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Infection Protection Healthcare Healthcare and Public Policy Infectious Disease

Testing Decisions May Haunt The Nation

4 years, 2 months ago

12774  0
Posted on Mar 23, 2020, 2 p.m.

It is common knowledge to get ahead of any epidemic/pandemic that broad screening of the masses is needed for proper tracking and quarantine procedure in efforts to slow spread and contain the virus. If anything has been shown by events over the past few months, American capabilities in this area are very lacking.

In February 200 test kits produced by the CDC were distributed to over 100 public health labs across the nation; each containing materials to test 300-400 patients and all labs received the same kits which were distributed to equal locales in all states

This decision was prelude to some chaos for the following weeks, in which the availability of the testing was completely out of sync with the number of testing that was and still is needed. South Dakota with few cases may have been getting quick results while areas such as New York, Seattle and San Francisco which were in the middle of serious outbreaks were not able to get enough tests and the information needed to protect the public and stem the curve of the outbreak. 

It can’t be stressed enough how critical rapid testing is in the early stages of an outbreak, it allows healthcare workers and families to identify and focus on tracking those possibly exposed, isolating, and treating any who may be infected to attempt to limit and/or contain further spread. 

Additionally, during the important early weeks free help from leading global viral experts was not only ignored but also declined by American officials at a time when it would have had the greatest impact to the watching world’s shock. During these weeks the virus took off, without testing that led to no proper tracking and no possibility of containment allowing the virus to spread unknown infecting thousands of people leading to nationwide social distancing and shut down and shelter in place orders. We are now just beginning to grapple within the failure from those early bungles, and it is likely to haunt all of America in the months to come. 

The limited and small first shipment to Washington state arrived well after more than weeks weeks after officials announced the first cases of COVID-19 for example, and at that same time outbreaks had been festering in many places within it; as a result within a few mere weeks over three dozen infected would die at a nursing home in the suburbs of Seattle. From that point it did not take long from the virus to continue its rapid spread to overwhelm the state. 

The administration has attempted to speed testing after so many missteps have further hampered responses to contain the virus, which has led to officials facing a barrage of criticism from global health experts, state officials, members of Congress, the American healthcare system, and the American public watching the continued bungles.

Federal officials have tried to ease the process for labs to perform their own testing, leading to university and commercial labs ramping up their capacity. Public and private labs are now estimated to be able to test more than 36,000 people a day, but this number can vary considerably and does not indicate how many tests are actually being given or are allowed to be given to patients. 

“We are now beginning to see that they have spread out in a prioritized way. We asked them to prioritize the regions that were mostly affected,” Deborah Birx, the coronavirus response coordinator for the White House Coronavirus Task Force, said Wednesday of private labs’ testing, without elaboration.

But is this ramping up a case of too little too late after weeks of faltering attempts, ignored warnings, denied requests and thousands of undiagnosed people spreading the virus to others, who then go on to continue the unknown spread? Let’s be honest the virus has been here since January, spreading largely unknown, and if any one cares to continue to be honest about it we actually have no idea how many people are infected due to lack of testing, and limiting testing to those displaying multiple symptoms, where's according to WHO 80% of those infected will experience mild to no symptoms. 

Then there is the faulty testing, for example on Feb.8, 2020 New York state received a faulty test kit for 800 specimens, this amount is also consistent with that of other states all contributing to lack of containment and further spread. Since then the state has begun testing based on CDC protocols and have tested  7,200 people statewide. 

Middle states within American have had few reported outbreaks, and they appear to have the luxury of time to plan such as Missouri only using 395 of their 800 tests reporting 26 positive cases, and when private labs are accounted for that number increases to 47 confirmed cases. 

Areas with less international travel to their regions will benefit from that lack. “This is very similar to 1918 with the influenza pandemic—St. Louis had more time to prepare and was able to put measures in place to flatten the curve than, say, Philadelphia,” Lawrence said. “Seattle didn’t have an opportunity to prepare as much in advance.”

As more commercial labs are becoming available, they are having their hands tied with strict restrictions that are limiting their testing capabilities nationwide. Due to the widespread lack of testing there is no way for tens of thousands of people to know if they have come into contact with a person who has been infected until well after it happens, if they find out at all. 

“CDC will distribute tests based on where they can do the most good. But without hospital-based testing and commercial testing, it will not be possible to meet the need,” said Tom Frieden, who led the CDC during the Obama administration and is a former commissioner of the New York City Health Department.

California is one of the states currently being hit hard by the initial wave of COVID-19. Many there are being told that they don’t qualify for testing because they have not traveled abroad, or had contact with a confirmed infected person, and are not displaying multiple symptoms. There are many reasons as to why this is wrong, the most important being wide screening is a critical component in any attempt to contain the spread of any outbreak. Some areas weren’t even able to begin their limited restricted testing until March 2 due to issues with the initial faulty test kits. 

“We are still limited on extraction kits,” Mandy Cohen, the Health and Human Services secretary in North Carolina, said in an interview in mid-March. Officials earlier this month could test only 300 patients because of shortages in the extraction materials needed to register whether the novel coronavirus is present.

Despite federal officials saying they are sending help/supplies and ramping up efforts, states are still waiting and have been told to purchase their own. In a recent press conference it was brought to the administration's attention that when states try to purchase supplies they are being outbid by federal purchase orders. This was met by snickering, denial and gas lighting comments which does not reflect positively or instill any confidence to the watching people looking for signs of hope. 

In many states, testing rules are so strict community outbreaks are going unnoticed until it is too late to go along with the serious lack of test kits. The vast majority of Americans still cannot get tested due to the patchworks of rules governing who can be tested even if a doctor requests permission. Broad testing/screening is critical, that’s a fact. 

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