After weeks of misleading claims, much of them generated by President Donald Trump, the US appears to be grinding into gear on coronavirus testing in part by allowing companies to step in where the government has fallen short.
At a press briefing in the White House on Tuesday, assistant health secretary Brett Giroir said government diagnostic laboratories carried out 31,878 tests and private labs another 27,000 or so.
While the numbers are still woefully short for a country of 327 million people and a virus spreading exponentially, momentum is picking up. Some 8,000 of those tests involving commercial labs were recorded in the previous 24 hours, Giroir said.
In an echo of the politics that has defined the crisis for weeks, however, Giroir praised the Trump administration in spite of its early crisis management shortcomings, claiming that laboratories were “blossoming”, before adding: “This is going on the way we expected.”
The totals are in sharp contrast to the much larger number of tests that other nations had carried out at a similar stage in their battle with the virus. The Trump administration has also been criticised for opting not to use a World Health Organisation test available in late February, squandering valuable weeks, and for possible lab contamination and logistical delays.
“The US is not doing as much testing as China and obviously Korea, which tested I believe over 200,000,” said Ali Khan, dean of public health at the University of Nebraska Medical Center and a former director at the US Centres for Disease Control and Prevention (CDC). “Obviously we’re picking up the pace.”
Shortcomings in the US system are perhaps best seen in steps finally taken in recent days, he said, in a system that does not tend to react well to diseases it hasn’t seen before.
Finally mobilised, Washington has cut red tape, increased reliance on private labs and improved coordination between regulators, doctors and hospitals, drawing on lessons from Asian and European countries.
“If you look what happened in the past week, it’s a good reflection of what we should’ve done,” Khan said. “As I tell people, if we’d had an anthrax attack, we would be better prepared … something we had a better sense of.”
The federal government’s new sense of urgency follows weeks of denials by Trump that the virus was a significant threat, tied to concern it would hurt his re-election chances in November, which impeded an early public health response.
“We, like most states I’m aware of in the country, have a limited supply of tests so we have to be very judicious as already mentioned with who we’re going to test,” said Dr. W. Graham Carlos, a medical school professor at Indiana University. “We hear help is on the way.”
Ten days ago, Trump said “anyone who wants a test can get one”, resulting in a rush of worried people to hospitals only to get turned away because tests weren’t available. Last Wednesday, in a televised speech to the nation, the president said insurance companies would cover all coronavirus treatment for free, a claim the White House had to quickly retract. And until recently, he predicted the virus would disappear shortly “like a miracle”, that it was no worse than the flu and claimed that attention given to the virus was part of a hoax by Democrats.
While a vaccine is probably a year or more away, epidemiologists say accurate and thorough testing is essential so experts know the extent of the contagion, where and how quickly it is spreading and the effectiveness of social distancing and other measures.
In a step toward streamlining decision-making and improving messaging, Giroir said on Tuesday that he expected the US to start reporting a single nationwide testing figure by the end of the week. Such information has been patchwork given weak coordination, varied standards and poor communication among 3,000 US health districts and 5,000 US government hospitals.
The administration said more than 1 million tests have been manufactured and are ready to ship, a figure it expects will rise to 2 million by next week and 5 million by the following week, tapping “an incredible distribution system”, Giroir said.
Many of the reasons behind the testing delays remain unclear.
“Although it is not known at this moment where this breakdown occurred, this issue must be corrected immediately,” said Isaac Weisfuse, an epidemiologist at Cornell University. “It appears to be more of a management and decision-making mistake” than fundamental differences between the US governing system and those of other nations.
But the administration has made claims before, and people are waiting to see results.
“I don't know when we'll have adequate testing. There’s a lot of effort going on now,” said Tara O’Toole, executive vice-president of In-Q-Tel, a not-for-profit venture capital firm and former undersecretary of science and technology with the US Department of Homeland Security. “Our public health system as it now stands was not built for speed.”
In particular, the US health system adopts technology and communication strategies at a far slower pace than companies, she said. Approval for new testing kits – which should ideally be as easy as a home pregnancy test – takes nearly as long as for new drugs. Insurer reimbursement systems are a disincentive for testing kit companies. The broader network is woefully underfunded. And there is a real need for a repository of pathogens for a faster response, she said.
“It involves putting together a much more systematic approach to diagnostics,” said O’Toole. “I think that we're not thinking big enough.”
In the face of contradictory and often inaccurate figures, Americans have turned to citizen groups trying to fill the gap, including the open-source Covid Tracking Project that as of late Tuesday afternoon reported that 5,740 people had tested positive, 47,645 tested negative, 90 died and 815 test results were pending.
Our public health system as it now stands was not built for speed
Tara O’Toole, former US undersecretary of science and technology
Others said there was always frustration at the early stages of a health crisis, but things were improving. US agencies, including the CDC, tend to move slowly for quality control reasons, they said.
“That really doesn’t work well in an emerging disease state like this,” said Carmen Wiley, president of the American Association for Clinical Chemistry, a lab testing group. “But once some of those restrictions were loosened, it allowed labs to do what labs do best,” including designing and manufacturing tests quickly, she added.
Khan said that the response to the coronavirus by Chinese citizens and scientists was impressive while the US reaction has been sluggish, but that Beijing allowed the disease to fester at great cost to its people and ultimately the world.
But the crisis also holds important lessons for the need to remain vigilant moving forward, he said.
“Anyone who’s part of this will remember the impact,” Khan said. “It’s not just the health aspect, but look at the economic impact, the social impact, the political impact.”
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