbs. – A single high safety that is too slow to play single high in the NFL IMO. Racked up a ton of tackles and loves to hit. I like him as a depth/3rd safety with plenty of upside in the box.

150. Derrek Tuszka – Edge – North Dakota St. – 6′-5″ 251 lbs. – A 43 end that will transition to a standup 34 edge. Tough, strong and can hold up vs the run. Great pass rush production. Decent athlete, but lacks flexibility to bend around the edge.

NFL

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http://www.nfl.com/news/story/0ap3000001110012/article/daniel-jeremiahs-top-150-prospects-in-the-2020-nfl-draft-class
Daniel Jeremiah’s top 150 prospects in the 2020 NFL Draft class

By Daniel Jeremiah
NFL Media analyst
Published: April 20, 2020 at 10:26 a.m.
Updated: April 20, 2020 at 11:50 p.m.

Top 150
Top 50: 4.0
3.0
2.0
1.0

With the Cincinnati Bengals set to make the first pick of the 2020 NFL Draft on Thursday, April 23, it’s time for my final prospect rankings of draft season.

RANK

1

Chase Young, Edge

School: Ohio State | Year: Junior
Previous rank: 1

Young is a tall, long and athletic defensive end. As a pass rusher, he explodes off the ball and gains ground in a hurry. He uses a quick swipe move and also has the ability to control the wrists of blockers. He can convert speed to power and is effective on loops and games. He does have a little tightness at the top of his rush. Against the run, he sets the edge easily and uses his quickness to slip blocks and create chaos behind the line of scrimmage. Overall, Young is an All-Pro talent, reminiscent of Julius Peppers and Mario Williams.

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2

Joe Burrow, QB

School: LSU | Year: Senior (RS)
Previous rank: 2

Burrow has solid size for the position and he possesses many elite qualities. He operated out of the ‘gun in the LSU spread attack and he is extremely accurate, efficient and instinctive. He is very smooth in his drop and he has the ability to process through his reads at a rapid pace. He throws with anticipation and he can naturally layer the ball over and under coverage. He doesn’t have top-shelf arm strength when driving the ball outside the numbers. He relies more on timing/touch. He doesn’t flinch versus pressure when he sees something he likes down the field. If he needs to buy time, he can slide and climb the pocket with excellent feel/awareness. He has a nice burst when he leaves the pocket and he is more than a capable runner. Overall, Burrow lacks special arm strength, but his combination of poise, accuracy and toughness is very appealing.

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3

Isaiah Simmons, LB/S

School: Clemson | Year: Junior (RS)
Previous rank: 3

Simmons is an extremely versatile, athletic defensive chess piece. He is a long, rangy athlete who lined up at linebacker, over the slot and in the deep middle for Clemson, thanks to his diverse and unique skill set. Against the pass, he has terrific range and instincts from the deep middle. He has the speed and agility to match up with top-flight tight ends and backs underneath. He is an explosive blitzer off the edge and in through the middle. Simmons overpowers running backs in protection. Against the run, he takes good angles and his speed allows him to make plays from the back side. He will struggle at times if he has to take on blocks on the edge. Overall, Simmons is built for today’s NFL and his role could change week to week, depending on the opponent.

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4

Jeff Okudah, CB

1

School: Ohio State | Year: Junior
Previous rank: 5

Okudah has ideal size, length, twitch and competitiveness for the position. He is very comfortable and effective in both press and off coverage. He is patient in press and very fluid/smooth when he opens up. He does a nice job of staying on top versus vertical routes and he can locate the football down the field. He has the agility to mirror underneath. In off coverage, he explodes out of his plant and he is a dependable open-field tackler. This is a very clean player with a very high floor and ceiling.

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5

Derrick Brown, DT

1

School: Auburn | Year: Senior
Previous rank: 4

Brown has excellent size, power and athleticism for the defensive tackle position. As a pass rusher, he has a quick first step and uses his hands very effectively. He wins with a violent club/swim move, a rip move or a nifty up-and-under counter move. Against the run, he easily holds the point of attack. The Auburn product creates separation from blockers with an explosive punch, which allows him to close quickly and make plays. His effort is consistent. Overall, this is a complete player capable of dominating on all three downs. He’ll be a difference maker on Day 1.

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6

Tua Tagovailoa, QB

School: Alabama | Year: Junior
Previous rank: 6

Tua lacks ideal height for the position, but he has quick feet, eyes and release. He primarily operated in the ‘gun at Alabama, but he did take some snaps under center. He is very crisp and urgent in his setup. He throws off a firm platform and he spins the ball really well. He always throws with the proper pace on slants and crossers. He doesn’t have an overpowering arm, but he can still place balls in tight windows. He understands how to hold and manipulate safeties with his eyes. He makes good decisions in the RPO game. He is a nifty runner, but he prefers to buy time behind the line and remain in passing mode. He did struggle with identifying some underneath defenders when in the red zone. He is coming off a serious hip injury and that must be factored into his evaluation. Overall, Tua is the ultimate point guard. If he can remain healthy, he has the potential to be one of the NFL’s most efficient passers.

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7

Mekhi Becton, OT

School: Louisville | Year: Junior
Previous rank: 7

Becton is a massive left tackle prospect with a similar size/skill set to former first-rounder Bryant McKinnie. In pass protection, he has surprisingly nimble feet and uses his length to steer defenders. Even when he fails to land his punch, he can absorb rushers with his girth. He needs to improve his awareness versus games up front. He is a dominating run blocker and collects knockdowns by the bunches. He latches on and uses his upper-body strength to torque and toss. He isn’t as effective when working in space. Overall, Becton has areas to improve — mainly balance and awareness — but he is a rare athlete at this size and his upside is through the roof.

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8

Javon Kinlaw, DT

School: South Carolina | Year: Senior
Previous rank: 8

Kinlaw is a hulking defensive tackle prospect. As a pass rusher, he has a sudden get-off and he’s quick to shoot his hands and drive back blockers. He will also incorporate a push/pull move on occasion. He does need to broaden his arsenal of moves, but there is tremendous upside. Against the run, he easily locks out single blocks, but he gets washed by angle blocks and double teams. His effort is solid. Kinlaw showed out against elite competition, but he played down to the level of lesser opponents. Overall, Kinlaw’s best football is in front of him and he has Pro Bowl potential.

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9

CeeDee Lamb, WR

School: Oklahoma | Year: Junior
Previous rank: 9

Lamb is a tall, lean wideout with top-tier hands, toughness and production. He lines up inside and outside. He is a smooth, fluid route runner and understands how to set up cornerbacks. He also has a good feel in zone. He attacks the ball when working back to the quarterback and tracks the ball naturally down the field. Lamb doesn’t have elite speed, but he can find some extra juice when the ball is in the air. He is at his best after the catch, as he consistently breaks tackles and is also very elusive. Overall, Lamb is a polished player who is equally explosive and reliable.

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10

Jedrick Wills, OT

School: Alabama | Year: Junior
Previous rank: 10

Wills lined up at right tackle for Alabama. He has average height for the position and he’s carrying a little extra weight. An excellent pass protector, Wills is quick out of his stance and he’s an easy mover versus speed and counters. He is a natural knee bender and he reworks his hands to maintain leverage/control. He is aware versus games and stunts. In the run game, he is at his best when working up to the second level. He also flashes the ability to roll his hips and uproot defenders over his nose. He’s never on the ground. Overall, Wills doesn’t have the ideal body type, but he has all of the necessary tools to be a 10-year starter at either tackle spot.

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11

Jerry Jeudy, WR

School: Alabama | Year: Junior
Previous rank: 11

Jeudy is an elite route runner with outstanding burst, body control and awareness. He explodes off the line and uses his quickness to avoid press coverage. His snap at the top of the route is as good as any prospect in the last decade. He has the ability to make plays outside of his frame, but he will have some concentration lapses, which lead to drops. After the catch, he is very slippery and elusive, although he isn’t going to break a lot of tackles. Overall, Jeudy is a loose athlete with elite route skills and he should emerge as a high-volume production guy very early in his career.

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12

Henry Ruggs III, WR

School: Alabama | Year: Junior
Previous rank: 12

Ruggs has an unbelievable blend of speed and toughness. He lines up outside and in the slot. He ran a lot of slants and take-off routes in Alabama’s offense — and he was special on both. Ruggs boasts world-class speed — he truly explodes off the line and after the catch. He needs to continue to refine his releases against press (he gives up his chest too often), but not many defenses will want to take that chance against his speed. His hands are good, not great, and he does allow too many balls into his chest. After the catch, he runs away from most defenders while occasionally running through them. He is outstanding on jet sweeps and also has kick-return value. Overall, Ruggs has Tyreek Hill-type ability. He will be a matchup nightmare every week.

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13

Tristan Wirfs, OT

School: Iowa | Year: Junior
Previous rank: 13

Wirfs is a big, powerful offensive tackle. In pass protection, he launches out of his stance and hasn’t had issues versus outside speed rushers. However, he has experienced issues against inside counter moves. He over-sets and struggles to redirect back inside, allowing too many pressures in the games I studied. When he can land his punch, it’s over. His hands are so strong and he has the power base to end the play right there. In the run game, he is very strong and aggressive. He creates a ton of movement, but also will overextend and fall off at times. He’s on the ground too much. I love his aggressive demeanor, but he needs to play more under control. Overall, I believe he can survive at tackle, but he’d benefit from playing with neighbors on both sides. I think Wirfs has All-Pro potential at guard.

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14

Justin Jefferson, WR

School: LSU | Year: Junior
Previous rank: 14

Jefferson is a tall, slender wideout with off-the-charts production. He lines up in the slot and out wide. He is an outstanding route runner. He does a nice job getting on the toes of cornerbacks and then creating separation out of the break point. He does a lot of work in traffic and will extend and finish before taking hard contact. He can play above the rim down the field and can contort his body to make special catches. He doesn’t have elite speed, but he’s plenty fast enough. After the catch, he has some wiggle and will fight for extra yards. Overall, Jefferson is a polished receiver and should make an immediate impact at the next level.

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15

Patrick Queen, LB

School: LSU | Year: Junior
Previous rank: 15

Queen is an undersized linebacker with outstanding burst, instincts and coverage ability. Against the pass, he is very fluid in his drops and his change-of-direction ability is excellent. He has good instincts to jump routes and he closes to the flat in a hurry. He is a very dynamic blitzer (see him flat-back an offensive guard in the Texas A&M game). In the run game, he is quick to key/read and shoot gaps. He does get uprooted at times because of his size, but he usually finds a way to beat blockers to spots. Overall, Queen is a high-tempo playmaker at the second level and should impact all three downs.

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16

D’Andre Swift, RB

School: Georgia | Year: Junior
Previous rank: 16

Swift is a compact running back with excellent patience, vision and quickness. On inside runs, he lets things develop before exploding through the line of scrimmage. He has the vision to see and set up second- and third-level defenders. He has make-miss ability in tight quarters, but prefers to drop his shoulder and seek contact. He has enough speed to capture the corner on outside runs. He is a cradle catcher in the passing game, but it’s effective. In pass protection, he likes to cut block and he’s reliable. Overall, Swift has a similar skill set to Josh Jacobs, and I expect comparable results at the next level.

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17

Kenneth Murray, LB

1

School: Oklahoma | Year: Junior
Previous rank: 18

Murray is an off-the-ball, run-and-hit linebacker. He is at his best when he’s free to chase and make plays to the perimeter. He closes in a heartbeat and he is an explosive tackler. He struggles when he has to play off blocks and locate the football through the trash inside, as he doesn’t use his hands and gets swallowed up. He has had some success dipping and slipping blocks. He is very athletic in coverage versus running backs, easily mirroring them in space. He is also a very dynamic blitzer. Overall, I believe Murray would be best served to play outside and off the ball, where he would be afforded clean sight lines to attack with his speed.

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18

Andrew Thomas, OT

1

School: Georgia | Year: Junior
Previous rank: 17

Thomas is a thick, powerful offensive tackle. In pass protection, he has average foot quickness in his set, but he possesses a powerful punch and strong anchor. He gets in trouble at times because his base is too wide; he lunges and loses balance. He plays with good overall awareness. He is a dominant run blocker. He can uncoil and uproot defenders over his nose and has the strength to wash defenders down the line of scrimmage on down blocks. He is effective working up a level when he can stay on one track, but he struggles to redirect in space. Overall, some teams view Thomas as a guard, but I believe he can hold up at tackle if he improves his balance issues.

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19

Ross Blacklock, DT

School: TCU | Year: Junior (RS)
Previous rank: 19

Blacklock is a dynamic interior defensive lineman. As a pass rusher, he launches out of his four-point stance and his bull rush is ferocious. He creates immediate knock-back. He is ultra-twitchy. He flashes a long-arm move where he can jolt, separate and finish. As a run defender, he successfully stacks and sheds single blocks, but he needs to improve his awareness and effectiveness versus double teams, where he gets washed down the line. He does have some durability concerns, but his skill set is special. Overall, Blacklock comes with some risk, but he’s worth it. He has the potential to develop into a top-flight interior pass rusher.

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20

Justin Herbert, QB

School: Oregon | Year: Senior
Previous rank: 20

Herbert has exceptional size, mobility and arm strength. He has quick feet in his setup and he bounces on his toes once he gets to the top of his drop. His motion can be a little robotic at times, but the ball comes out tight with high RPMs. He has a big arm, but his placement is a little inconsistent. His front side flies open on some throws, impacting his accuracy. That can be corrected. He has shown the ability to touch up the ball underneath and makes some impressive throws on the run. He is a very good runner. He builds speed and he is effective on zone reads. The biggest area he needs to improve is his lack of anticipation. He waits too long to cut it loose. According to everyone at Oregon, his work ethic and character are off the charts. Overall, Herbert has some special physical tools, but he needs to play with less caution and learn to embrace an attacking mentality.

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21

CJ Henderson, CB

School: Florida | Year: Junior
Previous rank: 21

Henderson is an extremely explosive and athletic cornerback prospect out of Florida. He played outside and inside on the games I studied. He is very physical in press coverage, landing a two-hand jam consistently. He is extremely loose and fluid to open up and mirror all over the field. He’s hardly ever out of position and possesses rare makeup speed when he is caught in a bind. You see that same burst when he’s in off coverage and the ball is thrown in front. He does need to improve on finding the ball down the field, as he’s often a little late to look back. The major concern with this player is tackling. He has way too many misses and that must be improved. Overall, Henderson has some elite traits and could emerge as the top cornerback in this class, but his tackling must be addressed.

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22

Xavier McKinney, S

School: Alabama | Year: Junior
Previous rank: 22

McKinney was an instinctive safety for the Tide and he also spent some time playing nickel linebacker. When aligned deep, he is fluid in his movement and he’s quick to key/read and drive on the football. His range is excellent. While he can effectively locate the ball, he will occasionally lose a 50/50 battle down the field. He is a dependable wrap/drag tackler. He has a very good feel as a blitzer, displaying timing and burst. Overall, McKinney is an intelligent, versatile defender and he should be very effective in multiple roles.

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23

Jordan Love, QB

School: Utah State | Year: Junior (RS)
Previous rank: 23

Love has ideal size, arm strength and athletic ability. He operated out of the ‘gun at Utah State and was very fluid and smooth in his setup. He throws from a variety of platforms and arm angles. The ball jumps out of his hand. He is at his best on skinny post drive throws and over-the-top deep balls. His decision making was very concerning this past season. He forced too many balls into crowds and didn’t ever give up on a play — to a fault. His supporting cast wasn’t very good, but he still fell into too many bad habits. He uses his athletic ability to escape and extend plays, but there are occasions when he fails to climb and reset his feet. Overall, Love is a raw prospect who will need some time to develop. There is risk with him, but the payoff could be huge.

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24

Brandon Aiyuk, WR

School: Arizona State | Year: Senior
Previous rank: 24

Aiyuk is one of my favorite players in the draft class. He has a solid, muscular frame and plays an aggressive brand of football. He is explosive in his release and he attacks the leverage of cornerbacks before suddenly snapping off his route. Aiyuk doesn’t run a wide variety of routes, but he’s very efficient and effective. He has strong hands and can finish in traffic. He is at his best after the catch, breaking tackles and making people miss without gearing down. Those skills serve him well as a returner, too. Overall, Aiyuk will need a little time to develop as a complete route runner, but he’s a tough, explosive playmaker with added special teams value.

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25

K’Lavon Chaisson, Edge

School: LSU | Year: Sophomore (RS)
Previous rank: 25

Chaisson primarily lined up as a stand-up rusher in the Tigers’ defensive system. He is long, explosive and very athletic. As a pass rusher, he relies more on pure get-off speed and athletic ability than technical skill. He is at his best as a looper, where he can find a crease and explode through. He has yet to figure out how to use his length to his advantage on a consistent basis. Against the run, he flashes the ability to stack and hold the point, but he excels at slipping blocks and creating havoc. His speed and effort show up on the back side of plays. Overall, Chaisson is more athlete than football player right now, but he has all of the raw tools to be a dominant force at the next level.

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26

A.J. Epenesa, Edge

School: Iowa | Year: Junior
Previous rank: 26

Epenesa is a skilled pass rusher with outstanding size, strength and effort. He has average get-off quickness, but he boasts strong hands, can flip his hips and is a reliable finisher. He has a variety of hand techniques, including a violent club move, swipe move and a push/pull move. He also will flash a long-arm move with his inside arm. He has a great feel when an OT is leaning outside, which creates an opening for his up-and-under inside-counter move. Against the run, he can hold the point of attack easily. His effort on the back side is outstanding, but he lacks the burst to make a ton of plays from distance. Overall, Epenesa has a very high floor as a prospect. He should be a consistent 8-to-10-sack performer at the very least.

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27

Tee Higgins, WR

School: Clemson | Year: Junior
Previous rank: 27

Higgins is a tall, long and rangy wideout with elite high-point skills. He uses a quick foot fire to defeat press coverage. He is a smooth, long-striding route runner. He is at his best when on the move: slants, posts and go routes. He lacks snap at the top of his route when working back downhill. He has incredible ball skills down the field. He can elevate and also adjust to the back-shoulder ball. After the catch, he is very smooth and slippery. Overall, Higgins isn’t going to do a lot of the dirty work in the middle of the field, but he’s very effective on the outside and provides big-play ability.

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28

Austin Jackson, OT

School: USC | Year: Junior
Previous rank: 28

Jackson brings an intriguing blend of size, athleticism and upside. In the passing game, he has the quickness to easily cut off speed rushers and he plays with good knee bend and balance. He needs to improve on his punch, as he’s often late to shoot his hands and gives up his chest, leaving him vulnerable to the bull rush. He flashes the ability to settle down after giving ground, but this needs to improve. In the run game, he has the quickness to reach/cut off on the back side and he does a good job of staying attached on the front side. His overall play strength needs to improve, but he’s only 20 years old and that should come in time. Jackson isn’t ready to play at a high level right away, but the upside is tantalizing.

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29

Jaylon Johnson, CB

School: Utah | Year: Junior
Previous rank: 29

Johnson offers an enticing size/speed combination for the position. He plays a lot of press-bail technique, but also flashes a firm two-hand jam. He is very fluid to open up and has plenty of long speed to carry vertical routes. He also excels when he slides inside to cover the slot. He was rarely challenged down the field in the games I studied. His ball production was outstanding in 2018 and opposing teams chose to avoid him last fall. He is very aggressive versus the run. He closes quickly before coming to balance and delivering firm tackles. Overall, Johnson is very talented and should be a Day 1 starter outside with the potential to cover in the slot as well.

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30

Yetur Gross-Matos, Edge

School: Penn State | Year: Junior
Previous rank: 30

Gross-Matos was a tall, long edge rusher for the Nittany Lions. He will stand up on the edge or launch out of his four-point stance. He is a very productive pass rusher. He doesn’t have an elite get-off, but he has very active hands and an array of moves. He has a quick swipe move, inside spin and he can also bend/wrap at the top of his rush. I’d like to see him develop more power, but he still has a lot to work with. He is very effective on loops and games. He does need to improve versus the run, as he sometimes plays too high and gets uprooted. Overall, Gross-Matos offers double-digit sack potential, but he does need to add strength at the next level.

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31

A.J. Terrell, CB

School: Clemson | Year: Junior
Previous rank: 31

Terrell is a tall, slender cornerback prospect with a strong resume in a variety of coverages and techniques. In press coverage, he uses an effective one-hand jam before turning and opening up. He can carry vertical routes with his speed, but he is a little bit sticky when he’s forced to gear down and come back downhill. In off coverage, he has a quick pedal, but there is a brief pause in his plant/drive. He has very good ball awareness down the field. He is a reliable tackler and an outstanding blitzer from the boundary corner spot. He had a rough outing against LSU in the national title game, but was otherwise very steady last season. Overall, Terrell has some tightness, but he’s a very solid player who should emerge as a quality No. 2 cornerback for his drafting team.

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32

Clyde Edwards-Helaire, RB

School: LSU | Year: Junior
Previous rank: 32

Edwards-Helaire is a short, compact runner with quick feet, power and prowess in the passing game. On inside runs, he’s a quick-stepper with darting lateral agility to slide and avoid contact. He runs extremely low to the ground and is tough for opponents to square up. He drives his legs on contact and pulls out of a lot of tackles. He is quick to capture the perimeter and refuses to run out of bounds, choosing instead to fight for extra yards. He is outstanding in the passing game. He can line up anywhere in the formation and he runs clean/crisp routes. He catches the ball outside his frame very smoothly and he’s outstanding after the catch. His ability to start/stop in space is elite. He is rarely used in pass protection because of his value out in the route. Overall, Edwards-Helaire has a very similar skill set to Austin Ekeler — I envision a similar role/results at the next level.

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33

Marlon Davidson, Edge

1

School: Auburn | Year: Senior
Previous rank: 34

Davidson has average height and a thick/square build. He typically lined up at defensive end for the Tigers, but also possesses the ability to slide inside. As a pass rusher, he is devastating when he has a runway. He generates a lot of power in his bull rush and has an array of hand moves he can incorporate on the move. He doesn’t have an elite get-off, but he wins in the ways just mentioned. He destroys tight ends with his strength and power combination. Against the run, he uses his length to stack blocks, and his effort to pursue is outstanding. Overall, Davidson has some inside/outside flexibility and his production should carry over to the next level.

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34

Zack Baun, LB

1

School: Wisconsin | Year: Senior (RS)
Previous rank: 33

Baun is a slightly undersized outside linebacker with excellent athleticism and versatility. He spends a lot of time playing over tight ends and gets the best of them in the run and pass games. As a rusher, he has a good initial burst and can really bend at the top of his rush. He has a nifty inside counter move and he can get skinny before closing on the quarterback. He mixes in a stutter/bull rush, but usually stalls out after generating some push. He is very athletic as a dropper in coverage. He is very good as a back-side run defender because of his burst and effort. Teams will differ on where to play him at the next level. He reminds me of former USC LB Uchenna Nwosu, someone whose versatility the Chargers have tapped into. I’d do the same with Baun.

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35

Jonathan Taylor, RB

School: Wisconsin | Year: Junior
Previous rank: 35

Taylor is an ultra-productive running back with outstanding strength and speed. On inside runs, he’s sudden, carries his pads low to the ground and shows the balance to bounce off tacklers while keeping his legs alive. He isn’t overly shifty, but he avoids taking flush hits and he always falls forward for extra yardage. He has plenty of speed to capture the edge and once he gets in space, he can run away from the crowd. In the passing game, he is very effective on screens, where he can set up his blocks and collect big chunks of yardage. He trusts his hands and attacks the ball when he’s out in the route. He didn’t have a lot of reps in pass protection in the games I studied. Overall, Taylor is an explosive home run hitter with upside in the passing game.

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36

Laviska Shenault, WR

School: Colorado | Year: Junior
Previous rank: 36

Shenault is arguably the best athlete in the entire draft class. He is tall with a thick, muscular build. He lined up everywhere in Colorado’s offense — out wide, in the slot, at running back and he even took snaps as a Wildcat quarterback. Shenault isn’t a nuanced route runner, but he is a monster with the ball in his hands. He excels on quick hitters, fly sweeps and vertical routes. He has strong hands and his transition into a running back is immediate after the catch. He steps through tacklers and has a burst to finish. He is very competitive. Overall, Shenault comes with some durability concerns and will need time to develop into a fully polished wideout, but he can have an immediate impact for a creative offensive coordinator. He’s too big, strong and fast to not contribute. His drafting team just has to figure it out.

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37

J.K. Dobbins, RB

3

School: Ohio State | Year: Junior
Previous rank: 40

Dobbins is a compact running back with tremendous power, balance and instincts. He is at his best on inside runs. He doesn’t hesitate, accelerating into contact and breaking a ton of tackles. He has a nifty inside spin move and can make second- and third-level defenders miss in space. He has enough speed to get to the perimeter, but he always looks to turn upfield as soon as possible. In the passing attack, he is effective in the screen game, but he has more work to do as a route runner. He had two tough drops vs. Clemson in the College Football Playoff, but he was reliable in every other game I studied. He is very aware in pass protection — he can drop his weight and anchor linebackers. Overall, Dobbins’ game should translate very well to the next level. He’ll be a dependable starter immediately.

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38

Cesar Ruiz, C

1

School: Michigan | Year: Junior
Previous rank: 37

Ruiz is an extremely consistent, physical and aware center. In pass protection, he has a tight punch and immediate anchor. His lower body is outrageously strong. He is very aware vs. twists/stunts. He lacks elite foot quickness, but he doesn’t have any issues sliding and redirecting to stay square vs. defenders. In the run game, he latches and runs his feet to create movement. He is outstanding on combo blocks, staying under control, locating and walling off linebackers. His lack of foot quickness shows up on outside pulls. Overall, Ruiz reminds me of Travis Frederick coming out of Wisconsin.

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39

Joshua Jones, OT

School: Houston | Year: Senior (RS)
Previous rank: 39

Jones lined up at left tackle for the Cougars. He has the ideal frame and length for the position. In pass pro, he is very smooth and efficient in his set. He isn’t overly explosive, but he has enough foot quicks to kick out and cover up speed rushes. He has a firm punch and he does a nice job replacing his hands when they get knocked down. He does play a little high and that impacts his ability to redirect versus up-and-under moves. In the run game, he can create movement on down blocks and is effective at the second level. He shows awareness against both run and pass. Overall, Jones has some games where he looks like a top-15 player (see: the Oklahoma tape), but he needs to play with better knee bend on a consistent basis. He should be a solid, dependable starter early in his career.

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40

Grant Delpit, S

2

School: LSU | Year: Junior
Previous rank: 38

Delpit is a tall, fast free safety who also possesses the ability to play in the slot. From the deep middle, he trusts his eyes and explodes to the ball, whether run or pass. He has outstanding range and I trust his ball skills. His numbers dropped this past season, but that was the result of some nagging injuries. He is fluid and smooth when lined up in the slot. He is aggressive as a force defender, but he has too many fly-by missed tackles. Everyone at the school raves about his leadership and intangibles. Overall, Delpit needs to clean up some tackling issues, but he has Pro Bowl potential at free safety.

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41

Cole Kmet, TE

School: Notre Dame | Year: Junior
Previous rank: 41

Kmet has an ideal frame for the TE position. He lined up inline and flexed out in Notre Dame’s offense. In the passing game, he has good speed and does a lot of damage working in the seams. He uses his big frame to wall off defenders and pluck the ball in traffic (see: Georgia game). He isn’t very polished or nuanced at the top of his route. He is at his best when he stays on the move instead of working back to the quarterback. He is physical after the catch, but he doesn’t provide much wiggle or elusiveness. In the run game, he can effectively shield and wall off at the point of attack, and he takes good angles working up to the second level. Kmet was the closer on Notre Dame’s baseball team and should make major strides now that he’s solely focused on football. Overall, Kmet isn’t a dynamic player, but he’s going to get stronger. I see him as a reliable, long-term starter at the position.

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42

Jeff Gladney, CB

4

School: TCU | Year: Senior (RS)
Previous rank: 46

Gladney lacks ideal size/bulk for the position, but he excels because of his blend of quickness and feistiness. He plays outside and inside. He is at his best in off coverage, where he uses a quick, fluid pedal before efficiently planting and driving on balls thrown in front of him. He doesn’t waste steps. He is always in good position, but will get walled off at times by bigger wideouts. When he does press, he usually sits at 2 yards and carries his hands low before trying to catch wideouts and re-route them. His overall ball awareness is very good. He does a good job coming to balance before tackling runners and he’s also an effective blitzer. Gladney needs to get a little stronger, but I love his scheme versatility and toughness.

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43

Kristian Fulton, CB

1

School: LSU | Year: Senior
Previous rank: 42

Fulton has good size for the position and he’s very fluid, smart and competitive. In press coverage, he switches up his technique. He’s primarily patient, but he’ll occasionally land a quick two-hand jam. He lacks elite top speed and he’s had some issues timing his leap on jump balls down the field. From off coverage, he’s very aware and shows some pop out of his plant/drive. He is very aggressive in run support. He fights through blocks and is very reliable in space. Overall, Fulton has some flaws, but I’ll bet on his intangibles and toughness.

RANK

44

Jeremy Chinn, LB

1

School: Southern Illinois | Year: Senior
Previous rank: 43

Chinn is a fun player to study. He lined up all over the field in SIU’s scheme. He has an outstanding blend of size, speed and instincts. He is at his best when he’s in the box as a down safety/nickel linebacker. He has tremendous range to make plays sideline to sideline. He can locate and play the ball naturally (see: the high-point INT vs. UMass). He does have a little tightness when he’s in space, but he recovers quickly. He is a very firm/reliable tackler. Overall, I believe Chinn is ideally suited to play WLB at the next level. He is exactly what teams are looking for in today’s NFL.

RANK

45

Justin Madubuike, DT

1

School: Texas A&M | Year: Junior (RS)
Previous rank: 44

Madubuike is a strong, versatile defensive lineman. He aligns at every spot along the defensive front, but he’s best suited as a 3-technique (on the edge of the guard). Against the pass, he is very quick to shoot his hands and generate knock-back. He has a quick club/rip move and is very adept at working through half the opponent instead of rushing down their numbers. His effort is outstanding. He is a dominant run defender. He excels at stacking blockers, separating and locating the football. Overall, Madubuike isn’t an elite pass rusher, but he’s impactful and can dominate on early downs.

RANK

46

Denzel Mims, WR

1

School: Baylor | Year: Senior
Previous rank: 45

Mims is a tall, rangy wideout with exceptional burst and body control. He uses his quickness and burst to escape press coverage, excelling on vertical routes down the field. He tracks the ball naturally and wins a bunch of 50/50 balls. He will need some time to develop as a complete route runner. He simply wasn’t asked to run a large variety of routes in Baylor’s offense. After the catch, he is slippery and elusive, but he isn’t going to break many tackles. Overall, Mims is a big-play generator on the outside and has all of the tools to develop into a complete receiver.

RANK

47

Antoine Winfield Jr., S

School: Minnesota | Year: Sophomore (RS)
Previous rank: 47

Winfield is an undersized safety prospect with outstanding instincts and ball skills. His movement skills are very smooth and easy from the back end. He does a nice job playing over the top. He keeps everything in front of him, collecting a bunch of picks on tips and overthrows. He also spends a lot of time covering in the slot. He has enough speed to carry vertical routes down the field and he is also an excellent blitzer. As a tackler, he usually comes to balance, settles his feet and wraps up. Overall, there is some concern due to size and durability (missed time in 2017 and 2018 due to injury), but Winfield is a playmaker from the deep middle and his ability to match up in the slot is a bonus.

RANK

48

Michael Pittman Jr., WR

NR

School: USC | Year: Senior
Previous rank: NR

Pittman is a tall, muscular wideout who had excellent production for the Trojans. He lines up out wide and he uses his upper-body strength to power through press coverage. He builds speed as he goes and he is a jump-ball specialist down the field. He high points the ball consistently and big brothers opposing cornerbacks routinely. He doesn’t have elite speed, but he’s very efficient getting in and out of breaks for such a big receiver. He is at his best after the catch, when his competitiveness and strength form a winning combination. He refuses to go down on first contact. Pittman has earned a reputation as one of the best special teams players in the country for his ability to cover and block punts. Overall, Pittman reminds me a lot of current Charger Mike Williams, and he can make an impact on all four downs because of his special teams value.

RANK

49

Trevon Diggs, CB

1

School: Alabama | Year: Senior
Previous rank: 48

Diggs has elite size, athleticism and ball skills. (He also played wide receiver and returned kicks during his career at Alabama.) He uses an effective one-hand jam in press before opening up and staying on the hip. He’s fluid for such a big cornerback. It’s important for him to stay in phase with the wideout because he lacks elite recovery speed. From off coverage, he reads through the wide receiver to the quarterback and has a good feel for jumping routes and making plays. His ball skills are outstanding — as you’d expect, considering his brother is Stefon Diggs. He does need to improve as a tackler in space. Overall, Diggs has some room to develop, but he will excite teams looking for a big cornerback to match up with guys like Mike Evans and Courtland Sutton.

RANK

50

Jalen Hurts, QB

School: Oklahoma | Year: Senior
Previous rank: 50

Hurts is slightly undersized for the position, but his production, poise and playmaking ability are very impressive. He has crisp footwork in his drop and he throws from a very firm platform. He has a quick release and generates excellent velocity on drive throws. Hurts flashed the ability to touch the ball up, but his ball placement still needs to improve. His vision and anticipation are other areas that need work. He’s an outstanding runner, both on designed runs and when pressured. He gains ground quickly and runs through contact consistently. I love his competitiveness and toughness. Overall, Hurts must continue to improve in the passing game, but I’m going to bet on his eventual success due to his playmaking skills and overall competitiveness.

RANK

51

Jordan Brooks, LB

School: Texas Tech | Year: Senior

RANK

52

Lloyd Cushenberry, C

3

School: LSU | Year: Junior (RS)

RANK

53

Ezra Cleveland, OT

School: Boise State | Year: Junior (RS)

RANK

54

Logan Wilson, LB

School: Wyoming | Year: Senior

RANK

55

Cam Akers, RB

School: Florida State | Year: Junior

RANK

56

Jalen Reagor, WR

School: TCU | Year: Junior

RANK

57

KJ Hamler, WR

School: Penn State | Year: Sophomore (RS)

RANK

58

Josh Uche, LB

School: Michigan | Year: Junior (RS)

RANK

59

Damon Arnette, CB

School: Ohio State | Year: Senior (RS)

RANK

60

Robert Hunt, OT

School: Louisiana-Lafayette | Year: Senior (RS)

RANK

61

Matt Hennessy, C

School: Temple | Year: Junior (RS)

RANK

62

Willie Gay, LB

School: Mississippi State | Year: Junior

RANK

63

Saahdiq Charles, OT

School: LSU | Year: Junior

RANK

64

Jacob Eason, QB

School: Washington | Year: Junior (RS)

RANK

65

Neville Gallimore, DT

School: Oklahoma | Year: Senior (RS)

RANK

66

Isaiah Wilson, OT

School: Georgia | Year: Sophomore (RS)

RANK

67

Jordan Elliott, DT

School: Missouri | Year: Junior (RS)

RANK

68

Adam Trautman, TE

School: Dayton | Year: Senior (RS)

RANK

69

Van Jefferson, WR

School: Florida | Year: Senior (RS)

RANK

70

Jake Fromm, QB

School: Georgia | Year: Junior

RANK

71

Harrison Bryant, TE

School: Florida Atlantic | Year: Senior

RANK

72

Chase Claypool, WR

School: Notre Dame | Year: Senior

RANK

73

Noah Igbinoghene, CB

School: Auburn | Year: Junior

RANK

74

Kyle Dugger, S

School: Lenoir-Rhyne | Year: Senior

RANK

75

Bradlee Anae, Edge

School: Utah | Year: Senior

RANK

76

Malik Harrison, LB

School: Ohio State | Year: Senior

RANK

77

Curtis Weaver, Edge

School: Boise State | Year: Junior (RS)

RANK

78

John Hightower, WR

School: Boise State | Year: Senior

RANK

79

Antonio Gandy-Golden, WR

School: Liberty | Year: Senior

RANK

80

Devin Duvernay, WR

School: Texas | Year: Senior

RANK

81

Lynn Bowden Jr., WR

School: Kentucky | Year: Junior

RANK

82

Ben Bartch, OT

School: St. John’s (Minn.) | Year: Senior

RANK

83

Darrynton Evans, RB

School: Appalachian State | Year: Junior (RS)

RANK

84

Reggie Robinson, CB

School: Tulsa | Year: Senior (RS)

RANK

85

Amik Robertson, CB

School: Louisiana Tech | Year: Junior

RANK

86

Ashtyn Davis, S

School: California | Year: Senior (RS)

RANK

87

Josiah Scott, CB

School: Michigan State | Year: Junior

RANK

88

Terrell Burgess, S

School: Utah | Year: Senior

RANK

89

James Lynch, DE

School: Baylor | Year: Junior

RANK

90

Darrell Taylor, Edge

School: Tennessee | Year: Senior (RS)

RANK

91

Damien Lewis, OG

School: LSU | Year: Senior

RANK

92

Hakeem Adeniji, OL

School: Kansas | Year: Senior

RANK

93

Davon Hamilton, DT

School: Ohio State | Year: Senior (RS)

RANK

94

Bryan Edwards, WR

School: South Carolina | Year: Senior

RANK

95

Akeem Davis-Gaither, LB

School: Appalachian State | Year: Senior

RANK

96

Leki Fotu, DT

School: Utah | Year: Senior

RANK

97

Matt Peart, OT

School: Connecticut | Year: Senior (RS)

RANK

98

Davion Taylor, LB

School: Colorado | Year: Senior

RANK

99

John Reid, CB

School: Penn State | Year: Senior (RS)

RANK

100

Bryce Hall, CB

School: Virginia | Year: Senior

RANK

101

Terrell Lewis, Edge

School: Alabama | Year: Junior (RS)

RANK

102

Cameron Clark, OG

School: Charlotte | Year: Senior (RS)

RANK

103

Grayland Arnold, CB

School: Baylor | Year: Junior (RS)

RANK

104

Jonathan Greenard, Edge

School: Florida | Year: Senior (RS)

RANK

105

Zack Moss, RB

School: Utah | Year: Senior

RANK

106

Brandon Jones, S

School: Texas | Year: Senior

RANK

107

Antonio Gibson, WR

School: Memphis | Year: Senior

RANK

108

Raekwon Davis, DT

School: Alabama | Year: Senior

RANK

109

Ke’Shawn Vaughn, RB

School: Vanderbilt | Year: Senior (RS)

RANK

110

Julian Okwara, Edge

School: Notre Dame | Year: Senior

RANK

111

Shaquille Quarterman, LB

School: Miami (Fla.) | Year: Senior

RANK

112

AJ Dillon, RB

School: Boston College | Year: Junior

RANK

113

Jack Driscoll, OT

School: Auburn | Year: Senior (RS)

RANK

114

Jared Mayden, DB

School: Alabama | Year: Senior

RANK

115

Julian Blackmon, S

School: Utah | Year: Senior

RANK

116

Larrell Murchison, DT

School: North Carolina State | Year: Senior (RS)

RANK

117

Khalid Kareem, Edge

School: Notre Dame | Year: Senior

RANK

118

Charlie Heck, OT

School: North Carolina | Year: Senior

RANK

119

Josiah Deguara, TE

School: Cincinnati | Year: Senior (RS)

RANK

120

L’Jarius Sneed, S

School: Louisiana Tech | Year: Senior

RANK

121

Devin Asiasi, TE

School: UCLA | Year: Junior (RS)

RANK

122

Kindle Vildor, CB

School: Georgia Southern | Year: Senior

RANK

123

Geno Stone, S

School: Iowa | Year: Junior

RANK

124

K’Von Wallace, S

School: Clemson | Year: Senior

RANK

125

Alton Robinson, Edge

School: Syracuse | Year: Senior

RANK

126

Hunter Bryant, TE

School: Washington | Year: Junior

RANK

127

Jabari Zuniga, Edge

School: Florida | Year: Senior (RS)

RANK

128

Dalton Keene, TE

School: Virginia Tech | Year: Junior

RANK

129

Joe Bachie, LB

School: Michigan State | Year: Senior

RANK

130

Jacob Phillips, LB

School: LSU | Year: Junior

RANK

131

Donovan Peoples-Jones, WR

School: Michigan | Year: Junior

RANK

132

Cameron Dantzler, CB

School: Mississippi State | Year: Junior (RS)

RANK

133

Tyre Phillips, OG

School: Mississippi State | Year: Senior (RS)

RANK

134

Jason Strowbridge, Edge

School: North Carolina | Year: Senior

RANK

135

Nick Harris, C

School: Washington | Year: Senior

RANK

136

Jonah Jackson, OG

School: Ohio State | Year: Senior (RS)

RANK

137

Kevin Dotson, OL

School: Louisiana-Lafayette | Year: Senior (RS)

RANK

138

Joshua Kelley, RB

School: UCLA | Year: Senior (RS)

RANK

139

Tyler Johnson, WR

School: Minnesota | Year: Senior

RANK

140

Darnell Mooney, WR

School: Tulane | Year: Senior

RANK

141

Darnay Holmes, CB

School: UCLA | Year: Junior

RANK

142

Javaris Davis, CB

School: Auburn | Year: Senior (RS)

RANK

143

Alohi Gilman, S

School: Notre Dame | Year: Junior

RANK

144

Azur Kamara, Edge

School: Kansas | Year: Senior

RANK

145

James Proche, WR

School: Southern Methodist | Year: Senior (RS)

RANK

146

D.J. Wonnum, Edge

School: South Carolina | Year: Senior

RANK

147

Albert Okwuegbunam, TE

School: Missouri | Year: Junior (RS)

RANK

148

Michael Ojemudia, CB

School: Iowa | Year: Senior

RANK

149

Jake Luton, QB

School: Oregon State | Year: Senior (RS)

RANK

150

Trevis Gipson, Edge

School: Tulsa | Year: Senior (RS)

Follow Daniel Jeremiah on Twitter @MoveTheSticks.

LAtimes:https://www.latimes.com/science/story/2020-04-17/malaria-drugs-fails-to-help-coronavirus-patients-in-controlled-studies
Malaria drugs fail to help coronavirus patients in controlled studies

By Melissa HealyStaff Writer
April 17, 2020
3:08 PM

The malaria drugs touted by President Trump as potentially “the biggest game changers in the history of medicine” have received a decidedly more sober assessment of their coronavirus-fighting potential from researchers in China, France and Brazil.

Both chloroquine and its close relative hydroxychloroquine offered signs that they may ease some of the hallmark symptoms of coronavirus infection in patients who were hospitalized with COVID-19. But the drugs largely failed to deliver improvements on other key measures when evaluated in rigorous research studies.

In research done in France, hydroxychloroquine reduced neither deaths nor admissions to intensive care units among patients who received it. In a study conducted in China and another in Brazil, the two drugs failed to help patients clear the coronavirus faster.

And in Brazil, two deaths and a rash of heart troubles among patients who got a high dose of chloroquine prompted a hasty alteration of the trial there after just 13 days. Concluding that “enough red flags” had been raised, the researchers halted testing of the drug in its extra-strength form.

“My own impression so far is that these medications are a colossal ‘Maybe,’” said Dr. Michael H. Pillinger, a professor of medicine at New York University and chief of rheumatology at the Veterans Affairs’ New York Harbor Healthcare System.

“Is there enough possible benefit that we could use these on a wing and prayer until something better comes along? I’m underwhelmed” by the evidence for that, Pillinger said.

In the Brazil study, two of the 37 patients who were getting high doses of chloroquine developed ventricular tachycardia, a dangerous heart arrhythmia that led to their deaths. Five other patients in this arm of the trial developed QT interval prolongation, a condition that makes the heart’s electrical system slower to recharge between beats. It can cause the heart to beat erratically, also raising the risk of sudden death.

The death toll among patients who were randomly assigned to receive high-dose chloroquine did not rise above that in a comparison group of patients who did not get the drug. But researchers had set out to establish that high-dose chloroquine would save lives. When it failed to do so, they concluded the risks of cardiac side effects could not be justified.

“Preliminary findings suggest that the higher chloroquine dosage should not be recommended for COVID-19 treatment because of its potential safety hazards,” the study authors wrote in a report posted Thursday to MedRxiv, a clearinghouse for preliminary research results.

After the two deaths, the remaining 39 patients were switched to a lower dose of chloroquine, which was already being tested in 40 other patients. All would be tracked for an additional 13 days, with results still to come.

Brazilian President Jair Bolsonaro has allied himself closely with President Trump and has echoed his extravagant claims about chloroquine and hydroxychloroquine. He has ordered the Brazilian army to ramp up its orders of chloroquine and told the public that the malaria drugs “could go down in history as having saved thousands of lives in Brazil.”

The authors of the Brazil study, which was conducted in the Amazonian city of Manaus, suggested that Bolsonaro’s support complicated their efforts to test the drugs as rigorously as they would have liked.

Normally, they would have conducted a head-to-head comparison by randomly assigning some people to get the drugs while others received a dummy pill, or placebo. But since the drugs have been “recommended at the national level,” the researchers were unable to assign anyone to a group that would not get chloroquine. Instead, they used “historical data from the literature to infer comparisons.”

The French study of hydroxychloroquine, posted Tuesday to MedRxiv, followed a more conventional design. Researchers there enrolled 181 COVID-19 patients who were admitted to four French hospitals over the last two weeks of March, then compared the outcomes of 84 people who quickly received hydroxychloroquine to 91 patients who never received the drug. (Patients in both groups got a range of other treatments, including antiviral medications, corticosteroids and breathing support.)

The researchers found that treatment with hydroxychloroquine did not reduce the likelihood that a COVID-19 patient would die or be admitted to the intensive care unit within a week of hospital admission. Nor did it drive down a patient’s likelihood of developing serious breathing problems.

Hydroxychloroquine did, however, raise some risks. Eight of the 84 patients who got hydroxychloroquine experienced changes in heart rhythm that required discontinuation of the drug, and another patient developed a related heart-rhythm disorder.

“The negative clinical results of this study argue against the widespread use of hydroxychloroquine in patients with COVID-19 pneumonia,” the French researchers concluded.

Chinese researchers were just a bit more encouraging.

Their study, also posted to MedRxiv on Tuesday, found that COVID-19 patients who got hydroxychloroquine were no better at clearing the coronavirus from their systems than patients who didn’t get the drug. And at the 28-day mark, patients in both groups had the same number of symptoms.

But two weeks after admission to the hospital, patients who got hydroxychloroquine reported they felt better than their counterparts who did not. And they appeared to have lower levels of inflammation — a symptom of COVID-19 that can escalate and lead to death if unchecked. (In fact, in doses much lower than those tested in the COVID-19 trials, hydroxychloroquine is used to treat autoimmune diseases such as lupus and rheumatoid arthritis because of its anti-inflammatory effects.)

Also, while 30% of the patients who got hydroxychloroquine reported a side effect, just 9% of patients in the comparison group did so. None of these side effects appeared to be heart-related.

The Chinese researchers referred to “shreds of evidence” that support the hope that hydroxychloroquine could help patients fend off bouts of inflammation that can damage the lungs and other organs.

But researchers in the United States cautioned that the small number of patients in the studies, their hurried execution and the difficulty of assessing any drug during a medical crisis made all of the findings far from definitive. And it doesn’t help that the drugs have become political footballs, they added.

“We kind of have the red pill people and the blue pill people,” said Dr. Michael J. Ackerman, a Mayo Clinic cardiologist who was among the first to warn that the malaria drugs can dangerously disturb heart rhythms. “I don’t think either side now has the ammunition to say these drugs do or don’t work,” he added.

Yale University cardiologist Harlan Krumholz agreed. He noted that the studies, none of which has been vetted in a traditional peer-review process, “can’t exclude large effects in either direction. They leave us a little bit where we started.”

But there is a troubling signal in these and previous studies, and they create a challenge for those who would advocate use of the malaria drugs, he said.

When a drug that could be widely used poses potentially deadly dangers to the heart, “we will need a strong amount of evidence that they provide benefit,” Krumholz said. “At the moment, there is no evidence” for that, he added.

Its being used in two London hospitals now, fwiw.

NHS:https://www.dailymail.co.uk/news/article-8211717/Malaria-drug-championed-Donald-Trump-used-coronavirus-patients-NHS-wards.html

“..Hydroxychloroquine is being used at Barts in London and the Royal Devon and Exeter to keep critically ill coronavirus patients alive.

President Trump described the drug as a ‘game changer’ and it has been added to the Chinese guidance for tackling the disease, but up until now the NHS has strongly discouraged its use….”

SLF

A friend of mine has both parents that have tested positive. Paraphrasing from his Facebook and a few texts I had with him.

-we’ve all heard about the loss of appetite and smell. As a result both parents slowed their eating.

-that messed with their blood sugar, potassium, sodium and other levels

-the problem is COVID-19 seems to then make it tough for the doctors/nurses to dial things back in. Under normal conditions they can adjust, but Coronavirus is throwing things for a loop when trying to get things like blood sugar right. Experienced medical professionals with decades of experience are now having problems getting patients back to correct ranges.

-then the cascade effect hits as heart attacks, strokes and other issues hit as a result of their blood numbers being off.

His dad had a stroke yesterday and his mom might have this morning.

NYtimes:https://www.nytimes.com/2020/04/06/us/politics/coronavirus-trump-malaria-drug.html
Trump’s Aggressive Advocacy of Malaria Drug for Treating Coronavirus Divides Medical Community

While Dr. Anthony Fauci has urged caution in using hydroxychloroquine, some doctors are prescribing it to patients who have the virus despite the fact it has never been tested for it.

WASHINGTON — President Trump made a rare appearance in the Situation Room on Sunday as his pandemic task force was meeting, determined to talk about the anti-malaria medicine that he has aggressively promoted lately as a treatment for the coronavirus.

Once again, according to a person briefed on the session, the experts warned against overselling a drug yet to be proved a safe remedy, particularly for heart patients. “Yes, the heart stuff,” Mr. Trump acknowledged. Then he headed out to the cameras to promote it anyway. “So what do I know?” he conceded to reporters at his daily briefing. “I’m not a doctor. But I have common sense.”

Day after day, the salesman turned president has encouraged coronavirus patients to try hydroxychloroquine with all of the enthusiasm of a real estate developer. The passing reference he makes to the possible dangers is usually overwhelmed by the full-throated endorsement. “What do you have to lose?” he asked five times on Sunday.

Bolstered by his trade adviser, a television doctor, Larry Ellison of Oracle and Rudolph W. Giuliani, a former New York mayor, Mr. Trump has seized on the drug as a miracle cure for the virus that has killed thousands and paralyzed American life. Along the way, he has prompted an international debate about a drug that many doctors in New York and elsewhere have been trying in desperation even without conclusive scientific studies.

Mr. Trump may ultimately be right, and physicians report anecdotal evidence that has provided hope. But it remains far from certain, and the president’s assertiveness in pressing the case over the advice of advisers like Dr. Anthony S. Fauci, the government’s top infectious disease specialist, has driven a wedge inside his coronavirus task force and has raised questions about his motives.

If hydroxychloroquine becomes an accepted treatment, several pharmaceutical companies stand to profit, including shareholders and senior executives with connections to the president. Mr. Trump himself has a small personal financial interest in Sanofi, the French drugmaker that makes Plaquenil, the brand-name version of hydroxychloroquine.

“I certainly understand why the president is pushing it,” said Dr. Joshua Rosenberg, a critical care at Brooklyn Hospital Center. “He’s the president of the United States. He has to project hope. And when you are in a situation without hope, things go very badly. So I’m not faulting him for pushing it even if there isn’t a lot of science behind it, because it is, at this point, the best, most available option for use.”

A senior physician at Wyckoff Heights Medical Center in Brooklyn, where doctors are not providing the drug, however, said the current demand was worrisome for patients on it chronically for rheumatic diseases. At St. Barnabas Hospital in the Bronx, another doctor said his staff was giving it to coronavirus patients but criticized the president and Gov. Andrew M. Cuomo for “cheerleading” the drug without proof. “False hope can be bad, too,” he said.

The professional organization that published a positive French study cited by Mr. Trump’s allies changed its mind in recent days. The International Society of Antimicrobial Chemotherapy said, “The article does not meet the society’s expected standard.” Some hospitals in Sweden stopped providing hydroxychloroquine to treat the coronavirus after reports of adverse side effects, according to Swedish news media.

But Mr. Cuomo told reporters on Monday that he would ask Mr. Trump to increase the federal supply of hydroxychloroquine to New York pharmacies, allowing the state to lift a limit on purchases. “There has been anecdotal evidence that it is promising,” Mr. Cuomo said, while noting the lack of a formal study….see link

The U.S. was beset by denial and dysfunction as the coronavirus raged
From the Oval Office to the CDC, political and institutional failures cascaded through the system and opportunities to mitigate the pandemic were lost.

https://www.washingtonpost.com/national-security/2020/04/04/coronavirus-government-dysfunction/?arc404=true

By the time Donald Trump proclaimed himself a wartime president — and the coronavirus the enemy — the United States was already on course to see more of its people die than in the wars of Korea, Vietnam, Afghanistan and Iraq combined.

The country has adopted an array of wartime measures never employed collectively in U.S. history — banning incoming travelers from two continents, bringing commerce to a near-halt, enlisting industry to make emergency medical gear, and confining 230 million Americans to their homes in a desperate bid to survive an attack by an unseen adversary.

Despite these and other extreme steps, the United States will likely go down as the country that was supposedly best prepared to fight a pandemic but ended up catastrophically overmatched by the novel coronavirus, sustaining heavier casualties than any other nation.

It did not have to happen this way. Though not perfectly prepared, the United States had more expertise, resources, plans and epidemiological experience than dozens of countries that ultimately fared far better in fending off the virus.

The failure has echoes of the period leading up to 9/11: Warnings were sounded, including at the highest levels of government, but the president was deaf to them until the enemy had already struck.

The Trump administration received its first formal notification of the outbreak of the coronavirus in China on Jan. 3. Within days, U.S. spy agencies were signaling the seriousness of the threat to Trump by including a warning about the coronavirus — the first of many — in the President’s Daily Brief.

And yet, it took 70 days from that initial notification for Trump to treat the coronavirus not as a distant threat or harmless flu strain well under control, but as a lethal force that had outflanked America’s defenses and was poised to kill tens of thousands of citizens. That more-than-two-month stretch now stands as critical time that was squandered.

33 times Trump downplayed the coronavirus

Trump’s baseless assertions in those weeks, including his claim that it would all just “miraculously” go away, sowed significant public confusion and contradicted the urgent messages of public health experts.

“While the media would rather speculate about outrageous claims of palace intrigue, President Trump and this Administration remain completely focused on the health and safety of the American people with around the clock work to slow the spread of the virus, expand testing, and expedite vaccine development,” said Judd Deere, a spokesman for the president. “Because of the President’s leadership we will emerge from this challenge healthy, stronger, and with a prosperous and growing economy.”

The president’s behavior and combative statements were merely a visible layer on top of deeper levels of dysfunction.

The most consequential failure involved a breakdown in efforts to develop a diagnostic test that could be mass produced and distributed across the United States, enabling agencies to map early outbreaks of the disease, and impose quarantine measures to contain them. At one point, a Food and Drug Administration official tore into lab officials at the Centers for Disease Control and Prevention, telling them their lapses in protocol, including concerns that the lab did not meet the criteria for sterile conditions, were so serious that the FDA would “shut you down” if the CDC were a commercial, rather than government, entity.

Other failures cascaded through the system. The administration often seemed weeks behind the curve in reacting to the viral spread, closing doors that were already contaminated. Protracted arguments between the White House and public health agencies over funding, combined with a meager existing stockpile of emergency supplies, left vast stretches of the country’s health-care system without protective gear until the outbreak had become a pandemic. Infighting, turf wars and abrupt leadership changes hobbled the work of the coronavirus task force.

It may never be known how many thousands of deaths, or millions of infections, might have been prevented with a response that was more coherent, urgent and effective. But even now, there are many indications that the administration’s handling of the crisis had potentially devastating consequences.

Even the president’s base has begun to confront this reality. In mid-March, as Trump was rebranding himself a wartime president and belatedly urging the public to help slow the spread of the virus, Republican leaders were poring over grim polling data that suggested Trump was lulling his followers into a false sense of security in the face of a lethal threat.

The poll showed that far more Republicans than Democrats were being influenced by Trump’s dismissive depictions of the virus and the comparably scornful coverage on Fox News and other conservative networks. As a result, Republicans were in distressingly large numbers refusing to change travel plans, follow “social distancing” guidelines, stock up on supplies or otherwise take the coronavirus threat seriously.

“Denial is not likely to be a successful strategy for survival,” GOP pollster Neil Newhouse concluded in a document that was shared with GOP leaders on Capitol Hill and discussed widely at the White House. Trump’s most ardent supporters, it said, were “putting themselves and their loved ones in danger.”

Trump’s message was changing as the report swept through the GOP’s senior ranks. In recent days, Trump has bristled at reminders that he had once claimed the caseload would soon be “down to zero.”

More than 7,000 people have died of the coronavirus in the United States so far, with about 240,000 cases reported. But Trump has acknowledged that new models suggest that the eventual national death toll could be between 100,000 and 240,000.

Beyond the suffering in store for thousands of victims and their families, the outcome has altered the international standing of the United States, damaging and diminishing its reputation as a global leader in times of extraordinary adversity.

“This has been a real blow to the sense that America was competent,” said Gregory F. Treverton, a former chairman of the National Intelligence Council, the government’s senior-most provider of intelligence analysis. He stepped down from the NIC in January 2017 and now teaches at the University of Southern California. “That was part of our global role. Traditional friends and allies looked to us because they thought we could be competently called upon to work with them in a crisis. This has been the opposite of that.”

This article, which retraces the failures over the first 70 days of the coronavirus crisis, is based on 47 interviews with administration officials, public health experts, intelligence officers and others involved in fighting the pandemic. Many spoke on the condition of anonymity to discuss sensitive information and decisions.

Scanning the horizon

Public health authorities are part of a special breed of public servant — along with counterterrorism officials, military planners, aviation authorities and others — whose careers are consumed with contemplating worst-case scenarios.

The arsenal they wield against viral invaders is powerful, capable of smothering a new pathogen while scrambling for a cure, but easily overwhelmed if not mobilized in time. As a result, officials at the Department of Health and Human Services, the CDC and other agencies spend their days scanning the horizon for emerging dangers.

The CDC learned of a cluster of cases in China on Dec. 31 and began developing reports for HHS on Jan. 1. But the most unambiguous warning that U.S. officials received about the coronavirus came Jan. 3, when Robert Redfield, the CDC director, received a call from a counterpart in China. The official told Redfield that a mysterious respiratory illness was spreading in Wuhan, a congested commercial city of 11 million people in the communist country’s interior.

Redfield quickly relayed the disturbing news to Alex Azar, the secretary of HHS, the agency that oversees the CDC and other public health entities. Azar, in turn, ensured that the White House was notified, instructing his chief of staff to share the Chinese report with the National Security Council.

From that moment, the administration and the virus were locked in a race against a ticking clock, a competition for the upper hand between pathogen and prevention that would dictate the scale of the outbreak when it reached American shores, and determine how many would get sick or die.
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The initial response was promising, but officials also immediately encountered obstacles.

On Jan. 6, Redfield sent a letter to the Chinese offering to send help, including a team of CDC scientists. China rebuffed the offer for weeks, turning away assistance and depriving U.S. authorities of an early chance to get a sample of the virus, critical for developing diagnostic tests and any potential vaccine.

China impeded the U.S. response in other ways, including by withholding accurate information about the outbreak. Beijing had a long track record of downplaying illnesses that emerged within its borders, an impulse that U.S. officials attribute to a desire by the country’s leaders to avoid embarrassment and accountability with China’s 1.3 billion people and other countries that find themselves in the pathogen’s path.

China stuck to this costly script in the case of the coronavirus, reporting Jan. 14 that it had seen “no clear evidence of human-to-human transmission.” U.S. officials treated the claim with skepticism that intensified when the first case surfaced outside China with a reported infection in Thailand.

A week earlier, senior officials at HHS had begun convening an intra-agency task force including Redfield, Azar and Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. The following week, there were also scattered meetings at the White House with officials from the National Security Council and State Department, focused mainly on when and whether to bring back government employees in China.

U.S. officials began taking preliminary steps to counter a potential outbreak. By mid-January, Robert Kadlec, an Air Force officer and physician who serves as assistant secretary for preparedness and response at HHS, had instructed subordinates to draw up contingency plans for enforcing the Defense Production Act, a measure that enables the government to compel private companies to produce equipment or devices critical to the country’s security. Aides were bitterly divided over whether to implement the act, and nothing happened for many weeks.

On Jan. 14, Kadlec scribbled a single word in a notebook he carries: “Coronavirus!!!”

Despite the flurry of activity at lower levels of his administration, Trump was not substantially briefed by health officials about the coronavirus until Jan.18, when, while spending the weekend at Mar-a-Lago, he took a call from Azar.

Even before the heath secretary could get a word in about the virus, Trump cut him off and began criticizing Azar for his handling of an aborted federal ban on vaping products, a matter that vexed the president.

At the time, Trump was in the throes of an impeachment battle over his alleged attempt to coerce political favors from the leader of Ukraine. Acquittal seemed certain by the GOP-controlled Senate, but Trump was preoccupied with the trial, calling lawmakers late at night to rant, and making lists of perceived enemies he would seek to punish when the case against him concluded.

In hindsight, officials said, Azar could have been more forceful in urging Trump to turn at least some of his attention to a threat that would soon pose an even graver test to his presidency, a crisis that would cost American lives and consume the final year of Trump’s first term.

But the secretary, who had a strained relationship with Trump and many others in the administration, assured the president that those responsible were working on and monitoring the issue. Azar told several associates that the president believed he was “alarmist” and Azar struggled to get Trump’s attention to focus on the issue, even asking one confidant for advice.

Within days, there were new causes for alarm.

On Jan. 21, a Seattle man who had recently traveled to Wuhan tested positive for the coronavirus, becoming the first known infection on U.S. soil. Then, two days later, Chinese authorities took the drastic step of shutting down Wuhan, turning the teeming metropolis into a ghost city of empty highways and shuttered skyscrapers, with millions of people marooned in their homes.

“That was like, whoa,” said a senior U.S. official involved in White House meetings on the crisis. “That was when the Richter scale hit 8.”

It was also when U.S. officials began to confront the failings of their own efforts to respond.

Azar, who had served in senior positions at HHS through crises including the 9/11 terrorist attacks and the outbreak of bird flu in 2005, was intimately familiar with the playbook for crisis management.

He instructed subordinates to move rapidly to establish a nationwide surveillance system to track the spread of the coronavirus — a stepped-up version of what the CDC does every year to monitor new strains of the ordinary flu.

But doing so would require assets that would elude U.S. officials for months — a diagnostic test that could accurately identify those infected with the new virus and be produced on a mass scale for rapid deployment across the United States, and money to implement the system.

Azar’s team also hit another obstacle. The Chinese were still refusing to share the viral samples they had collected and were using to develop their own tests. In frustration, U.S. officials looked for other possible routes.

A biocontainment lab at the University of Texas medical branch in Galveston had a research partnership with the Wuhan Institute of Virology.

Kadlec, who knew the Galveston lab director, hoped scientists could arrange a transaction on their own without government interference. At first, the lab in Wuhan agreed, but officials in Beijing intervened Jan. 24 and blocked any lab-to-lab transfer.

There is no indication that officials sought to escalate the matter or enlist Trump to intervene. In fact, Trump has consistently praised Chinese President Xi Jinping despite warnings from U.S. intelligence and health officials that Beijing was concealing the true scale of the outbreak and impeding cooperation on key fronts.

The CDC had issued its first public alert about the coronavirus Jan. 8, and by the 17th was monitoring major airports in Los Angeles, San Francisco and New York, where large numbers of passengers arrived each day from China.

In other ways, though, the situation was already spinning out of control, with multiplying cases in Seattle, intransigence by the Chinese, mounting questions from the public, and nothing in place to stop infected travelers from arriving from abroad.

Trump was out of the country for this critical stretch, taking part in the annual global economic forum in Davos, Switzerland. He was accompanied by a contingent of top officials including national security adviser Robert O’Brien, who took a trans-Atlantic call from an anxious Azar.

Azar told O’Brien that it was “mayhem” at the White House, with HHS officials being pressed to provide nearly identical briefings to three audiences on the same day.

Azar urged O’Brien to have the NSC assert control over a matter with potential implications for air travel, immigration authorities, the State Department and the Pentagon. O’Brien seemed to grasp the urgency, and put his deputy, Matthew Pottinger, who had worked in China as a journalist for the Wall Street Journal, in charge of coordinating the still-nascent U.S. response.

But the rising anxiety within the administration appeared not to register with the president. On Jan. 22, Trump received his first question about the coronavirus in an interview on CNBC while in Davos. Asked whether he was worried about a potential pandemic, Trump said, “No. Not at all. And we have it totally under control. It’s one person coming in from China. . . . It’s going to be just fine.”

Spreading uncontrollably

\The move by the NSC to seize control of the response marked an opportunity to reorient U.S. strategy around containing the virus where possible and procuring resources that hospitals would need in any U.S. outbreak, including such basic equipment as protective masks and ventilators.

But instead of mobilizing for what was coming, U.S. officials seemed more preoccupied with logistical problems, including how to evacuate Americans from China.

In Washington, then-acting chief of staff Mick Mulvaney and Pottinger began convening meetings at the White House with senior officials from HHS, the CDC and the State Department.

The group, which included Azar, Pottinger and Fauci, as well as nine others across the administration, formed the core of what would become the administration’s coronavirus task force. But it primarily focused on efforts to keep infected people in China from traveling to the United States even while evacuating thousands of U.S. citizens. The meetings did not seriously focus on testing or supplies, which have since become the administration’s most challenging problems.

The task force was formally announced on Jan. 29.

“The genesis of this group was around border control and repatriation,” said a senior official involved in the meetings. “It wasn’t a comprehensive, whole-of-government group to run everything.”

The State Department agenda dominated those early discussions, according to participants. Officials began making plans to charter aircraft to evacuate 6,000 Americans stranded in Wuhan. They also debated language for travel advisories that State could issue to discourage other travel in and out of China.

On Jan. 29, Mulvaney chaired a meeting in the White House Situation Room in which officials debated moving travel restrictions to “Level 4,” meaning a “do not travel” advisory from the State Department. Then, the next day, China took the draconian step of locking down the entire Hubei province, which encompasses Wuhan.

That move by Beijing finally prompted a commensurate action by the Trump administration. On Jan. 31, Azar announced restrictions barring any non-U.S. citizen who had been in China during the preceding two weeks from entering the United States.

Trump has, with some justification, pointed to the China-related restriction as evidence that he had responded aggressively and early to the outbreak. It was among the few intervention options throughout the crisis that played to the instincts of the president, who often seems fixated on erecting borders and keeping foreigners out of the country.

But by that point, 300,000 people had come into the United States from China over the previous month. There were only 7,818 confirmed cases around the world at the end of January, according to figures released by the World Health Organization — but it is now clear that the virus was spreading uncontrollably.

Pottinger was by then pushing for another travel ban, this time restricting the flow of travelers from Italy and other nations in the European Union that were rapidly emerging as major new nodes of the outbreak. Pottinger’s proposal was endorsed by key health-care officials, including Fauci, who argued that it was critical to close off any path the virus might take into the country.

This time, the plan met with resistance from Treasury Secretary Steven Mnuchin and others who worried about the impact on the U.S. economy. It was an early sign of tension in an area that would split the administration, pitting those who prioritized public health against those determined to avoid any disruption in an election year to the run of expansion and employment growth.

Those backing the economy prevailed with the president. And it was more than a month before the administration issued a belated and confusing ban on flights into the United States from Europe. Hundreds of thousands of people crossed the Atlantic during that interval.

A wall of resistance

While fights over air travel played out in the White House, public health officials began to panic over a startling shortage of critical medical equipment including protective masks for doctors and nurses, as well as a rapidly shrinking pool of money needed to pay for such things.

By early February, the administration was quickly draining a $105 million congressional fund to respond to infectious disease outbreaks. The coronavirus threat to the United States still seemed distant if not entirely hypothetical to much of the public. But to health officials charged with stockpiling supplies for worst-case-scenarios, disaster appeared increasingly inevitable.

A national stockpile of N95 protective masks, gowns, gloves and other supplies was already woefully inadequate after years of underfunding. The prospects for replenishing that store were suddenly threatened by the unfolding crisis in China, which disrupted offshore supply chains.

Much of the manufacturing of such equipment had long since migrated to China, where factories were now shuttered because workers were on order to stay in their households. At the same time, China was buying up masks and other gear to gird for its own coronavirus outbreak, driving up costs and monopolizing supplies.

In late January and early February, leaders at HHS sent two letters to the White House Office of Management and Budget asking to use its transfer authority to shift $136 million of department funds into pools that could be tapped for combating the coronavirus. Azar and his aides also began raising the need for a multibillion-dollar supplemental budget request to send to Congress.

Yet White House budget hawks argued that appropriating too much money at once when there were only a few U.S. cases would be viewed as alarmist.

Joe Grogan, head of the Domestic Policy Council, clashed with health officials over preparedness. He mistrusted how the money would be used and questioned how health officials had used previous preparedness funds.

Azar then spoke to Russell Vought, the acting director of the White House Office of Management and Budget, during Trump’s State of the Union speech on Feb. 4. Vought seemed amenable, and told Azar to submit a proposal.

Azar did so the next day, drafting a supplemental request for more than $4 billion, a sum that OMB officials and others at the White House greeted as an outrage. Azar arrived at the White House that day for a tense meeting in the Situation Room that erupted in a shouting match, according to three people familiar with the incident.

A deputy in the budget office accused Azar of preemptively lobbying Congress for a gigantic sum that White House officials had no interest in granting. Azar bristled at the criticism and defended the need for an emergency infusion. But his standing with White House officials, already shaky before the coronavirus crisis began, was damaged further.

Trump on his ‘natural ability’ for medical science: ‘I really get it’

White House officials relented to a degree weeks later as the feared coronavirus surge in the United States began to materialize. The OMB team whittled Azar’s demands down to $2.5 billion, money that would be available only in the current fiscal year. Congress ignored that figure, approving an $8 billion supplemental bill that Trump signed into law March 6.

But again, delays proved costly. The disputes meant that the United States missed a narrow window to stockpile ventilators, masks and other protective gear before the administration was bidding against many other desperate nations, and state officials fed up with federal failures began scouring for supplies themselves.

In late March, the administration ordered 10,000 ventilators — far short of what public health officials and governors said was needed. And many will not arrive until the summer or fall, when models expect the pandemic to be receding.

“It’s actually kind of a joke,” said one administration official involved in deliberations about the belated purchase.

Inconclusive tests

Although viruses travel unseen, public health officials have developed elaborate ways of mapping and tracking their movements. Stemming an outbreak or slowing a pandemic in many ways comes down to the ability to quickly divide the population into those who are infected and those who are not.

Doing so, however, hinges on having an accurate test to diagnose patients and deploy it rapidly to labs across the country. The time it took to accomplish that in the United States may have been more costly to American efforts than any other failing.

“If you had the testing, you could say, ‘Oh my god, there’s circulating virus in Seattle, let’s jump on it. There’s circulating virus in Chicago, let’s jump on it,’ ” said a senior administration official involved in battling the outbreak. “We didn’t have that visibility.”

The first setback came when China refused to share samples of the virus, depriving U.S. researchers of supplies to bombard with drugs and therapies in a search for ways to defeat it. But even when samples had been procured, the U.S. effort was hampered by systemic problems and institutional hubris.

Among the costliest errors was a misplaced assessment by top health officials that the outbreak would probably be limited in scale inside the United States — as had been the case with every other infection for decades — and that the CDC could be trusted on its own to develop a coronavirus diagnostic test.

The CDC, launched in the 1940s to contain an outbreak of malaria in the southern United States, had taken the lead on the development of diagnostic tests in major outbreaks including Ebola, zika and H1N1. But the CDC was not built to mass-produce tests.

The CDC’s success had fostered an institutional arrogance, a sense that even in the face of a potential crisis there was no pressing need to involve private labs, academic institutions, hospitals and global health organizations also capable of developing tests.

Yet some were concerned that the CDC test would not be enough. Stephen Hahn, the FDA commissioner, sought authority in early February to begin calling private diagnostic and pharmaceutical companies to enlist their help.

FDA leaders were split on whether it would be bad optics for Hahn to be personally calling companies he regulated. When FDA officials consulted leaders at HHS, they understood it as a direction to stand down.

At that point, Azar, the HHS secretary, seemed committed to a plan he was pursuing that would keep his agency at the center of the response effort: securing a test from the CDC and then building a national coronavirus surveillance system by relying on an existing network of labs used to track the ordinary flu.

In task force meetings, Azar and Redfield pushed for $100 million to fund the plan, but were shot down because of the cost, according to a document outlining the testing strategy obtained by The Washington Post.

Relying so heavily on the CDC would have been problematic even if it had succeeded in quickly developing an effective test that could be distributed across the country. The scale of the epidemic, and the need for mass testing far beyond the capabilities of the flu network, would have overwhelmed the plan, which didn’t envision engaging commercial lab companies for up to six months.

The effort collapsed when the CDC failed its basic assignment to create a working test and the task force rejected Azar’s plan.

On Feb. 6, when the World Health Organization reported that it was shipping 250,000 test kits to labs around the world, the CDC began distributing 90 kits to a smattering of state-run health labs.

Almost immediately, the state facilities encountered problems. The results were inconclusive in trial runs at more than half the labs, meaning they couldn’t be relied upon to diagnose actual patients. The CDC issued a stopgap measure, instructing labs to send tests to its headquarters in Atlanta, a practice that would delay results for days.

The scarcity of effective tests led officials to impose constraints on when and how to use them, and delayed surveillance testing. Initial guidelines were so restrictive that states were discouraged from testing patients exhibiting symptoms unless they had traveled to China and come into contact with a confirmed case, when the pathogen had by that point almost certainly spread more broadly into the general population.

The limits left top officials largely blind to the true dimensions of the outbreak.

In a meeting in the Situation Room in mid-February, Fauci and Redfield told White House officials that there was no evidence yet of worrisome person-to-person transmission in the United States. In hindsight, it appears almost certain that the virus was taking hold in communities at that point. But even the country’s top experts had little meaningful data about the domestic dimensions of the threat. Fauci later conceded that as they learned more their views changed.

At the same time, as the president’s subordinates were growing increasingly alarmed, Trump continued to exhibit little concern. On Feb. 10, he held a political rally in New Hampshire attended by thousands where he declared that “by April, you know, in theory, when it gets a little warmer, it miraculously goes away.”

The New Hampshire rally was one of eight that Trump held after he had been told by Azar about the coronavirus, a period when he also went to his golf courses six times.

A day earlier, on Feb. 9, a group of governors in town for a black-tie gala at the White House secured a private meeting with Fauci and Redfield. The briefing rattled many of the governors, bearing little resemblance to the words of the president. “The doctors and the scientists, they were telling us then exactly what they are saying now,” Maryland Gov. Larry Hogan (R) said.

That month, federal medical and public health officials were emailing increasingly dire forecasts among themselves, with one Veterans Affairs medical adviser warning, ‘We are flying blind,’” according to emails obtained by the watchdog group American Oversight.

Later in February, U.S. officials discovered indications that the CDC laboratory was failing to meet basic quality-control standards. On a Feb. 27 conference call with a range of health officials, a senior FDA official lashed out at the CDC for its repeated lapses.

Jeffrey Shuren, the FDA’s director for devices and radiological health, told the CDC that if it were subjected to the same scrutiny as a privately run lab, “I would shut you down.”

On Feb. 29, a Washington state man became the first American to die of a coronavirus infection. That same day, the FDA released guidance, signaling that private labs were free to proceed in developing their own diagnostics.

Another four-week stretch had been squandered.

Life and death

One week later, on March 6, Trump toured the facilities at the CDC wearing a red “Keep America Great” hat. He boasted that the CDC tests were nearly perfect and that “anybody who wants a test will get a test,” a promise that nearly a month later remains unmet.

He also professed to have a keen medical mind. “I like this stuff. I really get it,” he said. “People here are surprised that I understand it. Every one of these doctors said, ‘How do you know so much about this?’ ”

In reality, many of the failures to stem the coronavirus outbreak in the United States were either a result of, or exacerbated by, his leadership.

For weeks, he had barely uttered a word about the crisis that didn’t downplay its severity or propagate demonstrably false information. He dismissed the warnings of intelligence officials and top public health officials in his administration.

At times, he voiced far more authentic concern about the trajectory of the stock market than the spread of the virus in the United States, railing at the chairman of the Federal Reserve and others with an intensity that he never seemed to exhibit about the possible human toll of the outbreak.

In March, as state after state imposed sweeping new restrictions on their citizens’ daily lives to protect them — triggering severe shudders in the economy — Trump second-guessed the lockdowns.

The common flu kills tens of thousands each year and “nothing is shut down, life & the economy go on,” he tweeted March 9. A day later, he pledged that the virus would “go away. Just stay calm.”

Two days later, Trump finally ordered the halt to incoming travel from Europe that his deputy national security adviser had been advocating for weeks. But Trump botched the Oval Office announcement so badly that White House officials spent days trying to correct erroneous statements that triggered a stampede by U.S. citizens overseas to get home.

“There was some coming to grips with the problem and the true nature of it — the 13th of March is when I saw him really turn the corner. It took a while to realize you’re at war,” Sen. Lindsey O. Graham (R-S.C.) said. “That’s when he took decisive action that set in motion some real payoffs.”

Trump spent many weeks shuffling responsibility for leading his administration’s response to the crisis, putting Azar in charge of the task force at first, relying on Pottinger, the deputy national security adviser, for brief periods, before finally putting Vice President Pence in the role toward the end of February.

Other officials have emerged during the crisis to help right the United States’ course, and at times, the statements of the president. But even as Fauci, Azar and others sought to assert themselves, Trump was behind the scenes turning to others with no credentials, experience or discernible insight in navigating a pandemic.

Foremost among them was his adviser and son-in-law, Jared Kushner. A team reporting to Kushner commandeered space on the seventh floor of the HHS building to pursue a series of inchoate initiatives.

One plan involved having Google create a website to direct those with symptoms to testing facilities that were supposed to spring up in Walmart parking lots across the country, but which never materialized. Another centered on an idea advanced by Oracle chairman Larry Ellison to use software to monitor the unproven use of anti-malaria drugs against the coronavirus pathogen.

So far, the plans have failed to come close to delivering on the promises made when they were touted in White House news conferences. The Kushner initiatives have, however, often interrupted the work of those under immense pressure to manage the U.S. response.

Current and former officials said that Kadlec, Fauci, Redfield and others have repeatedly had to divert their attentions from core operations to contend with ill-conceived requests from the White House they don’t believe they can ignore. And Azar, who once ran the response, has since been sidelined, with his agency disempowered in decision-making and his performance pilloried by a range of White House officials, including Kushner.

“Right now Fauci is trying to roll out the most ambitious clinical trial ever implemented” to hasten the development of a vaccine, said a former senior administration official in frequent touch with former colleagues. And yet, the nation’s top health officials “are getting calls from the White House or Jared’s team asking, ‘Wouldn’t it be nice to do this with Oracle?’ ”

If the coronavirus has exposed the country’s misplaced confidence in its ability to handle a crisis, it also has cast harsh light on the limits of Trump’s approach to the presidency — his disdain for facts, science and experience.

He has survived other challenges to his presidency — including the Russia investigation and impeachment — by fiercely contesting the facts arrayed against him and trying to control the public’s understanding of events with streams of falsehoods.

The coronavirus may be the first crisis Trump has faced in office where the facts — the thousands of mounting deaths and infections — are so devastatingly evident that they defy these tactics.

After months of dismissing the severity of the coronavirus, resisting calls for austere measures to contain it, and recasting himself as a wartime president, Trump seemed finally to succumb to the coronavirus reality. In a meeting with a Republican ally in the Oval Office last month, the president said his campaign no longer mattered because his reelection would hinge on his coronavirus response.

“It’s absolutely critical for the American people to follow the guidelines for the next 30 days,” he said at his March 31 news conference. “It’s a matter of life and death.”

The Lost Month: How a Failure to Test Blinded the U.S. to Covid-19
Aggressive screening might have helped contain the coronavirus in the United States. But technical flaws, regulatory hurdles and lapses in leadership let it spread undetected for weeks.

link https://www.nytimes.com/2020/03/28/us/testing-coronavirus-pandemic.html

WASHINGTON — Early on, the dozen federal officials charged with defending America against the coronavirus gathered day after day in the White House Situation Room, consumed by crises. They grappled with how to evacuate the United States consulate in Wuhan, China, ban Chinese travelers and extract Americans from the Diamond Princess and other cruise ships.

The members of the coronavirus task force typically devoted only five or 10 minutes, often at the end of contentious meetings, to talk about testing, several participants recalled. The Centers for Disease Control and Prevention, its leaders assured the others, had developed a diagnostic model that would be rolled out quickly as a first step.

But as the deadly virus from China spread with ferocity across the United States between late January and early March, large-scale testing of people who might have been infected did not happen — because of technical flaws, regulatory hurdles, business-as-usual bureaucracies and lack of leadership at multiple levels, according to interviews with more than 50 current and former public health officials, administration officials, senior scientists and company executives.

The result was a lost month, when the world’s richest country — armed with some of the most highly trained scientists and infectious disease specialists — squandered its best chance of containing the virus’s spread. Instead, Americans were left largely blind to the scale of a looming public health catastrophe.

The absence of robust screening until it was “far too late” revealed failures across the government, said Dr. Thomas Frieden, the former C.D.C. director. Jennifer Nuzzo, an epidemiologist at Johns Hopkins, said the Trump administration had “incredibly limited” views of the pathogen’s potential impact. Dr. Margaret Hamburg, the former commissioner of the Food and Drug Administration, said the lapse enabled “exponential growth of cases.”

And Dr. Anthony S. Fauci, a top government scientist involved in the fight against the virus, told members of Congress that the early inability to test was “a failing” of the administration’s response to a deadly, global pandemic. “Why,” he asked later in a magazine interview, “were we not able to mobilize on a broader scale?”

Across the government, they said, three agencies responsible for detecting and combating threats like the coronavirus failed to prepare quickly enough. Even as scientists looked at China and sounded alarms, none of the agencies’ directors conveyed the urgency required to spur a no-holds-barred defense.

Dr. Robert R. Redfield, 68, a former military doctor and prominent AIDS researcher who directs the C.D.C., trusted his veteran scientists to create the world’s most precise test for the coronavirus and share it with state laboratories. When flaws in the test became apparent in February, he promised a quick fix, though it took weeks to settle on a solution.

The C.D.C. also tightly restricted who could get tested and was slow to conduct “community-based surveillance,” a standard screening practice to detect the virus’s reach. Had the United States been able to track its earliest movements and identify hidden hot spots, local quarantines might have confined the disease.

Dr. Stephen Hahn, 60, the commissioner of the Food and Drug Administration, enforced regulations that paradoxically made it tougher for hospitals, private clinics and companies to deploy diagnostic tests in an emergency. Other countries that had mobilized businesses were performing tens of thousands of tests daily, compared with fewer than 100 on average in the United States, frustrating local health officials, lawmakers and desperate Americans.

Alex M. Azar II, who led the Department of Health and Human Services, oversaw the two other agencies and coordinated the government’s public health response to the pandemic. While he grew frustrated as public criticism over the testing issues intensified, he was unable to push either agency to speed up or change course.

Mr. Azar, 52, who chaired the coronavirus task force until late February, when Vice President Mike Pence took charge, had been at odds for months with the White House over other issues. The task force’s chief liaison to the president was Mick Mulvaney, the acting White House chief of staff, who was being forced out by Mr. Trump. Without high-level interest — or demands for action — the testing issue festered.

At the start of that crucial lost month, when his government could have rallied, the president was distracted by impeachment and dismissive of the threat to the public’s health or the nation’s economy. By the end of the month, Mr. Trump claimed the virus was about to dissipate in the United States, saying: “It’s going to disappear. One day — it’s like a miracle — it will disappear.”

By early March, after federal officials finally announced changes to expand testing, it was too late. With the early lapses, containment was no longer an option. The tool kit of epidemiology would shift — lockdowns, social disruption, intensive medical treatment — in hopes of mitigating the harm.

Now, the United States has more than 100,000 coronavirus cases, the most of any country in the world. Deaths are rising, cities are shuttered, the economy is sputtering and everyday life is upended. And still, many Americans sickened by the virus cannot get tested.

In a statement, Judd Deere, a White House spokesman, said that “any suggestion that President Trump did not take the threat of Covid-19 seriously or that the United States was not prepared is false.” He added that at Mr. Trump’s direction, the administration had “expanded testing capacities.”

Dr. Bruce Aylward, a senior adviser at the World Health Organization, led an expert team to China last month to research the mysterious new virus. Testing, he said, was “absolutely vital” for understanding how to defeat a disease — what distinguishes it from others, the spectrum of illness and, most important, its path through populations.

“You want to know whether or not you have it,” Dr. Aylward said. “You want to know whether the people around you have it. Because you know what? Then you could stop it.”

“You can’t stop it,” he warned, “if you can’t see it.”

A Startling Setback

The first time Dr. Robert Redfield heard about the severity of the virus from his Chinese counterparts was around New Year’s Day, when he was on vacation with his family. He spent so much time on the phone that they barely saw him. And what he heard rattled him; in one grim conversation about the virus days later, George F. Gao, the director of the Chinese Center for Disease Control and Prevention, burst into tears.

Dr. Redfield, a longtime AIDS researcher, had never run a government agency before his appointment to lead the C.D.C. in 2018. Until then, his biggest priorities had been fighting the opioid epidemic and the spread of H.I.V. Suddenly, a man who preferred treating patients in Haiti or Africa to being in the public glare was facing a new pandemic threat.

At first, Dr. Redfield’s agency moved quickly.

On Jan. 7, the C.D.C. created an “incident management system” for the coronavirus and advised travelers to Wuhan to take precautions. By Jan. 20, just two weeks after Chinese scientists shared the genetic sequence of the virus, the C.D.C. had developed its own test, as usual, and deployed it to detect the country’s first coronavirus case.

“That’s our prime mission,” Dr. Redfield said later in an interview, “to get eyes on this thing.”

Assessing the virus would prove challenging. It was so new that scientists had little information to work with. China provided limited data, and rebuffed an early attempt by Mr. Azar and Dr. Redfield to send C.D.C. experts there to learn more. That the virus could cause no symptoms and still spread — something not initially known — made it all the more difficult to understand.

To identify the virus, the C.D.C. test used three small genetic sequences to match up with portions of a virus’s genome extracted from a swab. A German-developed test that the W.H.O. was distributing to other countries used just two, potentially making it less precise.

But soon after the F.D.A. cleared the C.D.C. to share its test kits with state health department labs, some discovered a problem. The third sequence, or “probe,” gave inconclusive results. While the C.D.C. explored the cause — contamination or a design issue — it told those state labs to stop testing.

The startling setback stalled the C.D.C.’s efforts to track the virus when it mattered most. By mid-February, the nation was testing only about 100 samples per day, according to the C.D.C.’s website.

Dr. Redfield played down the problem in task force meetings and conversations with Mr. Azar, assuring him it would be fixed quickly, several administration officials said.

With capacity so limited, the C.D.C.’s criteria for who was tested remained extremely narrow for weeks to come: only people who had recently traveled to China or had been in contact with someone who had the virus.

A string of critical errors.

The lack of tests in the states also meant local public health officials could not use another essential epidemiological tool: surveillance testing. To see where the virus might be hiding, nasal swab samples from people screened for the common flu would also be checked for the coronavirus.

The C.D.C. announced a plan on Feb. 14 to perform the screening in five high-risk cities: New York, Chicago, Los Angeles, San Francisco and Seattle. An agency official said it could provide “an early warning signal to trigger a change in our response strategy.” But most of the cities could not carry it out.

“Had we had done more testing from the very beginning and caught cases earlier,” said Dr. Nuzzo, of Johns Hopkins, “we would be in a far different place.”

The consequences became clear by the end of February. For the first time, someone with no known exposure to the virus or history of travel tested positive, in the Seattle area, where the U.S.’s first case had been detected more than a month earlier. The virus had probably been spreading there and elsewhere for weeks, researchers later concluded. Without a more complete picture of who had been infected, public health workers could not do “contact tracing” — finding all those with whom any contagious people had interacted and then quarantining them to stop further transmission.

The C.D.C. gave little thought to adopting the test being used by the W.H.O. The C.D.C.’s test was working in its own lab — still processing samples from states — which gave agency officials confidence. Dr. Anne Schuchat, the agency’s principal deputy director, would later say that the C.D.C. did not think “we needed somebody else’s test.”

And the German-designed W.H.O. test had not been through the American regulatory approval process, which would take time.

Throughout February, Dr. Redfield shuttled between Atlanta, where the C.D.C. is based, and Washington, holding multiple calls every day with Mr. Azar and participating in the coronavirus task force.

Mr. Azar’s take-charge style contrasted with the more deliberative manner of Dr. Redfield, who lacked the kind of commanding television presence that impressed Mr. Trump. He was “a consensus person,” as one colleague described him, who sought to avoid conflict. He relied heavily on some of the C.D.C.’s career scientists, like Dr. Schuchat and Dr. Nancy Messonnier, the director of the agency’s National Center for Immunization and Respiratory Diseases.

Under scrutiny from Congress, Dr. Redfield offered reassurances. Responding on Feb. 24 to a letter from 49 members of Congress about the need for testing in the states, he wrote, “CDC’s aggressive response enables us to identify potential cases early and make sure that they are properly handled.”

Days later, his agency provided a workaround, telling state and local health department labs that they could finally begin testing. Rather than awaiting replacements, they should use their C.D.C. test kits and leave out the problematic third probe.

Meanwhile, the agency’s epidemiologists were growing more concerned as the virus spread in South Korea and Italy. On Feb. 25, Dr. Messonnier gave a briefing with a much blunter warning than usual. “Disruption to everyday life might be severe,” she said.

Mr. Trump, returning from a trip to India, was furious, according to senior administration officials. Later that day, Mr. Azar seemed to be tamping down the level of concern. All Dr. Messonnier had meant, he said at a news conference, was that people should “start thinking about, in their own lives, what that might involve.”

“Might,” Mr. Azar repeated emphatically. “Might involve.”

Barriers to Testing

Dr. Stephen Hahn’s first day as F.D.A. commissioner came just six weeks before Mr. Azar declared a public health emergency on Jan. 31. A radiation oncologist and researcher who helped turn around MD Anderson in Houston, one of the nation’s leading cancer centers, Dr. Hahn had come to Washington to oversee a sprawling federal agency that regulates everything from lifesaving therapies to dog food.

But overnight, his mission — to manage 15,000 employees in a culture defined by precision and caution — was upended. A pathogen that Mr. Trump would later call the “invisible enemy” was hurtling toward the United States. It would fall to the newly arrived Dr. Hahn to help build a huge national capacity for testing by academic and private labs.

Instead, under his leadership, the F.D.A. became a significant roadblock, according to current and former officials as well as researchers and doctors at laboratories around the country.

Private-sector tests were supposed to be the next tier after the C.D.C. fulfilled its obligation to jump-start screening at public labs. In other countries hit hard by the coronavirus, governments acted quickly to speed tests to their populations. In South Korea, for example, regulators in early February summoned executives from 20 medical manufacturers, easing rules as they demanded tests.

But Dr. Hahn took a cautious approach. He was not proactive in reaching out to manufacturers, and instead deferred to his scientists, following the F.D.A.’s often cumbersome methods for approving medical screening.

Even the nation’s public health labs were looking for the F.D.A.’s help. “We are now many weeks into the response with still no diagnostic or surveillance test available outside of C.D.C. for the vast majority of our member laboratories,” Scott Becker, chief executive of the Association of Public Health Laboratories, wrote to Mr. Hahn in late February. “We believe a more expeditious route is needed at this time.”

Ironically, it was Mr. Azar’s emergency declaration that established the rules Dr. Hahn insisted on following. Designed to make it easier for drugmakers to pursue vaccines and other therapies during a crisis, such a declaration lets the F.D.A. speed approvals that could otherwise take a year or more.

But the emergency announcement created a new barrier for hospitals and laboratories that wanted to create their own tests to diagnose the coronavirus. Usually, they faced minimal federal regulation. But once Mr. Azar took action, they were subject to an F.D.A. process called an “emergency use authorization.”

Even though researchers around the country quickly began creating tests that could diagnose Covid-19, many said they were hindered by the F.D.A.’s approval process. The new tests sat unused at labs around the country.

Stanford was one of them. Researchers at the world-renowned university had a working test by February, based on protocols published by the W.H.O. The organization had already delivered more than 250,000 of the German-designed tests to 70 laboratories around the world, and doctors at the Stanford lab wanted to be prepared for a pandemic.

“Even if it didn’t come, it would be better to be ready than not to be ready,” said Dr. Benjamin Pinsky, the lab’s medical director.

But in the face of what he called “relatively tight” rules at the F.D.A., Dr. Pinsky and his colleagues decided against even trying to win permission. The Stanford clinical lab would not begin testing coronavirus samples until early March, when Dr. Hahn finally relaxed the rules.

Executives at bioMérieux, a French diagnostics company, had a similar experience. The company makes a countertop testing system, BioFire, that is routinely used to check for the flu and other respiratory illnesses in 1,700 hospitals around the country. It can provide results in about 45 minutes.

“A lot of us said, you know, your typical E.U.A. is just much too demanding,” said Dr. Mark Miller, the company’s chief medical officer, referring to the emergency approval. “It’s going to take much too much time. And can’t you do something to shorten that?”

Officials at the F.D.A. tried to be responsive, Dr. Miller said. But rather than throw out the rules, the agency only modified the regulatory requirements, still requiring weeks of discussions and negotiations.

After conversations with the F.D.A. in mid-February, the company received emergency approval for its BioFire test on March 24. (The company also began talking to the F.D.A. in January about another type of test, but decided not to pursue it in the United States for now.) Dr. Miller said that while he was ultimately satisfied with the F.D.A.’s actions, the overall response by the government was too slow, especially when it came to logistical questions like getting enough testing supplies to those who needed them.

“You’ve got other countries — and I’m sorry, unfortunately, the U.S. is one of those — where they’ve been slow, disorganized,” he said. “There are still not enough tests available there to test everybody who needs it.”

In an emailed statement, Dr. Hahn maintained that his agency had moved as quickly as it safely could to ensure that tests would be accurate. “Since the early days of this pandemic,” he said, “the F.D.A.’s doors have always been and still remain open to test developers.”

A Lack of Trust

Alex Azar had sounded confident at the end of January. At a news conference in the hulking H.H.S. headquarters in Washington, he said he had the government’s response to the new coronavirus under control, pointing out high-ranking jobs he had held in the department during the 2003 SARS outbreak and other infectious threats.

“I know this playbook well,” he told reporters.

A Yale-trained lawyer who once served as the top attorney at the health department, Mr. Azar had spent a decade as a top executive at Eli Lilly, one of the world’s largest drug companies. But he caught Mr. Trump’s attention in part because of other credentials: After law school, Mr. Azar was a clerk for some of the nation’s most conservative judges, including Justice Antonin Scalia of the Supreme Court. And for two years, he worked as Ken Starr’s deputy on the Clinton Whitewater investigation.

As Mr. Trump’s second health secretary, confirmed at the beginning of 2018, Mr. Azar has been quick to compliment the president and focus on the issues he cares about: lowering drug prices and fighting opioid addiction. On Feb. 6 — even as the W.H.O. announced that there were more than 28,000 coronavirus cases around the globe — Mr. Azar was in the second row in the White House’s East Room, demonstrating his loyalty to the president as Mr. Trump claimed vindication from his impeachment acquittal the day before and lashed out at “evil” lawmakers and the F.B.I.’s “top scum.”

As public attention on the virus threat intensified in January and February, Mr. Azar grew increasingly frustrated about the harsh spotlight on his department and the leaders of agencies who reported to him, according to people familiar with the response to the virus inside the agencies.

Described as a prickly boss by some administration officials, Mr. Azar has had a longstanding feud with Seema Verma, the Medicare and Medicaid chief, who recently became a regular presence at Mr. Trump’s televised briefings on the pandemic. Mr. Azar did not include Dr. Hahn on the virus task force he led, though some of the F.D.A. commissioner’s aides participated in H.H.S. meetings on the subject.

And tensions grew between the secretary and Dr. Redfield as the testing issue persisted. Mr. Azar and Dr. Redfield have been on the phone as often as a half-dozen times a day. But throughout February, as the C.D.C. test faltered, Mr. Azar became convinced that Dr. Redfield’s agency was providing him with inaccurate information about testing that the secretary repeated publicly, according to several administration officials.

In one instance, Mr. Azar appeared on Sunday morning news programs and said that more than 3,600 people had been tested for the virus. In fact, the real number was much smaller because many patients were tested multiple times, an error the C.D.C. had to correct in congressional testimony that week. One health department official said Mr. Azar was repeatedly assured that the C.D.C.’s test would be widely available within a week or 10 days, only to be given the same promise a week later.

Asked about criticism of his agency’s response to the pandemic, Dr. Redfield said: “I’m personally not focused on whether they’re pointing fingers here or there. We’re focused on doing all we can to get through this outbreak as quickly as possible and keep America safe.”

For all Mr. Azar’s complaints, however, he continued to defer to the scientists at the two agencies, according to several administration officials. Mr. Azar’s allies said he was told by Dr. Redfield and Dr. Fauci that the C.D.C. had the resources it needed, that there was no reason to believe the virus was spreading through the country from person to person and that it was important to test only people who met certain criteria.

But even in the face of a crescendo of complaints from doctors and health care researchers around the country, Mr. Azar failed to push those under him to do the one thing that could have helped: broader testing.

In a statement, Caitlin Oakley, Mr. Azar’s spokeswoman, said that the secretary had “empowered and followed the guidance of world-renowned U.S. scientists” on the testing issue. “Any insinuation that Secretary Azar did not respond with needed urgency to the response or testing efforts,” she said, “are just plain wrong and disproven by the facts.”

By Feb. 26, Dr. Fauci was concerned that the stalled testing had become an urgent issue that needed to be addressed. He called Brian Harrison, Mr. Azar’s chief of staff, and asked him to gather the group of officials overseeing screening efforts.

Around noon on Feb. 27, Dr. Hahn, Dr. Redfield and top aides from the F.D.A. and H.H.S. dialed in to a conference call. Mr. Harrison began with an ultimatum: No one leaves until we resolve the lag in testing. We don’t have answers and we need them, one senior administration official recalled him saying. Get it done.

By the end of the day, the group agreed that the F.D.A. should loosen regulations so that hospitals and independent labs could move forward quickly with their own tests.

But the evening before, Mr. Azar had been effectively removed as the leader of the task force when Mr. Trump abruptly put Mr. Pence in charge, a decision so last-minute that even the top health officials in the White House learned of it while watching the announcement.

Previous presidents have moved quickly to confront disease threats from inside the White House by installing a “czar” to manage the effort.

During an outbreak of the Ebola virus in 2014, President Barack Obama tapped Ron Klain, his vice president’s former chief of staff, to direct the response from the West Wing. Mr. Obama later created an office of global health security inside the National Security Council to coordinate future crises.

“If you look historically in the United States when it is challenged with something like this — whether it’s H.I.V. crises, whether it’s pandemic, whether it’s whatever — man, they pull out all the stops across the system and they make it work,” said Dr. Aylward, the W.H.O. epidemiologist.

But faced with the coronavirus, Mr. Trump chose not to have the White House lead the planning until nearly two months after it began. Mr. Obama’s global health office had been disbanded a year earlier. And until Mr. Pence took charge, the task force lacked a single White House official with the power to compel action.

Since then, testing has ramped up quickly, with nearly 100 labs at hospitals and elsewhere performing it. On Friday, the health care giant Abbott said it had received emergency approval for a portable test that could detect the virus in five minutes.

The president boasted on Tuesday that the United States had “created a new system that now we are doing unbelievably big numbers” of tests for the virus. The U.S., he said, had done more testing for the coronavirus in the last eight days than South Korea had done in eight weeks.

Yet hospitals and clinics across the country still must deny tests to those with milder symptoms, trying to save them for the most serious cases, and they often wait a week for results. In tacit acknowledgment of the shortage, Mr. Trump asked South Korea’s president on Monday to send as many test kits as possible from the 100,000 produced there daily, more than the country needs.

Public health experts reacted positively to the increased capacity. But having the ability to diagnose the disease three months after it was first disclosed by China does little to address why the United States was unable to do so sooner, when it might have helped reduce the toll of the pandemic.

“Testing is the crack that split apart the rest of the response, when it should have tied everything together,” said Dr. Nahid Bhadelia, ​the medical director of the Special Pathogens Unit at Boston University School of Medicine.

“It seeps into every other aspect of our response, touches all of us,” she said. “The delay of the testing has impacted the response across the board.”

=======================
Analysis of outcomes in 50k chinese people with covid-19

Posted by dan on March 20, 2020, 9:03 pm

Tweet from @Menon_Cambridge: Rigorous analysis of~50k Wuhan cases. Case fatality for COVID-19 =1.4% in symptomatic patients (below past estimates). OR for death 0.6 in those <30; and 5.1 in those >59 y. Risk of symptomatic infection increased ~4% per year between 30 & 60 years.

link:https://www.nature.com/articles/s41591-020-0822-7.epdf

How the Coronavirus Became an American Catastrophe
The death and economic damage sweeping the United States could have been avoided—if only we had started testing for the virus sooner.

MARCH 21, 2020

https://www.theatlantic.com/health/archive/2020/03/how-many-americans-are-sick-lost-february/608521/

How many people are sick with the coronavirus in the United States, and when did they get sick?
These are crucial questions to answer, but they have never been answered well. Archived data from the Centers for Disease Control and Prevention—illustrated in the chart below—reveal that the government dramatically misunderstood what was happening in America as the outbreak began.
On the last day of February, the CDC reported that 15 Americans had tested positive for COVID-19, the disease caused by the coronavirus.

In the past week, as the country’s testing capacity has increased, officials have discovered more cases. Today, more than 17,000 people have tested positive.

That may sound like a lot. But experts believe that the United States still isn’t testing enough people to detect the outbreak’s true spread. The virologist Trevor Bedford has found evidence that the coronavirus began spreading in the United States in January. It has already infected approximately 87,000 Americans, he says.

The truth is: We don’t know how many Americans are infected with the coronavirus.
The United States is a country soon to be overrun with sick people. As the positive tests for the new coronavirus have ticked upward, so, inevitably, will the deaths.

When Wuhan began burning with infections in December, the U.S. government took only illogical, inadequate actions to stop the virus’s spread: It banned foreigners from entering from China, but inconsistently monitored Americans returning from the country. The president laughed off the virus and the Democrats’ response to it, calling it their “new hoax,” which immediately polarized the citizenry’s response to precautionary public-health information. When the sparks of this conflagration hit, Seattle was aflame before anyone at the CDC had started to reach for water.

What’s happening here, in this country, was avoidable. Nearly every flaw in America’s response to the virus has one source: America did not test enough people for COVID-19.

Testing should have told doctors how to triage patients and hospitals when to prepare their wards. It should have allowed governors to gauge the severity of a local outbreak and informed federal officials as they allocated scarce masks and ventilators. Testing should have answered the all-important question in any pandemic: How many people are sick right now? Had the nation known that, the systems that were put into place over years of pandemic planning could have powered on, protecting millions of Americans and containing the illness.

Instead, the CDC botched its own test development. It sent testing kits to state public-health labs with a nonfunctioning ingredient. And by then, the virus was already spreading. It was already spreading as the Food and Drug Administration held up independent labs that had made their own tests. It was spreading as samples piled up, as the world’s top virology researchers pleaded to be permitted to test them and as the FDA denied their requests.

The virus was spreading as a delay in test kits became a national shortage. When community transmission in the United States was discovered, and states and hospitals lacked the supplies to diagnose even a dangerously ill patient, it was spreading. When a week passed, and the market began to collapse, and the country had barely tested 1,000 people, it was still spreading. Even as kits started to trickle out, the CDC and many state officials clung to restrictive rules that allowed only patients who had traveled internationally or been exposed to a known case to be tested, even though the coronavirus was already clearly spreading in American offices, day cares, and movie theaters. Doctors and nurses with all the symptoms of COVID-19 were denied tests because they could not prove exposure. The virus was still spreading.

Every six days that the country did not test, every six days that it did not act, the number of infected Americans doubled.

“The way no one expected how this response would fail in the U.S. is the testing,” Nahid Bhadelia, the medical director of the Special Pathogen Unit at Boston University School of Medicine, told us. She is an expert in infectious diseases and pandemics, and oversees the medical-response program at one of the few labs in the country permitted to handle the pathogens that cause Ebola, anthrax, and the bubonic plague.

“If you don’t know where the disease is early in the epidemic, you have no hope of containing it,” Bhadelia said. “Even now, [testing is] that Achilles’ heel; it’s the crack that is making its way throughout our entire response.”

Without testing, there was only one way to know the severity of the outbreak: counting the dead. On February 29, Washington State confirmed that a man who had been at the Life Care Center outside Seattle had died, the first American death officially attributed to the virus. According to a now-archived version of the CDC’s website, the United States had, by then, tested 472 total people.

The death came at the end of a month that was America’s last chance at containing COVID-19. But it was too late. February had been lost.

On the last day of January, Trevor Bedford, a scientist at the Fred Hutchinson Cancer Research Center, in Seattle, hit Publish on a 484-word blog post that should have shaken the nation.

Bedford is one of the country’s experts on the evolution and infectiousness of viruses. Virus genomes are like tree rings: They provide clues to where a virus came from and how many times it’s been passed from person to person. With the outbreak raging in Wuhan, Bedford had been studying the genetic sequences of the new coronavirus that Chinese researchers had posted. By January 11, six were in the record, which allowed him to reconstruct the relationships between the individual strains. Though the World Health Organization insisted that this new coronavirus had “limited human-to-human transmission,” the genomes told Bedford otherwise. Whatever this virus was, he suspected it could spread easily among strangers, like the common cold or the flu.

Six days later, when a pair of travelers in Thailand came down with a similar illness, and researchers published the genome of the virus that had infected them, Bedford’s worst fears were confirmed. An epidemic had already begun. The new coronavirus had slipped the cordon in Wuhan, and was out in the world.

“As this became clear to me, I spent the week of Jan 20 alerting every public health official I know,” Bedford wrote that month. On January 23, the Chinese government, which had spent weeks trying to cover up the virus, swung into action. It locked down the city of Wuhan and by mid-February had restricted the movement of 700 million people. On January 24, the CDC announced it had developed a test for the disease. The FDA wouldn’t approve it for another week and a half.

This was the moment that epidemiologists had spent years dreading and anticipating. Almost every city and state in America had a pandemic-preparedness plan, reams of paper ready to put into action.

King County, in which Seattle and Kirkland sit, had a plan, of course. The last revision, dated October 2013, forecast the consequences of a pandemic flu in now-eerie detail. The country, they predicted, would be faced with deaths that could range into the millions. The pandemic “has the potential to suddenly cause illness in a very large number of people, who could easily overwhelm the healthcare system throughout the nation.” No vaccines would be available at first. Community services could break down. Everything could become disrupted “for several weeks, if not months.” So many of the steps that then seemed unthinkable to regular people—closing schools for months, social distancing, curfews, and more—were not only contemplated but gamed out.

Except for one thing. The plan took as a given that a functional testing apparatus would catch diseases on the way in, or at least before the fire started raging. Under its “Planning Assumptions” section, the second bullet point read, “There will be a need for heightened global, national and local surveillance.” Surveillance is public-health jargon for testing and the system that surrounds it. The planners knew there would be a need; they barely considered that it would not be met.

“A heightened local surveillance system … serves as an early warning system for potential pandemics and a critical component of pandemic response plans,” they wrote in another section of the report. “Local surveillance during a pandemic outbreak provides important information regarding the severity of disease, characteristics of the affected population, and impacts on the healthcare system.”

For every contingency that was considered, every difficulty and problem was assumed to be downstream of the high-quality information that would flow from the testing system. Without data about American cases in hand, how to handle the virus would become a matter of guesswork, not judgment.

In late January, as Bedford began to warn public-health officials, there remained, according to the president, nothing to worry about. “We have it totally under control,” President Donald Trump said at Davos. “It’s one person coming in from China, and we have it under control. It’s going to be just fine.”

On or about January 15, someone infected by the coronavirus arrived in the Seattle area, Bedford’s research would later show. The virus began to silently spread in the region. It would not be detected for another six weeks.

If there is one thing about the novel coronavirus that you must understand, it’s that it is a firecracker with a long fuse. Here is what the explosion looks like: Every six days, the number of people infected by the disease doubles, according to estimates from Bedford and other epidemiologists. At the start of February, Bedford now believes, the United States had something like 430 infections; if American interventions have done nothing to slow the disease’s spread, then his simple calculations show that more than 120,000 people could be infected by this weekend. Because of the great uncertainty, it’s probably most appropriate to give Bedford’s range: About 60,000 to 245,000 people are now infected with COVID-19 in the United States.

An invisible fuse sets off this burst of disease. If someone is infected with the coronavirus on Monday, she may start being contagious and infecting other people by Wednesday. But she may not start showing symptoms until Friday—meaning that she was spreading the virus before she even knew she had it. And in some cases, infected people take 14 days to start showing symptoms.

The onset of symptoms starts another awful clock. Many people will recover in a few weeks. But if someone’s case is severe, he may not recover for a month. And even if someone’s case is fatal, she may still survive for three weeks. This means that, first, cases discovered now may not become deaths for weeks; second, some people who will die in early April may only start showing symptoms today.

Mitigation efforts must burn through the same fuse. Even the decision to lock down the Bay Area, the country’s richest region, will not relieve pressure on the medical system for weeks.

Both of these factors mean that time is of the essence. This virus hides effectively and doubles quickly, but it kills slowly and painfully, and it kills most effectively when medical care isn’t available. This makes the coronavirus a particular disaster for the American hospital system, which after decades of streamlining has little spare capacity.

If the coronavirus was in the United States, it had to be found early, before too many explosions could go off.

Helen Y. Chu, an infectious-disease specialist at the University of Washington, thought she had a way to detect COVID-19’s arrival. She directed a monitoring program called the Seattle Flu Study, which studied the spread of the seasonal flu and collected samples from sick people on an ongoing basis. What if some of those patients didn’t have the flu at all, but COVID-19? In January, she and her colleagues began asking federal and state officials for permission to repurpose specimens to test for this other, similar respiratory disease, according to The New York Times. They turned her down then—and they kept rejecting her requests as the weeks wore on. There were legitimate privacy concerns, and government officials were not ready to authorize Chu to look.

On the last day of January, roughly 380 people were already infected with the coronavirus, most of them in the Seattle area, according to Bedford’s estimate. (Bedford is also part of the Seattle Flu Study.)

But then the CDC hit a disastrous roadblock, as it began to send test kits to public-health labs across the country. Two of the test’s reagents were fine, in most cases, but a third chemical initially deemed necessary for the test simply did not work. For the time being, every test for COVID-19 would have to be conducted by the CDC.

As the CDC struggled to find a solution, other laboratories tried to bring their own tests online. They found themselves hamstrung by the FDA, which, though it repeatedly loosened the rules, could not move as fast as the coronavirus.

Alex Greninger, the assistant director of the clinical virology laboratory at the University of Washington, wanted to run a test of the lab’s own design. His lab would end up being one of the fastest to set up testing, and become the most important early source of information about the growth of the outbreak. But initially he, too, found himself caught up in the bureaucratic gears. On February 14, he sent a frustrated email to other clinical laboratories. The obstacles to setting up a test were unbelievable, he wrote: The FDA was asking him to show test results for more specimens than there were confirmed coronavirus cases in the United States—and the FDA wasn’t even making samples from those cases available to him. (The FDA did not immediately respond to The Atlantic’s request for comment.)

No one at the federal level was moving fast enough to actually deal with the looming disaster. “The most pernicious effect of the current regulatory environment is that it kneecaps our ability for preparedness should a true emergency emerge,” Greninger wrote to other laboratory directors. “Why bother getting ready as a clinical lab if you think that you won’t ever be allowed to do anything until May or June?” Even after his lab got FDA approval, another two to three weeks would pass before it could actually test a large number of samples. In coronavirus time, three weeks is about how long it takes for 100 cases to become more than 1,000. “We’ve been exceptionally fortunate to have so few positive cases,” he wrote. “Should that change in the coming weeks, this month will have been the time when we could have expanded our capacity for testing by including clinical labs.”

But the entire American testing effort, which would provide the crucial surveillance capability to understand any incipient outbreak, had stalled. The days ticked by; the virus spread. American public-health labs—which generally have far more capacity than the CDC—had completed only 16 tests, maybe a handful of people, by mid-February. All the way to February 26, only 102 specimens, or perhaps 50 people, had been tested by those labs. Overall, the CDC had tested fewer than 500 people. If the U.S. had a small number of cases, it was only because no one was looking for them. “We just twiddled our thumbs as the coronavirus waltzed in,” William Hanage, a Harvard epidemiologist, wrote in The Washington Post.

Perhaps because of the wildly constrained supply of tests, the criteria to get one were strict. You basically had to go to Wuhan, lick someone, and then develop pneumonia. No one from the federal government even tried to look for community transmission in the United States. In late February, the president voiced his hopes that “the numbers are going to get progressively better as we go along.”

They would not. In fact, as Trump spoke, the virus had reached a nursing home in the Seattle suburb of Kirkland, where it has so far killed 35 residents. The staff knew a mysterious virus was circulating, but life went on as normal. A concerned visitor who had gone to a Mardi Gras party at the center reached out to King County Public Health, the Los Angeles Times reported, and got the runaround.

On February 26, the CDC confirmed what should have been clear much earlier: Community transmission in the United States had begun. The coronavirus was now spreading among Americans who had not traveled abroad or known a confirmed case. At least 60 people in the country now had the virus, according to the CDC’s totals at the time—and, as researchers and analysts soon realized, the true number was almost certainly much higher.

The CDC’s website now says that there were already 268 cases in the United States by that date. When Japan had nearly as many confirmed cases, it closed every school in the country. But because of the testing backlog, the United States remained unaware of its infection rate. And the president encouraged happy thinking. As CDC officials warned that the number of cases could soon quickly rise, Trump disagreed. “Within a couple of days,” he said, the number of cases “is going to be down to close to zero. That’s a pretty good job we’ve done.”

Bedford now estimates that roughly 7,640 people in the United States were already infected.

Chu, the Seattle infectious-disease specialist, decided not to wait for government officials any longer. As the United States declared the first cases of community transmission, she tested through Greninger’s lab without official approval and got a positive. The meaning was obvious to her. “It’s just everywhere already,” she later told The New York Times.

Under pressure to get tests out, the most important fix that our national agencies could make was to simply allow labs to start testing people. In a description that has now been removed from the CDC’s website, the agency gave labs simple instructions: They should use the two working reagents in the old kits. These instructions could have gone out weeks before they actually did, Greninger says, because they relied on the supplies that the CDC had already sent.

Meanwhile, Bedford began examining the new coronavirus strains from patients in Washington State, just as he had, six weeks earlier, analyzed the Asian samples. The Seattle-area specimens led him to a devastating conclusion: The viral genomes were too similar to have arrived in the United States at different times, from different people, but they were also too varied to have arrived recently. By the end of February, the disease had not only established itself in the United States. It had been circulating for close to six weeks. Seattle, on March 1, found itself in the same position as Wuhan did on January 1, with a growing coronavirus outbreak that was on the verge of exploding.

If Seattle went the route of Wuhan, the nation had three weeks before being set on a track in which hundreds or even thousands of people might die in Washington State alone. If a fire was raging in Seattle, it would throw off sparks across the country, hitting many more.

The clock required urgent action. On March 2, Bedford pressed Seattle officials to implement social-distancing policies immediately. If the epidemic grew any further … well, the CDC knew what might happen.

“Widespread transmission of COVID-19 in the United States would translate into large numbers of people needing medical care at the same time,” the agency warned in a passage titled “What May Happen” on the coronavirus page of its website. “Public health and healthcare systems may become overloaded, with elevated rates of hospitalizations and deaths.”

One day after Bedford published his warning, the CDC announced that it would stop reporting how many people in the United States had been tested for the coronavirus. Donald Trump shared his views on Fox News the following night. “A lot of people will have this, and it’s very mild,” he said. “They’ll get better very rapidly. They don’t even see a doctor. They don’t even call a doctor.”

The virus was now clearly spreading, but the CDC still seemed stuck in neutral. On March 10, CDC Director Robert Redfield described his agency’s strategy to The New York Times. “It’s going to take rigorous, aggressive public health—what I like to say, block and tackle, block and tackle, block and tackle, block and tackle,” he said. “That means if you find a new case, you isolate it.”

Redfield’s advice would have sounded reasonable back on Planet A, where the U.S. surveillance apparatus had not failed so spectacularly, but it was almost nonsensical on Planet B, where we all now live. Almost no one was getting tested, so how could anyone find a new case? A few days earlier, a state-by-state investigation by The Atlantic found little evidence that more than 2,000 people had been tested nationwide. We also found that many states had effectively no ability to test for COVID-19, and the few that did—Washington and California—were already deep into their local outbreaks. After we published the story, reports flooded in from across the country from people who had been denied tests, or doctors who couldn’t get one for patients who they believed needed them. In some cases, even doctors who had treated COVID-19 patients were not able to get tested.

As we heard from dozens of frightened and frustrated people across the country, President Trump told reporters, “Anyone who wants a test can get a test.” This was and is still not true.

The scarcity of tests forced officials to ration them. States, counties, and hospitals implemented strict rules about who could qualify for a test. The rules, while based on CDC guidance, were often too limited, given how widely the virus had already spread: They asked about foreign travel and confirmed exposure to a COVID-19–positive patient, weeks after it was clear that the virus was in the United States and that many cases were going undetected. At least 19 states have used a version of the rules that made it effectively impossible to detect the first signs of community spread in a state or city.

In the few places where officials have tested people without known exposure to COVID-19, they have found the virus. In Sonoma County, California, the public-health department asked four hospitals to test the first 20 patients who walked in the door each day with any coronavirus symptoms—even if the patient had not traveled abroad or been exposed to another known case. They started the project on a Friday. They had found a positive by Saturday. “All we needed was one case to say: Yes, we have community transmission,” Jennifer Larocque, a spokesperson for the county, told us.

In other places, the criteria have prevented residents from understanding the true extent of community spread. Nebraska, which hewed closely to the rules, insisted it had only one case of community spread, even as suspicious cases filled ICUs, according to a 35-year-old doctor who asked not to be named, because she was not authorized to speak with the press. Nebraska announced its second case of community spread on Wednesday. The state has tested 800 people, total, for the coronavirus, the chief medical officer said.

The federal government’s reliance on CDC data about the severity of the outbreak froze efforts to stop it. Even after Bedford’s warning, the government published no studies of viral mutation. The void forced leaders to act on the basis of risk, not solid information. How could a mayor shut down her city if it had only 10 for-sure cases? How could a CEO tell employees to call off their trips—and not to Western Europe or central China, but to Seattle?

American cities, blinded by the lack of testing data, did little as crucial days went by. On March 7, as the severity of the local outbreak was becoming known, huge events were allowed to go on. More than 30,000 people attended a Seattle Sounders game that night. No one wanted to say what has now become clear: February was our chance to get this right. We lost that entire month. And we now live in a new era of work stoppages, overwhelmed hospitals, dead elders, and a wrecked economy.

No one had the guts to say what needed to be said over the past month: To save our people, we will have to keep our cities in a chokehold and decimate our economy. It would have taken guts and the full-throated backing of every level of government and agency, as well as irrefutable data, for local officials to do something like that. No one told them to, and the data did not exist for them to come to that conclusion on their own.

Without strong federal leadership, each state has been going after its own solutions and running its own show, as if its residents would stay neatly within their own state lines. Despite the rising number of cases and hospitalizations, President Trump tried to use partisan rhetorical tactics to fight the virus, and in so doing, encouraged Americans to ignore legitimate, dire warnings. Now, though Trump has begun to mobilize a response to the pandemic, his base has been slow to acknowledge that precautions are necessary. This dangerous remove from reality was possible for too long because of the absence of data showing how bad things already were.

Ironically, given that the debacle started with testing, it may end there as well. South Korea, which on March 1 was the site of the largest confirmed coronavirus outbreak outside of China, has aggressively tested a huge percentage of its population, and continues to screen massive numbers of people. Now, just three weeks later, new COVID-19 cases are declining, and only 102 people have died as of Friday. Washington State, with one-seventh the population of South Korea, already has 83 fatalities. The U.S. caseload has ballooned to almost 20,000, more than twice South Korea’s total. Bedford and other experts believe that Korean-style massive-scale testing will be essential to restoring normal economic conditions. “This is the Apollo program of our times,” he said this week. “Let’s get to it.”