Coronavirus pandemic: US testing system is failing as many go undiagnosed 8 weeks into outbreak, warn experts
The US, the world's leading economy, is increasingly losing control over the coronavirus situation in the country. Their testing capacity is a mess. This has allowed the virus to move freely undetected, leaving many Americans without a diagnosis and leading to more than 1,600 infections and 40 deaths.
The country is eight weeks into fighting COVID-19 and yet it finds itself staring at this situation. The first case was reported on January 20 in Washington.
From March 8, the CDC has conducted fewer than 90 tests. "A little more than 1,700 have been tested by the CDC and there is a lot of testing happening in state labs now. CDC has sent materials sufficient to test 75,000 people through the public health system," Dr Stephen Redd, head of the CDC's Office of Public Health Preparedness and Response, said on March 11.
Dr Anthony Fauci, the top infectious disease expert at the National Institutes of Health, has also expressed disappointment over the coronavirus testing system in the country. "That is a failing. It is a failing, let’s admit it," he said.
Other experts agree. "I want to be clear that I’m not blaming individuals at CDC or health departments for the testing debacles. This is the fault of our neglected public health infrastructure," Dr Angela Rasmussen, from Columbia University, tweeted.
The US is not testing enough
The US is not testing enough people, say experts. "I expect there are more infected individuals now," Dr Jonathan Braun, told AP. "This means that the level of disease in the US is much greater than has been reported by actual testing," he added.
In comparison, South Korea has tested more than 200,000 people and it is testing over 10,000 people a day across its country. Both the US and South Korea had reported their first case on January 20.
But South Korea has been aggressive since the beginning. Having learned valuable lessons from another coronavirus — MERS that killed 36 people — the country was better prepared.
"We learned the risk of new infection and its ramifications from the experience of the MERS back in 2015," Professor Gye Cheol Kwon, the chairman of the Laboratory Medicine Foundation, told BBC.
So South Korea began testing people aggressively. Over 96 labs, both public and private, are tasked with testing for coronavirus. To reduce the risk of spread in the hospital, the country opened up testing driveways, taking inspiration from McDonald's. The measure was also time-saving, taking only 10 minutes. The results, however, took two days.
"Detecting patients at an early stage is very important," South Korea's Health Minister Park Neung-hu told CNN. "South Korea is an open society and would like to protect the freedom of people moving around and traveling."
Carolyn Maloney, who recently chaired a meeting on coronavirus preparedness and response, expressed her disappointment at how the US is lagging. "Just last week, the Trump administration promised to deliver a million tests by the end of the week, but it did not even come close. On Sunday, they admitted that they delivered only 75,000 tests. That’s more than 900,000 tests short, and this was their own stated goal to the American people," she said.
She questioned whether the Trump administration has been downplaying the situation. "If we don’t have testing, we don’t know the full scope of the problem and if you don’t test people, then you have no idea how many people are infected. We don’t even know where community transmission is happening. We don’t know where to direct resources. We are operating in the dark."
What is more is that we do not know how many Americans have been tested. Alex Azar, the US Secretary of Health and Human Services, told CNN on Match 10 that his agency had no official numbers on how many Americans have received tests.
How did the US mess up?
Even the most advanced nations are not immune to the virus. Health systems can crumble if countries are not prepared enough.
But the US did have a headstart. Soon after Chinese scientists released the genome sequence of the virus, the CDC set out to design its diagnostic tests.
And it did. "Just to say very quickly CDC's role in this was we very rapidly, within almost seven to 10 days, developed a test from an unknown pathogen," Robert R Redfield, the CDC director, said at a hearing. The federal health agency shipped its tests to other labs across the country.
It was after this that the US began losing its plot. The CDC admitted that some of its tests were faulty. Armed with a few properly functioning tests, the CDC narrowed down its capacity, testing only those recently returned from Wuhan or those who were in close contact with an infected person.
The CDC was forced to change these stringent guidelines after a California woman, who was suspected to be infected, was not diagnosed for days only because she neither traveled to China and nor did she have any contact with infected people.
Some people with symptoms are still not getting tested. A woman from Seattle was reportedly turned away when she sought help. "I live in Seattle, I have all symptoms of COVID-19 and have a history of chronic bronchitis. Since I work in a physical therapy clinic with many 65+ patients and those with chronic illnesses, I decided to be responsible and go to get tested," she tweeted.
What is more, the agency came under fire after a federal scientist said that the CDC may have produced some of its coronavirus testing kits in a lab that was already contaminated, indicating why some of their tests were dysfunctional.
According to Dr Redfield, one of the reagents needed for the tests was not working properly. "We had to modify that with the FDA that took several weeks to get that completed, but the test was always available in Atlanta if you sent the sample to us," he added.
The US has paved the way for private companies to come up with test kits. "As we sit here today, Quest and LabCorp are now offering this test in their doctor's offices throughout this country," Dr Redfield said.
The CDC is currently working on widening its surveillance to include test results from private labs as well. This could fill the knowledge gap as to how many Americans have been tested so far.
More trouble for the agency?
Reports suggest that another threat has emerged: lack of enough materials for the testing. These materials help lab experts extract the virus's genetic material.
CDC Director Robert Redfield told Politico he is not confident that US labs have adequate stock of the supplies used to extract genetic material from any virus in a patient's sample — a critical step in coronavirus testing.
"The availability of those reagents is being looked at," he said, referring to the chemicals used for preparing samples. "I'm confident of the actual test that we have, but as people begin to operationalize the test, they realize there are other things they need to do the test."
Without them, lab experts cannot conduct tests on suspected individuals. If enough processing kits aren’t available, the risk that testing will be disrupted is huge, said Michael Mina, associate medical director of molecular diagnostics at Brigham and Women's Hospital in Boston.