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Indybay Feature
Delays in Testing Allow Coronavirus to Spread
by David R. Kimball
Sunday Mar 8th, 2020 5:17 AM
In the U.S., delays in testing for coronavirus are enabling the disease to spread rapidly and undetected.
SPECIFICS ABOUT THE NEW CORONAVIRUS

Coronavirus death rate:

• Mortality rate among known cases: 3.4% as of March 3, 2020 Source: World Health Organization (WHO) [1]
• Mortality rate among those infected: Unknown - many may have mild, or no symptoms. Perhaps about 1%. [1]
• Some types of people are more likely to die if they contract coronavirus: the elderly, the unwell and, maybe, men. [1]

Incubation period:

• An incubation period is the time between being exposed to a germ and having symptoms of the illness. Current estimates suggest that symptoms of COVID-19 usually appear around five days on average, but the incubation period may be as short as two days to as long as 14 days. [2]

Symptoms:

• Fever, dry cough, and trouble breathing are the common symptoms of COVID-19. There have been some reports of gastrointestinal symptoms (nausea, vomiting, or diarrhea) before respiratory symptoms occur, but this is largely a respiratory virus. [2]
• Those who have the virus may have no obvious symptoms (be asymptomatic) or symptoms ranging from mild to severe. In some cases, the virus can cause pneumonia and potentially be life-threatening. [2]

Can those who are asymptomatic [without symptoms] spread coronavirus?

• A person who is asymptomatic may be shedding the virus and could make others ill. [2]

• …Van Kerkhove [Maria Van Kerkhove, who heads the World Health Organization’s emerging diseases and zoonoses unit] said early studies on Covid-19 suggest people who have contracted the coronavirus are emitting, or “shedding,” infectious viruses very early on — in fact sometimes even before they develop symptoms.

“We do know from shedding studies that people can shed in the pre-symptomatic phase,” Van Kerkhove said, adding that while the data are still preliminary “it seems that people shed more in the early phases rather than the late phases of disease.”

If people can infect others before they know they themselves are ill, it makes it much more difficult to break the chains of transmission. [3]

• …a group of five infected people could spread the virus to about 368 people over just five cycles of infection. [4]
______________________

A CORONAVIRUS TIMELINE / Excerpts From News Articles

February 12, 2020
Some of the coronavirus testing kits sent to state laboratories around the country have flaws and do not work properly, the Centers for Disease Control and Prevention said on Wednesday. [5]

February 27, 2020
The White House moved on Thursday to tighten control of coronavirus messaging by government health officials and scientists, directing them to coordinate all statements and public appearances with the office of Vice President Mike Pence, according to several officials familiar with the new approach. [6]

…when confronted with a spiraling HIV outbreak in his home state as a result of opioid addicts sharing contaminated needles, Pence dragged his feet before agreeing to lift a ban on programs that distribute sterile needles. 8-7-16 [7]

February 28, 2020
Janet Hamilton, senior director of Policy and Science at Council of State and Territorial Epidemiologists, said that with the virus spreading through multiple countries, “now is the time” for widespread surveillance testing.

“The disease,” she said, “is moving faster than the data.”

It remains to be seen what effect the delay in producing a working test will have on the health of Americans. If the United States dodges the rapidly spreading outbreaks now seen in Iran and South Korea, the impact will be negligible. But if it emerges that the disease is already circulating undetected in communities across the country, health officials will have missed a valuable chance to lessen the harm.

The need to have testing capacity distributed across local health departments became even more apparent Wednesday, when the CDC said it was investigating a case in California in which the patient may be the first infected in the United States without traveling to affected areas or known exposure to someone with the illness.

Doctors at the University of California, Davis Medical Center, where the patient is being treated, said testing was delayed for nearly a week because the patient didn’t fit restrictive federal criteria, which limits tests only to symptomatic patients who recently traveled to China. [8]

March 5, 2020
If you don’t diagnose the disease, it doesn’t go away. It keeps being transmitted without being noticed, and a thousand little fires spark. If we don’t start aggressively testing mild illness and contacts of contacts, we will lose all track of them. [9]

March 6, 2020
But neither the CDC nor the coronavirus task force chaired by Vice President Mike Pence would say who made the decision to forgo the WHO test and instead begin a protracted process of producing an American test, one that got delayed by manufacturing problems, possible lab contamination and logistical delays.

“Please provide an explanation for why the Covid-19 diagnostic test approved by the World Health Organization was not used,” Sen. Patty Murray, the ranking Democrat on the Senate health committee, who represents the hard-hit state of Washington, asked in a 3½-page letter on the testing fiasco to Pence, Health Secretary Alex Azar, CDC director Robert Redfield, and Food and Drug Administration Commissioner Stephen Hahn.

So far, none has been provided. [10]

March 7, 2020
In California, where thousands are being monitored for the virus, only 516 tests had been conducted by the state as of Thursday. Washington health officials have more cases than they can currently process. And in New York, where cases have quadrupled this week, a New York City official pleaded for more test kits from the Centers for Disease Control and Prevention.

“The slow federal action on this matter has impeded our ability to beat back this epidemic,” the official said in a letter Friday. [11]

Ref:
[1] Coronavirus Death Rate: What Are the Chances of Dying? - BBC 3-4-20
https://www.bbc.com/news/health-51674743
[2] As Coronavirus Spreads, Many Questions and Some Answers by Todd Ellerin, MD 2-27-20
https://www.health.harvard.edu/blog/as-coronavirus-spreads-many-questions-and-some-answers-2020022719004
[3] We’re Learning a Lot About the Coronavirus. It Will Help Us Access Risk by Helen Branswell 3-6-20
https://www.statnews.com/2020/03/06/were-learning-a-lot-about-the-coronavirus-it-will-help-us-assess-risk/
[4] How Bad Will the Coronavirus Outbreak Get? Here Are 6 Key Factors
- NYTimes 2-28-20
https://www.nytimes.com/interactive/2020/world/asia/china-coronavirus-contain.html
[5] Coronavirus Test Kits Sent to States Are Flawed, C.D.C. Says - NYTimes 2-12-20
https://www.nytimes.com/2020/02/12/health/coronavirus-test-kits-cdc.html
[6] Pence Will Control All Messaging from Health Officials – NY Times 2-27-20
https://www.nytimes.com/2020/02/27/us/politics/us-coronavirus-pence.html
[7] How Pence’s Slow Walk on Needle Exchange Helped Propel Indiana’s Health Crisis by Paul Demko 8-7-16
https://www.politico.com/story/2016/08/under-pences-leadership-response-to-heroin-epidemic-criticized-as-ineffective-226759
[8] Key Missteps at CDC Have Set Back Its Ability to Detect the Potential Spread of Coronavirus by Caroline Chen, et al. 2-28-20
https://www.propublica.org/article/cdc-coronavirus-covid-19-test
[9] Testing For the Coronavirus Might Have Stopped It. Now It’s Too Late. by William Hanage 3-5-20
https://www.washingtonpost.com/outlook/coronavirus-testing-united-states/2020/03/05/a6ced5aa-5f0f-11ea-9055-5fa12981bbbf_story.html
William Hanage is an associate professor of epidemiology at the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health
[10] How Testing Failures Allowed Coronavirus To Sweep the U.S. by Joanne Kenen 3-6-20
https://www.politico.com/news/2020/03/06/coronavirus-testing-failure-123166
[11] With Test Kits In Short Supply, Health Officials Sound Alarms - NYTimes 3-7-20
https://www.nytimes.com/2020/03/06/health/testing-coronavirus.html
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