Wait, what did the director of the CDC say?

From January 21 through February 23, 2020, there were 14 confirmed cases of coronavirus disease 2019 (COVID-19) in the United States, all connected to travel from China. The first U.S. nontravel–related case was confirmed on February 26 in a California resident. Two days later, on February 28, a second nontravel–related case was confirmed in the state of Washington.

As of March 11, the U.S. had performed only 23 tests per million people. Conversely, the U.K had performed 347 tests per million, Italy 826 per million, and South Korea 3,692 per million, according to an analysis by multiple media outlets and the COVID Tracking Project.

Ashish Jha, director of the Harvard Global Health Institute, told NPR that the United States’ response was “much, much worse than almost any other country that’s been affected.” In his interview, he included troubling words such as “stunning,” “fiasco,” and “mind-blowing” to describe the situation. The extensive spread of COVID-19 throughout the U.S. after February emphasizes the importance of rapid response by public health systems to emerging infectious diseases.

Ashish Jha, director of the Harvard Global Health Institute, told NPR that the United States’ response was “much, much worse than almost any other country that’s been affected.” In his interview, he included troubling words such as “stunning,” “fiasco,” and “mind-blowing” to describe the situation.

Limited COVID-19 testing capabilities in the U.S.

A strict limitation on who could be tested appeared to have been due to a pitifully inadequate supply of test kits. In other words, the few tests we had were rationed for the people who needed them most. Under CDC guidelines, testing was prioritized for:

  • Severely ill patients with respiratory symptoms—and no other diagnosis—requiring hospitalization
  • Patients with symptoms who had traveled to common areas or had contact with confirmed coronavirus cases
  • Symptomatic adults who are older or have a complicating factor, such as heart disease, hypertension, or a suppressed immune system

The obvious problem with this approach is that it is almost certainly missing a large number of cases. According to a CDC spokesman, the Centers for Disease Control and Prevention guidelines “are meant to help guide decisions on testing.” In other words, decisions about who to test are best left to doctors. “Decisions on which patients receive testing should be based on the local epidemiology of COVID-19, as well as the clinical course of illness. Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested.”

The Centers for Disease Control and Prevention guidelines “are meant to help guide decisions on testing.” In other words, decisions about who to test are best left to doctors.

Why were we so miserably unprepared to test for this virus?

As the novel coronavirus pushed its way across the globe, in early February, the CDC distributed 200 test kits it had produced to more than 100 public health labs nationwide. However, each kit contained supplies to test only 300 to 400 patients. Additionally, the CDC gave huge cities roughly the same number of test kits as some rural areas. Distributing them almost equally to locations in all 50 states—whether labs were serving metropolitan New York City or small town, America—was a decision that seemed totally out of sync with where testing was needed.

Public health officials in places in the throes of severe outbreaks including New York, Boston, Seattle, and the San Francisco Bay Area couldn’t get enough tests to screen ill patients or the information they needed to protect communities and curb the outbreak of the virus, whose symptoms mimic those of common respiratory illnesses. Rapid testing enables healthcare workers and families to identify and focus on treating those infected and isolate them. It is critical in the early phases of an outbreak.

On July 10, the U.S. Department of Health and Human Services (HHS) made May and June COVID-19 Testing Plans from all states and jurisdictions publicly available on HHS.gov. Assistant Secretary for Health ADM Brett P. Giroir, M.D., stated, “We are pleased with what nearly every state has achieved to date, and look forward to continuing to expand SARS-CoV-2 testing capacity in the U.S.”

Assistant Secretary for Health ADM Brett P. Giroir, M.D., stated, “We are pleased with what nearly every state has achieved to date, and look forward to continuing to expand SARS-CoV-2 testing capacity in the U.S.”

The good news

The good news is the plans submitted by the states are considered very good to excellent. However, during the early weeks, the virus took off, infecting thousands of people, eventually leading to public social distancing and sheltering in place. The fallout from the early mismanaging of testing cost lives and will likely haunt the country for many more months.