Delays and errors have put the US far behind other countries in testing and treating coronavirus patients: 'We are trotting along while they're racing'
The US has reported six coronavirus deaths and nearly 100 cases. According to experts, that number could skyrocket once more Americans get tested. Health experts say the US lags behind other countries in terms of testing for the virus due to a lack of funding and issues with some testing kits' accuracy. As of March 1, the Centers for Disease Control and Prevention had only tested 472 suspected coronavirus patients. South Korea, by contrast, has tested tens of thousands. Visit Business Insider's homepage for more stories.
Health officials in South Korea tested 10,000 people for the coronavirus on Friday alone. This week, they built drive-thru coronavirus screening locations, giving hundreds of patients an assessment of their health in just 10 minutes. The US announced its first coronavirus case on the same day South Korea did. But six weeks later, less than 500 potentially infected Americans have gotten tests, according to the US Centers for Disease Control and Prevention (CDC). The agency's official test count — which had previously been updated daily — was stripped from the CDC site on Sunday, though US Secretary of Health and Human Services Alex Azar told ABC the same day that the US had tested 3,600 people. South Korea's case total is far higher than the US' — more than 4,000 compared to the US' nearly 100 — but South Korea has tested at least 100,000 people. In the US, meanwhile, experts say a lack of funding and faulty test kits have hampered health authorities' ability to control the outbreak.
"Coronavirus has been circulating in the United States for weeks. We didn't detect it because we weren't testing properly," Matthew McCarthy, a hospitalist at Weill Cornell Medicine in New York City, tweeted on Sunday. "There may have been cryptic transmission in Washington State since January. If I sound alarmed, it's because I am." 'A national scandal' Six people in Washington state died of the coronavirus in the last few days, and cases are cropping up in which patients had no exposure to an infected person or history of travel to China. Identifying those cases of "community spread" is challenging without effective, rapid testing. But because some CDC tests distributed to state labs turned out to be flawed, more than half of the labs received inconclusive results. A problem with one ingredient in the test kits resulted in further distribution delays. "It's easy to do for some countries, but what happened in the US is the CDC created and sent out a test to all 50 states and then said 'Wait hold up don't use it,'" McCarthy told CNBC Monday. While facilities wait for replacement tests, they have to send samples to the CDC in Atlanta to confirm a case. That causes a delay of up to 48 hours between testing and confirmation.
"For a country of our size, when you only have a single site doing that, it limits the resources available for testing," Richard Martinello, an associate professor of infectious disease at the Yale School of Medicine, told Business Insider. The CDC says it is ramping up testing Nancy Messonnier, director of the Center for the National Center for Immunization and Respiratory Diseases, said on Friday that the CDC aims "to have every state and local health department online doing their own testing by the end of next week." She added that the CDC has manufactured a new type of testing kit and acknowledged that testing "has not gone as smoothly as we would have liked." Azar told ABC that US testing is ramping up: "We now have 75,000 tests available," he said. But not all hospitals with potential cases have received those tests. "The idea that we would have to really fight to get that test done, when CDC is saying they have capacity, is alarming," Lauren Sauer, an expert in emergency medicine at Johns Hopkins University, told The New York Times.
McCarthy told CNBC that he hadn't seen more tests available yet, either. "I'm here to tell you right now — at one of the busiest hospitals in the country, I don't have it at my fingertips," he said. "I still have to call the Department of Health. I still have to make my case, plead, to test people." New York state confirmed its first case on Sunday: a Manhattan woman in her 30s. "The person who tested positive in New York was only the 32nd test in our state," McCarthy said. "That is a national scandal." Is the CDC's testing criteria too limited? Until Thursday, the CDC's criteria only called for testing symptomatic patients with a travel history to China and those who may have had contact with a lab-confirmed coronavirus patient. That meant that the country's first case involving community spread, a patient in California, went untested for multiple days at two different hospitals.
The agency changed the testing guidelines on Thursday to include patients with conditions so severe that they require hospitalization. But some patients with mild symptoms, even those who recently traveled to countries with high case totals like Italy or Iran, still might not get tested. "I know the infectious-disease community and the public health community desire to do much more testing than is currently feasible," William Schaffner, an infectious-disease specialist at the Vanderbilt University School of Medicine, told Business Insider. "Other countries are testing much more broadly than we are," he added. "We are trotting along while they're racing along." Switzerland, whose population is 38 times smaller than the US, has said it's capable of conducting around 1,000 tests per day.
As the US caseload starts to spike, health experts say it's important for the CDC to begin monitoring cases without a connection to outbreaks abroad. "This seem likes a logical next step," Robert Amler, a dean at New York Medical College and a prior CDC director, told Business Insider. "The best defense is a good offense, meaning we should be looking a little more closely at which subgroups within the population seem to be most susceptible." But coronavirus tests are expensive — around $250 apiece, Politico reported. The Trump administration cut the CDC's global disease-fighting budget in 2018. As a result, the agency scaled back on efforts to prevent disease outbreaks. The administration's proposed budget for 2021 includes another 16% cut to the CDC budget. SEE ALSO: 6 ways the Trump administration has already botched responding to the coronavirus Join the conversation about this story » NOW WATCH: Pathologists debunk 13 coronavirus myths
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Georgia lifted its shelter-in-place order April 30, and state public health officials have since released optimistic-looking...Georgia lifted its shelter-in-place order April 30, and state public health officials have since released optimistic-looking data on new coronavirus cases and deaths. But it's still too early to draw the conclusion that reopening states won't worsen COVID-19 outbreaks. Georgia's Department of Public Health has faced criticism over publishing inaccurate or misleading data in recent weeks, and Gov. Brian Kemp's office has apologized over the mishaps. But even with accurate data, there can be a weeks-long delay between the time when a person contracts the virus, when they get a positive test result, and when that test result is actually reported to state health authorities. Experts have said that coronavirus case counts don't show what the outbreaks look like in realtime — they're a snapshot of what the outbreaks looked like two weeks earlier. Visit Business Insider's homepage for more stories. Just over two weeks after Georgia ended its shelter-in-place order, preliminary data from public health officials on the number of new coronavirus cases in the state has prompted some to claim victory over the outbreak. Though it's tempting to celebrate any optimistic-looking data as a sign that reopening states can help local economies bounce back without worsening COVID-19 outbreaks, it's still very early to draw such a conclusion. Data published by the Georgia Department of Public Health showed a decline in both confirmed cases and deaths in the time since the state started reopening certain businesses on April 24 and ending its shelter-in-place order on April 30. But the state also warned that the data is "preliminary," and that the "data during the reporting period may be incomplete due to the lag in time between when the case was tested and/or reported and submitted to the Georgia DPH for reporting purposes." So, in many cases, there could be a roughly two-week delay — or even longer — between a person contracting the virus, and their positive test result getting reported to state health authorities. According to the US Centers for Disease Control and Prevention, coronavirus' incubation period can last up to 14 days, though research has shown that the vast majority of coronavirus patients who develop symptoms do so within 11.5 days of infection. Then, once a person gets tested, further delays may occur between the test, the notification of a positive result, and the reporting of that positive result to public health authorities. Furthermore, Georgia's data so far has been criticized for being misleading, inaccurate, or filled with errors, as the Atlanta Journal Constitution has reported. Gov. Brian Kemp's office even apologized for one graph that incorrectly suggested that new coronavirus cases in the hardest-hit counties had dropped each day for two weeks. In fact, there was no such trend. Rather, the Atlanta Journal Constitution's analysis of Georgia's data has shown more of a plateau in new coronavirus cases in the state, rather than a decline. Coronavirus case counts don't show what the outbreaks look like in realtime — they're a snapshot of what the outbreaks looked like 2 weeks earlier Experts have explained that current coronavirus case counts are not representations of how severe the outbreaks are in that very moment — rather, the case counts show how severe the outbreaks were roughly two weeks earlier. Therefore, Georgia's optimistic-looking data from recent weeks may be reflecting the success of the state's lockdown measures, rather than reflecting the success of lifting those measures. As for deaths, there's an even greater lag in the data since a patient may not actually die of the virus until weeks after they first contracted it, and a further lag could occur between the time of the patient's death and the moment the death certificate is processed for reporting. The CDC has said the reporting lag for deaths could range from one to eight weeks, or more, "depending on the jurisdiction, age, and cause of death," though the CDC also says the average lag is closer to one or two weeks. The amount of testing is also crucial to consider in the number of reported cases, as positive cases cannot be detected without widespread testing. Though Georgia has ramped up their testing, and now promises that anyone in the state who requests a test can get one, it's far from certain that the state's current testing capacity is accurately depicting the extent of the coronavirus outbreak. For instance, between April 30 and May 6 — the first week the state reopened — Georgia averaged 8,600 tests per day. Experts from Harvard University's Global Health Institute said that average was far below the estimated minimum of 25,979 daily tests needed by May 15 to contain its outbreak, according to a data analysis by NPR. Georgia may have managed to simultaneously tamp down its coronavirus outbreak and reopen its economy — but it will take more time for the data to reflect that conclusion.Join the conversation about this story » NOW WATCH: Inside London during COVID-19 lockdown
More than 1.3 million people have recovered from the coronavirus — and are likely now immune. But painful symptoms may last far longer than people realize.
More than 1.3 million people worldwide have recovered from the coronavirus. Recovered COVID-19 patients may have...More than 1.3 million people worldwide have recovered from the coronavirus. Recovered COVID-19 patients may have a residual cough or fatigue for weeks after major symptoms disappear. Though long-term effects remain unclear, patients who develop severe pneumonia could come away with scarred lungs and reduced lung function. Recovery likely means immunity, at least for a period of time, so people who were once infected could go back to work with low risk of reinfection. Visit Business Insider's homepage for more stories. Most people who get the coronavirus recover. More than 1.3 million such cases have been documented worldwide. "Eventually, if all goes well, your immune system will completely destroy all of the virus in your system," Tom Duszynski, director of epidemiology education at Indiana University–Purdue University Indianapolis, wrote in The Conversation. "A person who was infected with and survived a virus with no long-term health effects or disabilities has 'recovered.'" Still, many uncertainties remain: It's not yet clear how many people have recovered, how the illness will affect them in the long run, or how long they'll be immune. The process can take much more time and pain than people realize. Here's what the research so far reveals about people who have recovered from COVID-19. Recovery by the numbers Although more than 1.3 million people who had the coronavirus have recovered worldwide, according to Worldometer, the true number is probably far higher. Data on recoveries is less precise than case counts and death tolls, and many counties, states, territories, and regions don't report how many of their residents have recovered. "Recovered cases outside China are country-level estimates based on local media reports and may be substantially lower than the true number," Douglas Donovan, a spokesman for Johns Hopkins University, which previously tracked global recoveries in its COVID-19 database, told CNN. Plus, due to limited testing availability in some countries (including the US), the most severe cases were initially prioritized for official diagnoses. People who had mild symptoms, or none at all, have been less likely to get tested — if they even seek testing in the first place. That means that many mild infections are not included in the count of total cases or recoveries. That can skew experts' understanding of the disease and how they predict its trajectory. "Knowing the real number of infected people in the population would be very useful to have better models of when disease will peak and decline, and also when we can begin to return people to work," Dr. Bala Hota, a professor of infectious diseases and Associate Chief Medical Officer at Chicago's Rush University Medical Center, told CNN. What recovery is like Recovery doesn't necessarily mean feeling all better. Hota told CNN that many patients still have a mild cough and feel tired even once they're considered recovered and are no longer contagious. It can take a long time to fully get back to normal. "It takes anything up to six weeks to recover from this disease," Dr. Mike Ryan, executive director of the World Health Organization's Health Emergencies Program, said in March. "People who suffer very severe illness can take months to recover from the illness." The process is different for patients who were put on a ventilator. "What we're seeing in patients who end up on ventilators is that they often stay on them for several weeks," Dr. J. Randall Curtis, a professor at the University of Washington Harborview Medical Center, told US News & World Report. "And then, coming off the ventilator, they're often going to be in the ICU for several days, and then back [in a regular hospital unit] for a few days to a week or so to regain their strength." People who were put on a ventilator can walk away with long-term physical and psychological damage. If they develop acute respiratory distress syndrome (ARDS), that can scar their lung tissue. Lasting effects Dr. Shu-Yuan Xiao, a pathology professor at the University of Chicago School of Medicine, told ABC News that most people with mild cases of COVID-19 should recover "with no lasting effect." The future is murkier for patients who develop severe illness, though. Hong Kong's Hospital Authority reported in March that within a group of 12 recovered patients, "two to three" showed decreased lung capacity in follow-up visits with doctors. Those few patients gasped for air when they walked, according to the South China Morning Post. Scans of nine patients' lungs revealed signs of organ damage. But because the coronavirus was first identified in December, there hasn't been much time to research recovered patients and publish the findings. "This is a little bit of an understudied group," Hota said. Experts do have a sense of the effects that severe pneumonia can have on the body, though. If a patient develops acute respiratory distress syndrome (ARDS), that can scar their lung tissue. "It's the same general thing that you have with any type of phenomena that's severe enough to land you in the ICU," Dr. Amesh Adalja, an infectious-disease expert at the Johns Hopkins Center for Health Security, told ABC News. Adalja and Xiao both said that some severely ill patients may never recover full lung function. Antibodies and immunity People who have been infected develop antibodies that can probably fight off the coronavirus if they encounter it again. A pre-print study published Tuesday reported the results of 1,300 antibody tests from people who had confirmed and suspected cases of COVID-19 in and around New York City. The findings showed that 99.8% of people who got a positive diagnostic test later got positive results for antibodies. The research countered fears that not all patients walk away with antibodies. One Chinese study, which has also not yet been peer-reviewed, tested 175 recovered COVID-19 patients and found that 10 of them had not developed any detectable coronavirus antibodies. Antibody tests can sometimes return false negatives as well as false positives. But proponents of antibody testing say that it's imperative in the fight against the outbreak, since immune people could return to work safely. "Ultimately, this might help us figure out who can get the country back to normal," Florian Krammer, a professor in vaccinology at Mount Sinai's Icahn School of Medicine, told Reuters. "People who are immune could be the first people to go back to normal life and start everything up again." Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in an interview on "The Daily Show" that he was "willing to bet anything that people who recover are really protected against reinfection." "What we don't know yet is how long that immunity will last, the quality of that immunity, and whether all individuals will generate a long-lasting high immune response," Frances Lund, chair of the microbiology department at the University of Alabama at Birmingham, previously told Business Insider. Fauci also said on April 8 that because the virus doesn't seem to be mutating much, people who recover will likely be immune should the US see a second wave of spread in the fall. "If we get infected in February and March and recover, next September, October, that person who's infected — I believe — is going to be protected," he said. Although China, South Korea, and Japan have all reported rare instances in which people who recovered from the coronavirus later tested positive, those cases were probably the result of false positives, experts say. When you can leave self-quarantine If you're sick and wondering how to know when you've recovered, CDC guidelines depend on whether or not you were tested. If you weren't tested and probably won't be, you should stay isolated until you meet three criteria: You've have had no fever for at least 72 hours (without fever-reducing medication), your other symptoms (such as shortness of breath or coughing) have improved, and at least ten days have passed since the onset of symptoms. If you have gotten or will receive a diagnostic test, you need to test negative twice, 24 hours apart, before leaving isolation. Those tests must be done after you no longer have a fever (without fever-reducing medicine) and after other symptoms have improved. Once you have met these criteria, you can leave your home for essential outings, in accordance with your city, county, and state rules. You should still minimize contact with others, though, as well as disinfect all surfaces, clothes, and objects you've touched. Scientists still aren't sure when a person with the virus stops being contagious to others, but a team of German researchers found that coronavirus patients "shed" high amounts of virus early on in their infection. (The research is not peer-reviewed yet, however.) In mild cases, the amount of the virus the gets shed decreased significantly after day five. Patients with mild cases were not infectious eight days after they first started experiencing symptoms. The serious cases were not infectious after day 10 or 11. Holly Secon contributed reporting.Join the conversation about this story » NOW WATCH: How to help hospitals and healthcare workers fighting the coronavirus
Pelosi and Schumer say it's 'alarming' that Trump failed to mention the lack of coronavirus testing in the US in his national address
House Speaker Nancy Pelosi and Senate Minority Leader Chuck Schumer said in a joint statement it...House Speaker Nancy Pelosi and Senate Minority Leader Chuck Schumer said in a joint statement it was "alarming" that the president failed to mention the lack of coronavirus testing kits available in the US. The president spoke in an address from the Oval Office about the novel coronavirus and the measures that he and his administration are taking to curb the spread and help impacted business and workers. The US has been struggling to distribute tests as case numbers grow in the country, due in part because of the CDC's decision to create their own test, which was ini tally faulty. Visit Business Insider's homepage for more stories. House Speaker Nancy Pelosi and Senate Minority Leader Chuck Schumer expressed concern that President Donald Trump failed to mention the lack of coronavirus testing available in the US during his Wednesday night, televised national address. The president spoke from the Oval Office about the coronavirus and the measures that he and his administration are taking to curb the spread of the virus and offer relief to workers and businesses. Some measures the president mentioned included suspending travel for 30 days from all countries in Europe except the United Kingdom for non US-citizens and permanent residents, and asking Congress to provide payroll tax relief and waivers for small businesses. In a joint statement, Pelosi and Schumer said it was "alarming" that the president failed to mention the lack of coronavirus testing kits available in the US as the outbreak continues. "We have a public health crisis in this country and the best way to help keep the American people safe and ensure their economic security is for the president to focus on fighting the spread of the coronavirus itself," they said in the statement. "Alarmingly, the president did not say how the administration will address the lack of coronavirus testing kits throughout the United States." While Trump did mention that major health insurance companies would waive copays for coronavirus treatment, insurance industry group America's Health Insurance Plans contradicted the president's statement and said it would only apply to coronavirus testing, not treatment. The US has been struggling to distribute tests as case numbers grow in the country, prompting the CDC's decision to create their own test, which turned out to be faulty. As of Wednesday, there are more than 1,300 confirmed coronavirus cases in the US and 38 deaths. However, in comparison to other countries completing coronavirus tests like South Korea and Italy, the US is falling far behind in detecting cases. As of Monday evening, The Atlantic tallied that fewer than 5,000 people in the US had been tested, compared to more than 24,000 tests in the United Kingdom. This week, Health and Human Services Secretary Alex Azar said the federal government was not tracking how many people were tested. "Coronavirus has been circulating in the United States for weeks. We didn't detect it because we weren't testing properly," Matthew McCarthy, a hospitalist at NYC's Weill Cornell Medicine, said in a tweet on Sunday. "There may have been cryptic transmission in Washington state since January. If I sound alarmed, it's because I am." In his national address, Trump called on Congress to push past the partisanship and to unify in order to fight the coronavirus outbreak in the US. In response, Pelosi and Schumer urged members of the GOP to pass a bill called the Families First Coronavirus Response Act. "The bill will include free coronavirus testing, paid emergency leave for workers, food security assistance, help to states overburdened by Medicaid costs, and strengthened Unemployment Insurance, among other much-needed measures to keep the American people safe," they said in a statement. Read more: One chart shows how many coronavirus tests per capita have been completed in 8 countries. The US is woefully behind. Trump's coronavirus task force is reportedly awaiting 'research' from Jared Kushner before making an emergency declaration The White House scrambles to clarify key details from Trump's speech announcing his coronavirus response Global stocks plunge after Trump announces coronavirus response package All the times Trump risked exposing himself to coronavirus as his advisers urge people his age to be extremely cautious SEE ALSO: Trump was caught saying 'oh f---" into a 'hot mic' moments before he began his televised speech on the coronavirus Join the conversation about this story » NOW WATCH: A law professor weighs in on how Trump could beat impeachment