The CDC is in charge of pandemic preparedness for the USA and it has been reporting how many covid-19 tests have been done in the US three times every week, “on Mondays, Wednesdays, and Fridays.” Today they stopped. I predicted this last week because Trump responded to criticisms of his administrations’ public health efforts by putting an expert politician in charge of the effort instead of getting an expert in public health. Pence may be a savvy politician, but he is also known for a history of bad public health decisions. What is Pence’s priority? He immediately started restricting the coronavirus information that is being released.
Last Wednesday, the CDC announced the first covid case in the US that was due to the spread of the virus in the general community rather than any link to foreign cases. I fully expected that testing would surge, but two days later, the Friday CDC report showed that only six more people were tested for covid-19 in two days. That is slower than the very slow rate of testing in the weeks before that. Today I expected that the CDC would either report a huge surge in testing since there are several more community spread victims or if they had not fixed their problem, they would hide the embarrassing lack of testing. They are hiding the problem. For the first time in the epidemic, they simply stopped reporting how many tests they are doing on their reporting page. Thanks for the brave leadership Mike Pence.
This is the current report (which excludes the 48 cases that have been repatriated to the US from abroad):
As of Friday, the CDC reported that a total of only 451 Americans had been tested. That is pathetic. It is less than tiny Scotland had tested and their population is much smaller than the twin cities of Dallas-Fort Worth alone. Plus Scotland had zero cases, so they have had much less to worry about than the US with our 88 cases reported by the CDC today. The CDC isn’t telling us if they have tested more than 500 Americans yet! Pathetic.
The CDC data does show that the disease cases are increasing exponentially in the US though. This disease has a much slower incubation period than the flu, so it moves slowly though populations. What China has shown is that if we can test people rapidly, and take basic public health precautions with infected individuals, we could nearly halt the spread. That is what they have accomplished, but they stopped the disease by being able to process up to 1.65 million tests per week, according to the World Health Organization. That way the know who has it and how to stop it. Here are some recommendations from Bryce Aylward, a public health expert who would be much better than Pence at directing our response because he has first-hand knowledge of the situation in China and is a veteran epidemiologist rather than a veteran politician.
“I think the key learning from China is speed — it’s all about the speed. The faster you can find the cases, isolate the cases, and track their close contacts, the more successful you’re going to be… In China, they have set up a giant network of fever hospitals. In some areas, a team can go to you and swab you and have an answer for you in four to seven hours. But you’ve got to be set up — speed is everything… China took a whole bunch of steps when they realized they had to repurpose big chunks of their hospital systems to [respond to the outbreak]. The first thing is, they said testing is free, treatment is free. Right now, there are huge barriers [to testing and treatment] in the West. You can get tested, but then you might be negative and have to foot the bill. In China, they realized those were barriers to people seeking care, so, as a state, they took over the payments for people whose insurance plans didn’t cover them. They tried to mitigate those barriers… every hospital should test people with atypical pneumonia for Covid. People with flu-like symptoms — test for Covid.”
Costs are an ongoing problem in the US because going to the ER to get a “free” covid test has cost Americans thousands of dollars.
Even bigger than the cost problem, there have been two key problems which have led to our disastrously incompetent testing situation. First, the CDC completely botched the job. On February 14, the CDC announced that they intended to begin monitoring people with influenza-like-illness in five major cities with plans to expand the program into a national surveillance system. None of that plan had not begun as of last Friday, the last date when the CDC was still admitting how few people they were testing.
The CDC’s incompetence wouldn’t have been so bad if the CDC and FDA had allowed state public health labs, university research labs and other health providers to begin testing, but until last week, it was illegal for anyone else but the CDC to do the test. Finally, two days ago on February 29, Mike Pence finally allowed New York to do their own testing and presumably more permission will be forthcoming. One of the reasons why South Korea was so much more successful than the US at scaling up their testing program was that their version of the FDA gave early approval to many health labs to develop their testing capability. At the point when the US had only tested 445 people, South Korea had already tested a total of 66,652 and had developed the capability to test about 10,000 per day around the clock.
China, meanwhile has tested millions of people. They even test pets for the virus. This has been a cornerstone of their surprising success in beating back the virus.
We still have no idea how bad the spread of covid in the US is because we haven’t been testing in any significant way for a population as large as the US. Actually, it is possible that we have started testing, but if we have then why has the government has started hiding how much our capabilities have improved? You decide which is more likely.
UPDATE: Axios interviewed some of the CDC people responsible and says that the Trump Administration is investigating the problems and that the administration claims “the U.S. has now tested more than 3,600 people for the virus,” If so, that would be a dramatic and welcome increase in testing over the weekend. Science magazine did a story about the administration’s new rules that allow more labs to do testing and claims that, “public health labs will be able to run 10,000 tests a day by the end of next week.” Hopefully.
There is a story in the WSJ about how the Chinese built two hospitals in about 10 days! It would be difficult to match that kind of logistical capability here. Apparently, the King County executive here in Seattle is going to purchase a hotel to handle isolation.
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