What began as a review of the recent documentary “Totally Under Control” became a deep dive into the University of Michigan’s failure to develop an adequate COVID-19 testing program. The documentary is a critical play-by-play analysis of a still-unfolding catastrophe, and it exposes the disgusting and wanton flippancy with which the Trump administration (mis)handled the COVID-19 pandemic. My writing of this article roughly coincided with the announcement of the Washtenaw County Health Department’s stay-in-place order for undergraduates, and it was not difficult to draw unfortunate parallels between Trump’s bungling and Schlissel’s blundering.
The documentary draws heavily on interviews with insiders: personal protective equipment manufacturers, ex-Trump administration officials, former Obama administration figures, medical professionals and scientists. These people tell a clear story of what we knew and when, and what we didn’t do, even when we knew we should have. From the first calls and emails coming from Chinese officials, “Totally Under Control” lays out a clear timeline of the pandemic.
Contrasting the U.S. government’s response with that of the South Korean government, the documentary makes painfully clear the fact that we knew what needed to be done but didn’t do it. This fact hits closer to home when comparing the University’s response with that of our Big Ten peer, the University of Illinois, which has carried out over 690,000 tests to date, dwarfing our 59,051 since March 8. The documentary’s most insightful perspective is that of Rick Bright, former director of the Biomedical Advanced Research and Development Authority, an office within the Department of Health and Human Services. Bright reported to HHS Secretary Alex Azar, the former Eli Lilly executive responsible for tripling the price of insulin who consistently ignored Bright and his colleagues’ warnings and advice — advice developed by a global network of scientists and doctors, individuals with experience and knowledge.
The two-hour timeline constructed by “Totally Under Control” only covers the first few weeks of April in great detail. The 100,000-death milestone isn’t really addressed, nor is the July-August case surge. A title card at the end of the documentary notes that Trump’s positive COVID-19 test was announced a day after the film was completed. Despite a limited focus on the beginning and development of the crisis, “Totally Under Control” is totally overwhelming. The most damning and upsetting thing, of course, is the film’s key message, “We knew,” just as, I suspect, President Mark Schlissel knew the University would end up where we are now.
In an Oct. 15 briefing, the University’s Chief Health Officer Dr. Preeti Malani shared that “things have moved in the wrong direction, in terms of COVID.” This is an understatement, by my estimation. One of the key pieces of early knowledge that the documentary emphasized was that testing and tracing is the only way to manage this pandemic. South Korea excelled in this respect, while the U.S. did not. In an Aug. 26 interview with The Michigan Daily, Schlissel tried to justify the University’s limited testing plan, noting that “the whole state of Michigan right now is averaging around 25,000 tests a day — the whole state … If we were to test everybody twice a week, we would dramatically exceed the testing done in our 10 million person state.” I know I won’t be the first to ask: What is wrong with exceeding expectations? Is that not what makes us the Leaders and Best? If we only test a small fraction of the campus population each week, only a fraction of cases are identified. The rest are allowed to spread with clearly disastrous consequences.
In an interview, Assistant Vice President for Public Affairs Rick Fitzgerald shared information about the University’s testing program. Currently, the University provides two types of tests, the first of which being nasopharyngeal swab tests “primarily for symptomatic students.” Swab tests cost UHS roughly $70, but Fitzgerald emphasized that this number does not encompass overhead costs. “It’s not practical to break down the labor costs, because these are employees of the Health Service.” The second type of test relies on detecting Coronavirus RNA present in saliva. Saliva tests for the University’s Community Sampling and Tracking Program are administered by School of Public Health staff and are then processed by a local biotechnology company called LynxDx. In September, the Board of Regents approved an eight-month contract not to exceed $2.124 million with LynxDx. Fitzgerald shared that the University pays LynxDx “about $59 per test,” and that volume might lower that price “slightly.” When contacted, LynxDx declined to confirm whether this number was accurate, stating just that “there’s different pricing under different conditions and parameters.”
LynxDx CEO Yashar Niknafs claimed that “the financial component is honestly not even a large part” of the University’s decision-making process. When asked why the University hasn’t developed its own test, Niknafs shared that the process to develop an in-house test had begun, but “‘what’s the point if there’s already a lab that’s right down the street… that can do this high-volume testing already?’” However, I see a key discrepancy between “high-volume” and high-enough volume. LynxDx processed 10,000 tests last week (though not all for the University), and the University has stated that our capacity for the CSTP program is 6,000 tests. At this rate, with a campus of over 94,000 faculty, staff and students, it would take over 15 weeks to test every individual once.
Niknafs reiterated one crucial point a few times during our conversation: “You can’t just go to any . . . testing provider and say I want 15,000 tests a week.” He said that the most labor-intensive portion of the process is accessioning the metadata and administrative processing of the tests. LynxDx’s staff grew tenfold over the course of just a few months this year, and 39 of the now 47 employees are “needed to support” the 8 who are hands-on in the lab. “It’s one thing to actually do the science … it’s another thing to actually perform this assay at massive scale.”
If we are going to discuss massive scale, we must look to the University of Illinois and their 690,000 tests since July 6. Robin Kaler, the associate chancellor for public affairs at the University of Illinois, said that very early on, in March or April of this year, the chancellor and provost directed faculty and researchers to start strategizing.
LynxDx has developed its own test which they say “draws from” but is more sensitive than the Yale School of Public Health’s SalivaDirect test. Also inspired by SalivaDirect, the University of Illinois was able to develop a roughly $10 test with $6 million in start-up costs.. They project 1 million tests to be completed this semester alone. The University of Illinois converted their Veterinary Medicine lab into a COVID-19 lab and are now processing over 50,000 tests per week, more than we have cumulatively performed since March.
I asked Kaler what enabled the University of Illinois to develop such a robust plan. “We turned to our faculty experts and asked them to partner with us … always with the goal of having the safety and well-being of our students, faculty, staff and greater community as the number one goal.” The University of Illinois blazed a new trail and reached admirable heights.
How can the University of Illinois process saliva tests for $10 while LynxDx charges the University of Michigan $59? Anne Wyllie of the Yale School of Public Health, an associate research scientist in epidemiology, confirmed that the reagents (chemicals necessary to perform the test) for SalivaDirect, on which both the University of Illinois’s and LynxDx’s tests are based, cost roughly $1. Everything on top of that is overhead — labor costs, equipment costs, materials costs, even lab certification costs. When a lab is able to perform a higher number of tests, some of that overhead can be distributed over the cost-per-test, but Wyllie noted that the prices charged by labs vary greatly. The Yale Pathology Laboratory began processing the test at a rate of 1,400-2,100 tests per week for a familiar sum: $59. According to Wyllie, “some labs originally said, ‘we’re charging $59 because Yale Pathology Lab was.’” But by the time processing could increase to 7-14,000 tests per week, costs dropped, and Yale Pathology Lab’s price was reduced to $25.
I also asked Wyllie about the University of Illinois. “What U of I has done is absolutely phenomenal. … They do not have a clinical virology lab. … (They were) good academic researchers who just wanted to make it happen.” The Yale School of Public Health and the University of Illinois both realized that there was real potential in saliva. Most importantly, these institutions had one thing that the University of Michigan seems to lack: foresight. When asked about our testing program, which according to preliminary data has only just surpassed 7,000 total tests per week, Wyllie’s response was simple: “It’s shortsighted.”
Niknafs speculated that there was “some happenstance… that enabled (the University of Illinois) to have the resources” to scale so quickly. “I don’t know if that infrastructure existed at the (University of Michigan).” He largely attributed the focus on saliva and rapid development of a testing program to chance. “No one knew where this could go. … Saliva tests, that are able to be performed in a very high-throughput manner, were not commonplace. … Imagine, on day one, we knew this was possible, the University probably would have responded in a different way.” After speaking with Wyllie and Kaler, it is clear that despite the lack of a known trajectory for this pandemic, some researchers embraced the unknown with determination and intentionality. The University of Michigan did not foster that pioneering research and is now without an adequate testing program. Niknafs stated, “It’s a matter of circumstance. … We at Michigan, no one on their own accord developed a saliva test, so, you know, it is what it is.”
If student health and pandemic control were truly priorities of the University’s administration, we would have made test development a priority and spent what money necessary to grow in-house capacity. Fitzgerald remarked in the same follow-up email that LynxDx was chosen because they provide “the efficiencies of a commercial operation while also adding value of being a local testing partner that is familiar with the needs of the university.” I am a firm believer in supporting start-ups, and I know the University is as well. However, 6,000 tests per week is dismally insufficient, and there is nothing more “local” than the University’s own labs.
The University’s mismanagement and failure to appropriately test students has led to rapid growth in cases and the imposition of a two-week “stay-in-place” order by the Washtenaw County Health Department. Kaler spoke to an unexpected surge in cases early in the University of Illinois’ academic year which was swiftly quelled, without the need for country intercession, due to the University of Illinois’ precise knowledge of who was sick. Earlier this year, Schlissel expressed his belief that “It’s more likely than not we will make it through the semester.” Without detailed knowledge of who is and is not spreading COVID-19 through the community, it was foolish to think that the present situation was avoidable. In the briefing webinar which followed the announcement by the Health Department on Oct. 20, our Pollyanna president’s denialism was again on display.
Only minutes after Schlissel praised students for “spectacular” compliance with public health measures like mask wearing, blaming “momentary lapses … errors in judgement” by “small subsets of people” for the surge in cases, Vice President for Student Life Martino Harmon reported “over 1,100” noncompliance violations written for students in residence halls. Schlissel must not see what Harmon and I have seen: hordes of students partying indoors to celebrate game day on Oct. 31.
Schlissel’s baseless positivity is a departure from reality, echoing similarly misguided rhetoric from President Donald Trump, who said on Oct. 19 that “we’re rounding the turn.” National data tells a much different story. The myopia of our two presidents has made the country, and this campus, unsafe.
Testing and tracing save lives. “Totally Under Control” shows that the Trump administration knew this. Common sense, and the examples set by the University of Illinois and Yale School of Public Health, say the Schlissel administration should have known this too. The culmination of Kaler’s lucid commentary makes for a perfect summary: “We needed to use the innovation and excellence of the University of Illinois to help fight COVID. Because that’s what universities are supposed to do, right? Leading research universities are supposed to solve societal problems.” This is the University’s failure. “There’s nothing about any Big Ten institution that would prevent us from solving this problem.”
Ani Shirvanian, Clinical Operations Manager at LynxDx, emphasized one thing above all. “Every person who is involved in this endeavor is extremely committed to the safety of the campus.” LynxDx’s contribution to the University’s testing operation is laudable, and the way in which the start-up was able to pivot from prostate cancer research to running 10,000 tests last week speaks to their dedication. The blame is not on LynxDx. The blame is on the University for choosing to put all of our eggs into one basket. Even at 10,000 tests per week, impressive for a start-up with fewer than 50 employees, LynxDx is far too small to be the sole saliva-based testing partner of the University. In fact, we would be far better off contracting with the University of Illinois itself through their ShieldT3 program, through which they’ve rolled out their successful test and trace protocol at other universities. At a capacity of roughly 10,000 tests daily, the cost would be $10-20 dollars per test, or $25-30 for “turnkey service” with University of Illinois personnel and equipment – half the cost of a LynxDx test.
The success achieved by the University of Illinois is the standard to which every other institution of higher education should hold themselves. When it comes to COVID-19 testing and the directly-related health of the student body, Schlissel’s administration and the Board of Regents have not only failed to adequately protect our campus, but have also failed to live up to our motto. The Fighting Illini are the Leaders and Best, and it should be with deep shame that the University’s administrators reflect on the Fall 2020 semester.
Daily Arts Writer Ross London can be reached at rhorg@umich.edu.
Editor’s note: An earlier version of this op-ed falsely stated that the University of Illinois does not have a medical school. This op-ed has been updated to reflect that the University of Illinois does have a medical school but does not have a hospital or clinic associated with the school.
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