COVID-19 SARS-CoV-2 Testing Problems
Why aren’t there enough tests to guide our response?

COVID-19 SARS-CoV-2 testing problems are preventing us from collecting data fast enough. Better data would help guide our response to the COVID-19 pandemic. Testing would be particularly helpful for autoimmune patients, who may be at higher risk of severe disease. As demonstrated in Singapore, South Korea, and Taiwan, early testing enables containment strategies for a fast-moving outbreak. However, the United States has been woefully slow to roll out tests and collect test data. This has impeded our response and left many Americans in lockdown of unknown duration.

Why are COVID-19 SARS-CoV-2 testing problems so different country-to-country or state-to-state?

Tests have been slow to roll out

COVID-19 SARS-CoV-2 Testing Problems

COVID-19 SARS-CoV-2 technical testing problems

Tests weren’t available before the first COVID-19 outbreak because SARS-CoV-2 is a novel virus. It is technically difficult to develop and prepare such tests. In fact, it is only in the last 20 years that we have only developed the infrastructure and capabilities to test for new viruses. This capability is based on recent advances in biotechnology, genomics, and virology. Our decades-long, worldwide struggle against the HIV (another RNA virus) AIDS pandemic (which played out over years, not months!) was a big reason for those advances.

The United States is the originator of and most advanced country in biotechnology. Despite this, the US CDC failed on its first attempt to develop tests. Some smaller countries (note, all ethnic Chinese) with advanced scientific infrastructure and experience with previous SARS outbreaks (e.g., Singapore, S. Korea, Taiwan) were better prepared to respond quickly with new tests. Developing, scaling up, and distributing tests for large populations is a huge logistical challenge. 

COVID-19 is disrupting worldwide just-in-time supply chains, many dependent on the PRC. These include key materials, from reagents and samples to testing swabs. This is also contributing to many SARS-Cov-2 testing problems.

Government delays caused COVID-19 SARS-Cov-2 testing problems

The CCP’s delay in reporting the Wuhan COVID-19 outbreak to the rest of the world slowed other countries’ actions for weeks. This included early rejection of offers of help from the WHO and the United States. That delay was the first source of SARS-Cov-2 testing problems. Nevertheless, some Chinese scientists started sharing virus sequences with other researchers in January. This provided data that researchers (such as NextStrain.org) used to place the virus within the SARS family and to track its source and spread.

Many other governments, including the United States, have been woefully slow to react. This is in part because official agencies were not doing proper pandemic surveillance, leaving academic and private laboratories to do the work instead. Also, data from those alternative sources were not reaching the ears of government bureaucracies and leaders, although they were readily available to the public online and via social media. 

While early lockdowns seem to work, they inconvenience the electorate, disrupt economic activity, deprive people of income and jobs, and will bankrupt a lot of small businesses. Walking the tightrope between saving as many lives as possible and not tanking the US or world economy is an unprecedented dilemma. Ongoing political strife in China, the Middle East, the United States, and Europe have exacerbated these problems.

Regulatory delays slowed SARS-CoV-2 test roll-outs

Regulatory agencies are slow to react to a crisis. In the early 2000s, FDA rules were set that under a declared state of emergency, hospitals, universities, and private companies with certified laboratories must apply for FDA approval in order to produce tests. This red tape and the failed first CDC test significantly slowed the US response.

The Seattle Flu Study was seeing anomalies in their data that suggested an outbreak in January, but the CDC refused to authorize them to test for SARS-CoV-2. They went ahead anyway.  Similar SNAFUs have, without a doubt, slowed testing in other countries.

COVID-10 SARS-CoV-2 test rationing

Right now, there are not enough tests to screen everybody. Testing has been tightly rationed, with the exception of South Korea, Singapore, and Taiwan. The WHO and US CDC guidelines have focused on people with COVID-19 infection symptoms, direct contact with known infected people, and those traveling from known hotspots. Guidelines suggest testing for healthcare workers and first responders as well.

This shortage of tests means we do not have enough data to predict infection rates. In turn, that impedes launching effective containment or mitigation strategies. We still aren’t sure how many cases are in California (perhaps 10-20 times more than the confirmed case rate). It’s lower than NY in part since many Californians self-isolated and began teleworking in February. Even if they had access to tests, many cities did not have procedures to respond quickly to the demand for tests during the exponential phase of the pandemic. Some people who met WHO or national criteria for testing have been refused tests. Furthermore, tests are voluntary, not mandatory, in the United States. Some 60% of the Grand Princess passengers in quarantine in California refused testing.

Lack of testing data

Testing should increase over the next few weeks. However, many test results have not been released yet to populate the datasets on which analysis and modeling depend. Some 65,000 tests in California have now been performed in the past two weeks, yet most of the results had not yet been made public as of the end of March!

Breaking through these blockages will hopefully supply a wave of data that will clarify the scope and trajectory of the pandemic, the case and case-fatality rates, and provide feedback and guidance on how well mitigation strategies are working and when they can be loosened.

This graph shows how the trajectory of the pandemic has changed in countries around the world. The underlying data still has problems, including the gap in California and US results, and the continuing unreliability of PRC statistics.

Stay well!

Written by: Bonnie Feldman, DDS, MBA, Ellen M. Martin, Annie Rooker

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Let us know your thoughts!

The COVID-19 pandemic is a rapidly moving situation. Therefore, it’s hard to keep up with the tsunami of information, misinformation, disinformation and the high noise-to-signal ratio, especially on social media. Let us know in the comments if you have good sources to share, questions, or if you spot errors or incorrect/outdated information in our posts. Also, let us know if there are additional topics you’d like us to tackle.

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