Coronavirus: With medical supplies dwindling, here's what the US can learn from Asia to contain the outbreak
"Increase your testing capacity." "Get your hospitals ready." "Ensure essential supplies are available." These statements from the World Health Organization (WHO) tell how countries must prepare to fight the virus.
But is the US well prepared? The country does not have enough test kits yet. According to Vice-President Mike Pence, the Trump administration will not meet its goal of testing one million people this week. Earlier, Pence promised 2,500 test kits — capable of testing a million Americans.
What is more, the US has other gaps, including a shortage of medical supplies and preparing hospitals for the worse.
"I do think it [the US] is probably one of the better-prepared countries, however, there will be gaps especially with our ability to deal with the surge of patients we may receive," Amesh A Adalja from Johns Hopkins Center for Health Security, told MEA WorldWide (MEAWW).
On Thursday, the US Senate approved USD 8.3 billion to combat COVID-19.
Testing kits saga
So far, over 233 Americans are fighting COVID-19. However, experts believe there could be more. Test shortages indicate that the US has confirmed only a fraction of the total number of coronavirus cases in the country, the former director of the US Agency for International Development told CNBC. At least, 12 have succumbed to the disease, according to reports.
"We still don't have anywhere near full visibility on total cases in the US because of the testing shortfalls," Jeremy Konyndyk said on 'Squawk Box'. He added that these official numbers are probably just the tip of the iceberg.
There are other challenges too. For instance, fighting a new and mysterious virus. "The challenge is that we don’t know exactly how the outbreak is going to play out, so there is only so much we can do in advance," Dr Brian Labus, University of Nevada Las Vegas, told MEAWW.
"While we have techniques that we have refined over many outbreak responses, viruses always like to throw us a curve and force us to improvise," he added.
Despite these uncertainties, there are ways to prepare. "Important actions need to be taken to prepare the US health care sector for COVID-19 and to aim to slow the spread of disease through public health interventions," wrote the authors of a JAMA study that focused on how the country's health community should be responding to COVID-19.
Testing woes in the US began after some of the Centers for Disease Prevention and Control's (CDC) kits sent out early in the outbreak were found to be defective, leaving many without a diagnosis.
The CDC has come under fire. According to ProPublica, the US lost valuable weeks that could have been used to track its possible spread in the United States because it insisted upon devising its test.
"We're weeks behind because we had this problem. We're usually up-front and center and ready," said Scott Becker, chief executive officer of the Association of Public Health Laboratories, which represents 100 state and local public laboratories.
The agency has since fixed the issue. But the damage has been done — the virus has begun spreading within communities. The lack of enough test kits also meant that the US, until recently, was only testing people with either a travel history to affected countries or contact with an infected patient.
The CDC has since changed its guidelines, allowing doctors to decide when to use the kits. Private companies are now allowed to come up with their kits. "This will allow broader testing and has already resulted in various places in the US with the recognition of additional cases without travel links to China," says the JAMA study.
The team recommends that medical and public health experts should test patients who have unexplained acute respiratory distress syndrome (ARDS), a type of respiratory failure that deprives people of oxygen, severe pneumonia, and patients showing mild symptoms similar to COVID-19.
They also make the case for antibody tests. By looking for antibodies against the virus in a population, health experts can understand the magnitude of damage wreaked by the virus. This means they can accurately figure out how fatal the virus is. As of now, we have a crude estimate: 3.4% of the patients die from the disease.
Gaps in medical supplies
According to the Health and Human Services Secretary Alex Azar, the country has a stock of just 30 million surgical masks and 12 million respirators in reserves to protect health workers against the coronavirus threat.
These supplies are not going to be enough: the US needs 300 million respirators and face masks. The department intends to purchase as many as 500 million respirators and face masks over the next 18 months, a senior official with the Strategic National Stockpile told the National Geographic.
The WHO also spoke about the shortage of personal protective equipment (PPE), including gloves and face masks. "We're concerned that countries' abilities to respond are being compromised by the severe and increasing disruption to the global supply of personal protective equipment, caused by rising demand, hoarding and misuse," Dr Tedros Adhanom Ghebreyesus, WHO director-general, said at a press briefing at the agency’s headquarters in Geneva on Tuesday.
"Prices of surgical masks have increased sixfold, and N95 respirators have more than tripled, and gowns cost twice as much," he added.
Getting hospitals ready
In addition to making sure that hospitals protect their staff with enough PPE stocks, they have another area to focus on: measures to isolate and treat patients suspected of having the infection in emergency departments. Such measures could stop others from contracting the disease.
"Similar procedures need to be established in outpatient clinics, dialysis centers, and other medical facilities — especially nursing homes assisted living centers, and long-term care facilities with particularly vulnerable populations — so that COVID-19 does not disrupt normal medical care and compound the direct morbidity and mortality of the disease," the study said.
This is important after a nursing care and rehabilitation facility in Washington, the Life Care Center in Kirkland, reported five deaths. The site could be the epicenter of the outbreak in the US. Authorities are now investigating the issue.
Kirkland cases expose the vulnerability of hospitals, where health care workers and patients are at risk of contracting the infection. China, where the outbreak took off, has experienced hospital spread.
These are some of the challenges US hospitals could face too. "Health care leaders will need to work closely with PPE suppliers and government agencies to maximize manufacture and access to PPE," say experts.
Lessons from Asia
One country seems to have everything under control: Singapore. Its proximity to China meant its citizens were at risk. The country has confirmed 117 infections and no deaths. Of them, 78 have recovered.
Singapore has been aggressive from the start: the government has placed all potentially infected patients under a strict hospital and home quarantine. Their surveillance was on point, tracing out contacts of those infected and providing information on their website.
"There seems to be more of a willingness to place the community and society needs over individual liberty and that helps in a public health crisis," Kent Sepkowitz, an infectious disease control specialist at Memorial Sloan Kettering Cancer Center in New York, told the Fortune.
China enforced lockdowns in Wuhan — the epicenter of the outbreak-- and other affecting cities. These measures, which locked movement into and out of the city, were hugely criticized for being cruel and unethical. However, recently experts have said that China's draconian measures bought the world time to prepare for the virus. However, these findings are preliminary.
Besides, China was criticized for being overly autocratic. In the early days of the outbreak, a Chinese doctor named Li Wenliang tried to issue the first warning about the deadly coronavirus outbreak.
The Chinese authorities did not take too well to this and tried to silence him. Li subsequently contracted the infection while working at the Wuhan Central Hospital and died a month ago.
However, the outbreak in the country is slowing down: there are 143 new cases of confirmed infections and 30 deaths on March 5, 2020. Totally, the country has more than 80,000 cases with over 3,000 deaths.
Should the US follow some of these measures? "If a health agency has had success with a particular approach to control or surveillance, we will happily adapt it to local conditions and needs. It's not as simple as copying what someone else has done, as it worked well because of the particular environment where it was implemented, and our environment is different," Dr Labus told MEAWW.
For now, in the US, the CDC is advising social distancing: avoiding public gatherings to slow the spread of the disease. Dr Labus believes this could stop hospitals from getting overwhelmed.
"The lessons at the US can take from the rest of the world include not using authoritarian measures such as China did, being very open with the population regarding what is going on, and being very liberal and testing policy," Dr. Adalja told MEAWW.