Where Are the Tests? COVID-19 Sidelines Clinicians



March 17, 2020

On Friday, I sat on my couch in the middle of what should have been my operating day, watching President Trump's address in disbelief.

The President stated that any doctor seeking COVID-19 testing can get it. This is not true.

I was dumbstruck by the irony of the President's reassurance that testing was readily available for providers like me, while I sat at home in a self-quarantine, unable to get COVID-19 testing to clear me to go back to work.

To be absolutely clear, testing for COVID-19 for healthcare providers is still limited. It's becoming more available every day and may soon become available to providers at my hospital needing clearance. But there is still limited access at most hospitals, and these delays have set us back.

I'm not alone. In Vacaville, California, delayed testing in the first case of community-transmitted COVID-19 in the United States left over 200 healthcare workers in quarantine.

Testing is currently recommended only for those with a known exposure and symptoms highly suggestive of coronavirus, or for symptomatic, high-risk patients.

So far, only around 22,000 people have been tested by the US Centers for Disease Control and Prevention (CDC) and US public health laboratories. South Korea, on the other hand, has tested more than 200,000 people and has the capacity to test 15,000 a day. We are way behind.

One reason for this delay: hubris. The CDC was unwilling to use readily available World Health Organization (WHO) test kits.

German researchers had already developed the first test for COVID-19 by January 17. The WHO began shipping around 250,000 tests to laboratories across the globe in the beginning of February.

Instead of partnering with and capitalizing on the efforts of the global community, the CDC determined that it would make its own test, a process that was plagued with delays.

Another reason for the delay: laboratory error.

The first US test was approved on February 4, but the CDC announced problems with the test a week later. Error is inevitable in the scientific process, for sure. But in circumstances where a pathogen is spreading so rapidly, there is little room for such error. Delays of 2 weeks result in thousands of potential cases going undetected, leading to exponentially increased rates of transmission.

By the end of February, only three public health laboratories in the United States had verified the test for use.

Another reason for the delay: government red tape.

FDA regulations set back approval by nearly a month for COVID-19 testing at US academic and private laboratories. The CDC's COVID-19 test is available to the limited number of labs that have the right equipment, but they are nowhere near capacity to meet national testing needs.

On February 29, the FDA finally began allowing academic and private laboratories to develop and administer their own coronavirus tests.

Limited in-house testing became available at hospitals in New York City last week. Until then, testing was only available by a very cumbersome and lengthy process through the New York State Department of Health.

President Trump signed an $8.3 billion coronavirus emergency spending package on March 6, and Congress passed legislation freeing up an additional $50 billion on March 14, with the promise of increased access to testing, care for the uninsured and underinsured, grants to support businesses, and paid sick leave for affected individuals.

The coronavirus emergency spending package pales in comparison to the Federal Reserve's plan for $1.5 trillion in capital market injections to stimulate the economy, announced on March 12.

The President and Congress will need to support our healthcare system the same way they are supporting the economy if we are going to catch up and gain control of the spread of this virus. And we will only get ahead if we can talk truthfully about how behind we are in this race, particularly in regard to testing.

I get daily email updates on the status of testing availability in my hospital system, each indicating a small step forward. But for the moment, I sit on my couch, hoping to return to my work at the hospital — maybe tomorrow, maybe the next day.

Waiting for more testing, waiting to join the race.

Editor's note: The author asked not to be identified due to concerns about potentially negative publicity for her institution.

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