Enlarge /. Patients wait for their COVID-19 drive-through exams in their cars at Advocate Lutheran General Hospital in Park Ridge, IL on Thursday. The hospital suspended the drive-through exam on Friday due to a lack of test kits.
Eric Bangeman / Ars Technica
America is finally beginning to test the corona virus in significant quantities. According to the COVID tracking project, the total number of coronavirus tests performed in America on Thursday was over 100,000. That's a 10-fold increase over a week earlier. In the coming days, we can expect the pace of testing to continue to increase as more and more organizations – both academic laboratories and profit-making companies – step up their testing efforts.
This is important because America has a lot of catching up to do. A series of early federal failures hampered America's testing efforts in the early weeks of the coronavirus crisis. It wasn't until the end of February that the Food and Drug Administration opened the door to a large number of organizations to offer coronavirus tests.
In the last week we started to see the results of this change. Private companies start shipping hundreds of thousands of test kits. Drive-through test stations are being built all over America.
However, the explosion of new testing efforts will bring its own challenges. Josh Sharfstein, a professor at the Johns Hopkins University School of Public Health, argues that coordination becomes increasingly important as test volume increases. A Thursday story in the Wall Street Journal painted a picture of the chaos when patients struggled to be tested – even after receiving a referral from a doctor to get a test. Some transit testing facilities had long lines and unpredictable hours, the journal reports.
To get the maximum benefit from all of these tests, officials must rationalize and rationalize these test processes. Patients need predictable rules of when to start testing and a predictable process to actually get a test and get results. And public health officials need standardized methods for collecting test results
Some laboratories also suffer from a lack of supplies, reports Axios. As we detailed in our February statement, testing for the virus behind COVID-19 is a multi-step process involving a number of chemical reagents. Most of these chemicals are available from stock, but the system is not designed for sudden, massive peaks in demand.
"We keep redundancy very much in mind," Harvard's Michael Mina told Axios. "There is concern that some items will be out of stock. Once we have finished our test, we will validate other changes."
We saw this firsthand. On Thursday, Ars editor-in-chief Eric Bangeman drove to a drive-through test site near his home in the Chicago area to get some photos for this story. On Friday, the hospital where these tests were carried out announced that it would discontinue its transit test program due to a lack of test kits.
However, there is every reason to believe that test providers will solve these problems. The number of coronavirus tests has risen sharply this week and we should expect this progress to continue in the coming weeks. And that's important because America will do a lot more testing to control the coronavirus outbreak.
Federal missteps meant that America was lagging behind with tests
America began testing capacity due to a number of early federal failures. The story begins on January 31, when the Minister of Health and Human Services declared the novel corona virus an emergency for public health. Due to a peculiarity of the federal law, this declaration meant that anyone who wanted to test for the corona virus first had to obtain approval from the Food and Drug Administration.
The FDA has great discretion in using this agency. The agency could have set up an optimized process so that a large number of organizations could create their own tests. But it didn't.
The disease control centers were working on a coronavirus test, and initially the FDA decided not to allow anyone to develop their own tests. Unfortunately, many laboratories were unable to validate the results when the CDC shipped an early batch of coronavirus test kits to government and local laboratories.
The CDC's efforts to correct this error wasted valuable time. With a limited number of tests available, the CDC initially limited the tests to those who had recently traveled to coronavirus hotspots or had come into contact with a known coronavirus carrier. This made it difficult to track early cases of community expansion within the United States.
Corona virus tests are increasing exponentially
Enlarge /. A COVID-19 test site at the Advocate Lutheran General Hospital in Park Ridge, IL.
Eric Bangeman / Ars Technica
Finally, on February 29, the FDA opened the door to other laboratories that developed their own tests. The new FDA framework allows laboratories that meet certain prior regulatory requirements to use their own tests before they have received FDA approval. Under the new guidance, the laboratories had a grace period of 15 days after they began testing to submit the required documentation to the FDA.
"It changed everything," said a laboratory manager to the New Yorker. "We didn't have to wait to get the forms and then wait for the answer."
This decision opened the locks. The volume of coronavirus testing has grown exponentially in the past three weeks. Data from the COVID tracking project shows that the total number of US coronavirus tests increased from less than 1,000 on March 4 to almost 10,000 by March 12 and from more than 100,000 by March 19.
These numbers are far from sufficient to bring the corona virus under control. South Korea has tested 270,000 people with about 15 percent of the U.S. population. However, testing capacity in America has grown rapidly and we can expect further growth in the coming days and weeks.
On Wednesday, Abbott Labs announced FDA approval of its coronavirus test. The company said it had "immediately performed 150,000 laboratory tests" and plans to achieve one million tests a week before the end of March.
Another major medical test provider, Roche, announced on Monday that it plans to ship 400,000 test kits. "The test kits will be sent to a network of more than 30 hospital and reference laboratories in the United States that already have the necessary tools and are able to perform high volume tests immediately."
These are just two of many examples of US vendors working to increase coronavirus testing capacity. With their help, the United States will soon have far more coronavirus testing capabilities than today.
Why testing is important
Tests are not only important because they help individual patients understand their health and control their treatment – although this is obviously important. In an epidemic, tests are also critical to help public health officials effectively manage resources, control the spread of the virus, and ultimately enable people to return to normal life.
Until recently, health professionals and public health officials flew blindly. They were only able to test a small proportion of the patients who showed coronavirus-like symptoms, and therefore tended to reserve tests for patients who showed severe, potentially life-threatening symptoms. Other patients are usually told to go home and isolate themselves – without knowing whether they have the coronavirus.
This uncertainty makes it difficult to take precautions to prevent the virus from spreading further. If a patient can confirm that they have the coronavirus, they (or public health officials) can warn friends, family members, and other close contacts about a possible infection. Ideally, these people can also be tested. Without tests, health authorities don't know which cases to focus on.
And, ultimately, large-scale tests will allow public health efforts to be more focused and more Americans to return to normal life. That won't happen immediately, Johns Hopkins expert Josh Sharfstein told Ars. There are now so many coronavirus cases that additional weeks of extensive social detachment are required to control the outbreak.
However, because these measures are gradually taking effect and infection rates are falling, health authorities can use tests to precisely target further efforts to suppress them. Officials can identify areas where the coronavirus has been eradicated and people can safely resume normal activities. They identify other areas that remain coronavirus hotspots and require more public health resources. As infections become less common and numerous tests are carried out, officials can test close contacts of newly affected people, making it less likely that a single new coronavirus case will become a group of them.