Coronavirus Testing Gap Creates Public-Health Chaos Across U.S. 

March 11, 2020 by Redirect Health

The new coronavirus has outrun America’s power to diagnose it, complicating efforts to contain an outbreak that has led to economic turmoil and increasingly disrupted daily life.

Hospitals, state public-health labs and doctors say overall testing capacity around the U.S. is growing, but not fast enough. In recent days, commercial labs have started offering screening, and the U.S. Centers for Disease Control and Prevention said the country’s public-health labs can test a cumulative total of 75,000 people.

But even as more testing options come online, the country remains far short of the 1.5 million tests Vice President Mike Pence said last week would soon be available.

“The system is not really geared to what we need right now,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in Congressional testimony Thursday.

“The idea of anybody getting it easily, the way people in other countries are doing it, we’re not set up for that,” Fauci said. “Do I think we should be? Yes. But we’re not.”

The testing that is taking place remains focused mostly on people with known exposures and the highest risk of becoming seriously ill. The CDC, in guidance published March 8, advised giving priority to patients in hospitals, vulnerable people such as the elderly or those with underlying health problems, and people with symptoms and known exposure to the virus through travel or contact with other people infected.

That approach has likely allowed people with mild symptoms to go undetected, complicating the decisions of countless Americans weighing whether to go to work, get on a plane or cancel a conference.

“If testing capacity were not a constraint, then everyone with flu-like symptoms would be getting tested,” said Andrew Lover, a professor of public health at University of Massachusetts Amherst and an expert in infectious diseases.

Patrick Nosker, 31, lives in New Jersey and has been unable to get tested despite potentially being exposed to the coronavirus at a conference in Boston, where infected employees of drugmaker Biogen Inc. were in attendance last week. He intends to self-quarantine.

“If you want to be able to try to reduce the impact of the disease, you try to figure out who has it,” said Nosker, who is director of research at Affinity Asset Advisors, a hedge fund. “And if people who have been exposed to the disease can't find out if they have it or not, there's no way you can get there."

“If testing capacity were not a constraint, then everyone with flu-like symptoms would be getting tested.”

In the early stages of the outbreak, CDC ran every coronavirus test in two laboratories at its Atlanta headquarters. Only in recent weeks did most state labs begin screening for Covid-19 using CDC-provided kits. Each result still must be confirmed by the federal agency.

U.S. public-health labs had tested nearly 4,900 people as of Monday, CDC Director Robert Redfield said Tuesday at a Congressional hearing. Public labs across the country have the capacity to test a total of 75,000 people, but "different states will have different capacity for testing as well as different policies about who should be tested," Nancy Messonnier, director of the CDC's National Center for Immunization and Respiratory Diseases, said in a briefing Monday.

To ease the crunch, companies including Laboratory Corp of America Holdings and Quest Diagnostics Inc. have introduced screening in the past week. LabCorp said it began receiving specimens on Friday. It says it can perform several thousand tests a day and is adding capacity. Quest said it expects to be able to do tens of thousands of tests a week within six weeks.

On Tuesday, when physician George Liakeas called Quest, he was told testing was available only on the West Coast and not in New York, where he sees patients in midtown Manhattan. But Quest later told Liakeas it would accept specimens and that anyone who wanted to get tested should. Doctors anywhere in the U.S. could begin ordering tests starting Wednesday, a Quest spokeswoman said.

Some large medical centers are doing their own testing as well. At Northwell Health, New York’s largest hospital system, the lab started testing Sunday with a manual process that could handle about 90 patients a day. A switch to a partially automated process on Wednesday raised its capacity to hundreds, Northwell said, though there are still constraints on who can get tested.

“Until the testing capacity increases, we still limit who we test,” said Terry Lynam, a spokesman for Northwell. “There's still not of adequate supply of the kits yet.” Lynam said Northwell is focused on people who are at high risk of severe illness or had direct contact with someone infected.

Northwell is also setting up a testing site in New Rochelle, where a cluster of cases prompted state officials to shut down schools and public gatherings in part of the New York City suburb.

Printers Without Ink

Leaders in states where the virus is spreading quickly said the added diagnostic firepower still isn’t enough. While California has almost 8,000 tests available, the state doesn’t have enough chemical reagents and other supplies needed to complete all of them, Governor Gavin Newsom said at a news conference Tuesday.

“Many of these test kits are like printers, but without ink," he said. That’s created a backlog of up to 200 tests at the state’s labs. The state had tested 1,075 people as of Tuesday, and as Quest and others expand capacity in the state in the next few weeks, they ought to be able do more than 5,000 tests a day, Newsom said.

Having more testing data in hand is revealing the virus’s movement through the Seattle area, where county public-health officials have recorded 234 cases as of Wednesday. “Access to more testing is showing us that Covid-19 is spreading more rapidly in King County,” local health officials said in a news release. Infections have spread to 10 long-term care facilities there, and 26 people have died.

In other places, officials are wondering what they’re not yet able to see and asking for more tests.

“We need to be able to gauge the exact scope of Covid-19 spread,” Illinois Governor J.B. Pritzker said Tuesday at a news conference in Chicago. As of Wednesday, the state had investigated 367 people for Covid-19, with 25 confirmed cases and 76 pending. Pritzker said he is frustrated with the federal government for not making tests more widely available sooner. Illinois has three state labs that run tests but Pritzker said not enough tests are available and there is a nationwide shortage of reagent.

“We would like to be able to test anybody that shows signs that they need to be tested and anybody who would like a test,” he said.

States where the virus has touched down more lightly are better equipped to diagnose it. In Nevada, where four people have tested positive, the state has the capacity to test 1,400 people, said Mark Pandori, director of the Nevada State Public Health Laboratory. “Here in Nevada, anyone can get a lab test if a clinician thinks it is merited," he said in an interview.

Rapid Escalation

The scarcity of tests is frustrating for health-care providers. Janice Johnston, the medical director of primary-care clinic Redirect Health, said that each of Redirect's five locations in Phoenix has just five test kits, and "that's all we're going to get at this point."

"People are expecting that we can and will just test them," she said. But tight supply means the clinics will only "do a test on somebody who I think really warrants having a test."

Not everyone with possible symptoms should be tested for Covid-19, clinicians say. Doctors want to rule out flu and other familiar respiratory infections first. William Jaquis, president of the American College of Emergency Physicians and an attending physician at Aventura Medical Center in Florida, said emergency departments see dozens of people with flu-like symptoms every day.

The need to isolate patients and staff who are potentially exposed to the coronavirus may make some physicians reluctant to order tests in mild cases, said Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security. Adalja said he witnessed a request for Covid-19 testing at a community hospital that triggered alarms up through the hospital management hierarchy.

"As soon as there was a suspicion, it rapidly escalated out of the clinician’s hands," he said.

Adalja said the diagnostic needs to be much more widely available to understand how the pathogen is spreading. “We don’t have visibility of the virus because our testing is so limited,” he said.

"It’s great that they're saying everybody who wants a test can get a test,” he added. “We need to make that a reality."

— With assistance by Jason Grotto, Ben Elgin, David R Baker, and Shruti Singh