On 3/13/2020, Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, commented during the MSNBC “Morning Joe” TV news show that the White House is coming up to speed on the need for widespread croronavirus COV-19 testing. This change in direction is supported in part by the below 3/13/2013 Washington Post report.
The problem with the well intended comments by Dr. Fauci is that it doesn’t match reality.
See: 3/13/2020 Atlantic article: America Isn’t Testing for the Most Alarming Coronavirus Cases (“In many states (like FL), testing rules are so strict that doctors may not notice a community outbreak until it’s too late.”)
The republican President Donald J. Trump has no choice but to change course away from avoidance of tests that would reflect higher numbers of Americans with the COV-19 infection towards pushing for better accessibility of these tests, because some US sates are establishing their own in-state kits/ protocols to test for the coronavirus COV-19 bug.
Finally, on 3/13/2020, he’s taken the step of declaring the spread of the coronavirus COV-19 US pandemic, a US “National Emergency.” (This will be covered in a future post.)
Here are several examples of regions taking over from the US government, the task of testing for COV-19:
Statements from Cleveland Clinic Related to Coronavirus (COVID-19)
Statement from Cleveland Clinic on Testing for COVID-19 – March 12 2020, Updated at 5:00 PM
We want to clarify misinformation that has been trending on social media related to Cleveland Clinic testing for COVID-19. Cleveland Clinic has not developed a new test for COVID-19. We have purchased the necessary CDC components and validated the test in our own lab. This means we can now conduct on-site testing for the virus, allowing us to test patients and receive the results more rapidly – in most cases, within one day.
Statement from Cleveland Clinic on Testing for COVID-19 – March 12 2020
“Our organization will soon have the capabilities to conduct on-site testing, as will other hospitals and academic medical centers across the country. We are in the process of validating our testing capabilities and will soon send out more information. We anticipate test results will be available within a day. Please continue to look for updates on https://clevelandclinic.org/coronavirus and https://clevelandclinic.org/newsroom for updates on this rapidly evolving situation.
Statement from Cleveland Clinic on How to Seek Care for Coronavirus (COVID-19) –March 10, 2020
If you are concerned you have COVID-19, we recommend you seek care first from Express Care Online or call your primary care physician. They can evaluate you and determine if you meet the CDC guidelines for testing based on symptoms, travel and exposures. If you do meet the criteria, you will be advised as to how to proceed with testing.
The Ohio Department of Health also has set up a COVID-19 hotline (1-833-4-ASK-ODH) for those with questions or concerns.
Currently, we are testing in accordance with CDC guidelines. As this situation changes, we will continue to evolve our testing procedures.
UW Virology @UWVirology
On 3/12/2020, a drive-through coronavirus testing site was set up at a University of Washington hospital which could serve as the model for more such facilities around the Seattle area — and perhaps around the country. Dr. Seth Cohen, who runs the infectious disease clinic at UW Medical Center Northwest, is quoted.
As per 3/11/2020 Denver7 report by Blair Miller, “Colorado’s first drive-up COVID-19 testing facility opens in Denver, is free of charge” (“People will need to have doctor’s note saying they meet criteria for testing”)
“Colorado’s first drive-up testing facility for the novel coronavirus (COVID-19) opened Wednesday (3/11/2020) in Denver’s Lowry neighborhood and saw several dozen vehicles in line after it opened.”
“The drive-up facility, located at 8100 E. Lowry Blvd. in Denver, will be open from 10 a.m. to 2 p.m. Wednesday through Friday, and next week’s schedule will be posted on the state’s website once the schedule is decided.”
“Wait times at the facility on Thursday were 3-4 hours, according to the Colorado Department of Health and Environment, which advised people to bring food and water because of the long waits.”
As per a 3/13 Washington Post article:
“Earlier this week, New York Gov. Andrew M. Cuomo (D) announced he was moving ahead to contract with 28 private labs in New York. “We’re not in a position where we can rely on the CDC or the FDA to manage this testing protocol,” the governor said.”
“Cuomo said that he told the private labs they should “get up, get running and start moving forward with testing.”
“The state’s Health Department has a preexisting relationship with these labs, which Cuomo says has the experience with virology to get the testing done.”
One issue that I foresee as an obstacle to widespread COV-19 testing is the CDC’s guidance (test parameters) to doctors in order to request a test for their patients. The Centers for Disease Control and Prevention (CDC) is telling doctors that “they should consider the presence of symptoms (fever, cough, shortness of breath), travel history, contact with a confirmed COVID-19 patient and local epidemiology, and should rule out other potential causes of illness.”
The problem with the above CDC rules, it is very likely that many folks who show the symptoms of fever, cough, shortness of breath / respiratory problems and who do not test positive for the typical flu, would not know if they came into contact with someone who had recently traveled to countries like China, Italy, Iran and other developing hot spots if they’ve attended events with huge crowds, like the president’s rallies.
To truly allow for widespread testing, the CDC cannot include the directive that a patient show that he/she had direct contact with a party who tested positive for COV-19 and/ or who had traveled to a regional hot spot for this disease, as there’s the issue of “community transmission /spread.”
As per 3/5/2020 (American Academy of Pediatrics) AAP News:
Federal health officials are loosening criteria on testing for coronavirus disease 2019 (COVID-19).
The Centers for Disease Control and Prevention (CDC) is telling clinicians to use their judgment in determining whether testing is necessary. They should consider the presence of symptoms (fever, cough, shortness of breath), travel history, contact with a confirmed COVID-19 patient and local epidemiology, and should rule out other potential causes of illness.
“Those with a suspected case should immediately notify their state or local health department and implement infection control practices.”
“Sean T. O’Leary, M.D., M.P.H., FAAP, a member of the AAP Committee on Infectious Diseases, said availability of testing will be another factor to consider.”
“In some places it’s going to be easier to get the testing done than others, so listening to your state and local health departments’ guidance is probably the best way to go in terms of the decisions around who and when to test,” he said.”
“The Food and Drug Administration recently said it would allow facilities such as state laboratories to immediately use tests they developed under emergency use authorization. In addition, kits are being distributed to hospitals this week, and officials are working with commercial laboratories.”