The U.S. lag in coronavirus testing is "a failing," a top federal health official said Thursday, and public health experts say they still don’t have a good understanding of how widely the new virus has spread.
"The system is not really geared to what we need right now; that is a failing, let's admit it," Dr. Anthony Fauci of the National Institutes of Health told a House committee hearing Thursday. "The idea of anybody getting it easily the way people in other countries are doing it, we're not set up for that. Do I think we should be? Yes. But we're not."
The effort initially was hobbled by delays in getting testing kits out to public health labs, but the stumbles have continued, leading scientists to conclude that the virus has already spread far wider than government officials are reporting.
U.S. health officials, for example, promised nearly a month ago to tap into a national network of labs that monitor for flu. That system still isn’t up and running.
Large-scale testing is a critical part of tracking the spread of infectious diseases and allocating resources for treatment. The lack of comprehensive figures means U.S. health providers could quickly be overwhelmed by undetected cases.
As of Thursday afternoon, the Centers for Disease Control and Prevention was reporting about 1,260 U.S. illnesses — a number that trailed independent researchers, who are adding reports from individual states more quickly.
But some experts believe any number based on test results of individual patients is a dramatic undercount. Researchers at Cedars-Sinai Medical Center in Los Angeles this week estimated that the true count of infections was close to 9,000 — about two weeks ago.
"I expect there are more infected individuals now," said one of the researchers, Dr. Jonathan Braun. "This means that the level of disease in the U.S. is much greater than has been reported by actual testing."
The problem, these experts say: the U.S. simply is not testing enough people.
There are no official numbers from the federal government on the country's overall testing capacity. One of the only comprehensive estimates comes from Dr. Scott Gottlieb, the former FDA commissioner who is now a resident fellow at the American Enterprise Institute, a conservative think tank.
As of Thursday, his group estimated U.S. labs could process results for more than 20,000 patient per day. The figure is based on a combination of publicly reported information and historical estimates from government, private and academic labs. It reflects the total number of patient results that could be processed in a day, not the current number being run.
Whatever the actual number, the U.S. effort is trailing other nations.
South Korea, a country one-sixth the size of the U.S. in terms of population, is reportedly testing 15,000 people per day. CDC Director Dr. Robert Redfield noted that officials there are using automated, high-volume testing systems capable of processing thousands of samples at a time. In contrast, the equipment used by most U.S. state and local labs requires technicians to manually process each sample in small batches, sometimes 100 or fewer per day.
The testing process in the U.S. requires mixing various chemicals to setup chain reactions that extract genetic information from patients' swabs. Each lab must fine-tune the process on its own equipment, something experts have likened to perfecting a new recipe.
Unlike countries with centralized, government-based health care systems, the U.S. response is fragmented between public labs and private efforts by hospitals, universities and diagnostic companies.
U.S. officials have boasted of shipping well over 1 million tests to labs across the country. But it is unclear how many have actually been used on patients, because tests have gone out to private labs and hospitals that do not report into the CDC, Health and Human Services Secretary Alex Azar told reporters earlier this week.
Azar said the government is working to setup a data system to combine government testing figures with those of large companies like Quest Diagnostics.
Government officials have pledged that these private testing companies would drastically expand U.S. capacity. But a Quest spokeswoman Wednesday said it could take up to six weeks to ramp up to testing tens of thousands of samples per week.
On Feb. 14, the CDC's Dr. Nancy Messonnier said the agency was "in the coming weeks" going to use labs in five cities to provide a good look at whether coronavirus might be appearing. The idea: When patients tested negative for flu, their specimens would go through coronavirus testing to see if the new bug was what had been causing their flu-like symptoms.
"Results from this surveillance would be an early warning signal, to trigger a change in our response strategy" if cases started appearing, she said. CDC officials subsequently said the number would be expanded beyond five.
But nearly four weeks later, doctors and scientists are still awaiting news that the surveillance system is up and running. This week, health officials in Hawaii said they planned to begin randomly testing negative flu samples in that state for the new coronavirus.
CDC officials have for weeks declined to detail why the system has been delayed, leaving experts mystified.
Dr. Jeffrey Engel is executive director of an organization of disease investigators, the Council of State and Territorial Epidemiologists.
"I don't know" why the system is not running, Engel said this week. "I'm eager to find out."
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