WASHINGTON (Sinclair Broadcast Group) — In a letter to governors Thursday, President Donald Trump envisioned a scenario where expanded testing capabilities will soon enable health officials and scientists to identify which counties are at highest risk from COVID-19 infections to guide the next phase of “our war against this invisible enemy.”
“With each passing day, our increasingly extensive testing capabilities are giving us a better understanding of the virus and its path,” Trump wrote. “As testing gives us more information about who has been infected, we are tracking the virus and isolating it to prevent further spread.”
Trump indicated this would advance his goal of easing social distancing restrictions in many parts of the country, while singling out the areas where extreme measures are still justified. The president has said he hopes to see much of the nation “reopen” by Easter, but experts say doing so safely would entail scaling up testing far beyond current levels.
The death toll from the novel coronavirus in the United States passed 1,000 Thursday, with more than 78,000 confirmed cases. The number of actual infections is likely much higher, but many who have experienced possible symptoms have gone untested and anyone tested in the last few days has not yet gotten results.
Federal public health officials have acknowledged that the nation’s testing system was failing until recently, but they insist it has rapidly improved. Dr. Deborah Birx, the White House coronavirus response coordinator told reporters at a briefing Tuesday that testing has been accelerating at a “record rate,” with the U.S. testing as many people in eight days as South Korea did in eight weeks.
Despite ongoing criticism of the slow rollout of testing kits, President Trump has seized upon that statistic as proof that the administration’s approach is working, citing it on Twitter and several times in Wednesday’s White House briefing.
“In South Korea -- and this is not a knock in any way because I just spoke with President Moon; we had a very good conversation about numerous other things -- but they've done a very good job on testing, but we now are doing more testing that anybody, by far,” Trump said. “We do more in eight days than they do in eight weeks. And we go up, on a daily basis, exponentially.”
South Korea is widely seen as one of the countries that has been most successful in slowing the rate of infection, in part due to early, aggressive testing and tracing recent contacts of those who tested positive. That allowed South Korea to contain the virus much more effectively and quickly than the U.S., even though the two countries reported their first confirmed cases on the same day.
In late February, South Korean doctors were seeing nearly 1,000 new cases daily, but by the end of last week, they were only reporting a few dozen a day. Government officials there began laying the groundwork for widespread testing when the first case emerged in January, coordinating with private companies to mass-produce kits and setting up hundreds of testing sites.
“The news, the reporters, the media always likes to bring South Korea -- they called me and they told me, ‘It’s amazing. Your testing procedures are amazing,’” Trump claimed Wednesday. “Plus, we have a test that's a very high-level test, and it's a test that's very accurate.”
However, even Birx acknowledged the current rate of coronavirus testing in the U.S. is not sufficient to contain the outbreak, and steps are being taken to rectify that. Efforts are underway to enable patients to swab their own samples and bring them to labs, for example, so hospitals and testing facilities will not need to use increasingly scarce personal protective equipment.
“We're very proud of those numbers, but we know that we have to do more, and we continue to accelerate in testing to ensure that those who need the tests are tested first and have access,” she said Tuesday.
While it is true total American testing has now exceeded South Korea’s—as of Wednesday, South Korea had conducted 357,896 tests and the U.S. had done at least 418,000—the number is somewhat misleading since the U.S. population is six times that of South Korea. According to CNN, 1 in 142 South Koreans have been tested, compared to 1 in 786 Americans.
"I think the important clarification is that we should be considering the number of cases per 1 million population and considering a rate of people tested and not the absolute numbers," Jennifer Horney, founding director of the University of Delaware's epidemiology program, told CNN Wednesday. "The absolute number of tests is not very meaningful."
Infectious disease experts say the U.S. still needs to do much more testing to get a clearer picture of how widely the coronavirus has already spread and what measures are required to contain it going forward. Private labs have stepped in to supplement the government’s testing capacity, but distributing tests, collecting samples, and providing results in a timely manner remains a challenge.
“The main immediate goal of testing is to identify and isolate the sick so that we can stop the spread,” said Eleanor Murray, an assistant professor of epidemiology at Boston University School of Public Health. “But because testing was so delayed, we really have no clear idea how widespread infection is already.”
With tens of thousands of confirmed infections and significant clusters in several cities, it is too late for testing and basic preventative measures alone to eliminate the virus, but Sarah Connolly, an associate professor of microbiology at DePaul University, stressed identifying the infected must still be a priority for public health officials.
“On average, an infected person infects two to three others. Each of those people then infect two to three others, on average,” Connolly said. “By increasing testing capacity, we can still slow the spread and slowing the spread will be critical for our overloaded hospitals. With this exponential growth, every single case matters.”
The U.S. has lagged behind the level of testing experts have recommended since the outbreak began for several reasons. The first test distributed by the Centers for Disease Control and Prevention produced inaccurate results, and regulations prevented private labs from deploying their own tests for several weeks as the virus quietly spread.
In late February, the Trump administration lifted some restrictions on private tests and accelerated the approval process to put them into wide use. Many more testing kits are now being produced, but there are still shortages of supplies and backlogs of samples in many communities.
Testing on the scale that South Korea did from the start might have helped prevent COVID-19 from spreading, but now that infections are escalating across the country, some governors and mayors have ordered citizens to close businesses and remain in their homes for weeks. That has already had drastic economic ramifications, including a record number of unemployment claims in the last week, but it might not succeed in curtailing the virus without substantially increased testing.
“The goal of social distancing, physical distancing, and the stay-at-home orders or advisories that governments have been instituting is to stop the clock on the spread of COVID-19,” Murray said. “If we all stay far enough apart from each other in space and time, then we can buy ourselves time to ramp up testing to the level where we can use it to identify and isolate people who are infectious.”
According to Connolly, three things are needed to recover from this outbreak: committed social distancing, fully resourced and staffed hospitals, and accessible, accurate, and rapid testing.
“Social distancing will slow the spread of the disease. A supported medical staff will give our sick the best chance of survival,” she said. “Testing supports both these goals, by allowing us to notify contacts and decrease spread. This alleviates the pressure on the hospitals, as well as properly identifies cases for appropriate treatment.”
As the government was stepping up testing earlier this month, President Trump claimed anyone who wanted a test could get one, but that remains untrue today. The CDC has issued narrow guidelines for who should be tested, noting most people who get infected experience mild symptoms and can recover at home.
According to current guidance, hospitalized patients and symptomatic health care workers are the highest priority. Next come first responders and those who are at highest risk to suffer severe symptoms: patients over 65, those with underlying medical conditions, and those in long-term care facilities.
Beyond that, the CDC fact sheet states, “As resources allow, test individuals in the surrounding community of rapidly increasing hospital cases to decrease community spread, and ensure health of essential workers.”
That is far from ideal, experts say. Prioritizing those who are most at risk and health care workers is appropriate, but it will be difficult to effectively contain COVID-19 without significantly broadening the criteria for testing.
“Everyone who has symptoms severe enough to come to the hospital is definitely the first priority,” Murray said. “Once we have enough tests for that, we absolutely need to provide tests to front line responders — doctors, nurses, EMTs, cleaning staff, delivery workers, everyone who’s work is essential to our continuing efforts against COVID. After that, we would ideally have rapid tests available to anyone with even mild symptoms.”
Connolly agreed that vulnerable populations and medical professionals must come first as long as supplies are limited, but testing those with mild symptoms is also a key element of ending the outbreak. Those patients may not need professional treatment, but they can easily infect others if they do not know they have it.
“In an ideal scenario, anyone who has a reason to want a test should get a test,” she said. “We know some people with coronavirus show mild symptoms. This means people can spread the virus without knowing they are infected. Widespread testing would decrease the level of that spread.”