The Washington Post - 13.03.2020

friday, march 13 , 2020. the washington post eZ su A

The coronavirus outbreak

BY MIKE DEBONIS, ERICA WERNER AND SEUNG MIN KIM

Concerns about the lagging
pace of coronavirus testing have
exploded into a major political
issue, w ith lawmakers o f both par-
ties angrily demanding m ore t ests
for A mericans a s President Trump
has insisted problems that have
hindered capacity are being ad-
dressed.
The issue dominated separate
briefings for members of the
House and Senate on Thursday,
emerged in the presidential race
and became a flash point at a
House Oversight and Reform
Committee hearing, where the
country’s top public health offi-
cials struggled to explain why
more Americans could not get
tested f or a global pandemic.
“The system is not geared to-
ward what we need right now,
what you are asking for,” Anthony
S. Fauci, an immunologist and the
head of the National Institute of
Allergy and Infectious Diseases at

the National Institutes of Health, said at the hearing. “That is a failing. Let’s admit it.” At the White House on Thurs- day, Trump responded to a ques- tion about the lack of test availability by claiming that “over the next few days, they’re going to have 4 million tests out.” “Frankly, the testing has been going very smooth,” he said. “If you g o to the r ight agency, i f you g o to the r ight a rea, you get the t est.” So far, in the United S tates, o nly about 11,000 people have been tested, according to figures shared with members of Congress on Thursday. According to statistics compiled by the American Enter- prise Institute, nationwide capacity to process the test kits being distributed has so far ramped up only to about 20,000 people per day — meaning it could be weeks before any tested patient gets results. Members of Trump’s party sounded alarms Thursday. After a Senate briefing with Fauci and other officials, Sen. James Lank-

ford (R-Okla.) acknowledged that Trump’s recent statement that anyone who wants to get tested can get tested is “not consistent right now” with what is actually happening. “We couldn’t get a good clear answer on w hen w e’re going t o get commercial testing out t here, l abs that can get faster responses and when we’re going to allow every person who wants to be tested to be able to be tested,” he said. Separately, Sen. Rick Scott (R- Fla.) took his complaints about testing directly to the White House in a conversation T hursday morning, according to an official familiar with the details who spoke on t he c ondition of a nonym- ity to speak freely. Later in the day, Scott an- nounced that he was self-quaran- tining after coming in contact with a member of a Brazilian delegation who tested positive for the disease, as did Sen. Lindsey O. Graham (R-S.C.), who was also in proximity to the Brazilian delegation. Graham said he was tested

and awaiting results. The uproar extended to the presidential campaign, where Democratic candidate Joe Biden called the Trump administration’s inability to quickly scale up testing a “colossal... failure of planning, leadership, and e xecution.” “Tests should be available to all who need them and the government should stop at nothing to make that happen,” h e said. The concern about testing has been at the center of the response to the crisis on Capitol Hill. An economic relief package intro- duced by Democrats late Wednes- day includes provisions providing for free t esting f or any patient w ho seeks one, and the White House has signaled openness to support- ing that language, according to two people familiar with the matter who spoke on the condition of anonymity to discuss pending ne- gotiations. But the concern about the cost of tests, which could stretch over $1,000 for the uninsured, was sec- ondary Thursday to the dismay of

the lack of test availability. Law- makers of b oth parties r eached f or the same touchstone — South Ko- rea, which has managed to treat hundreds of thousands of its people, allowing it to avoid the rapid spread seen in China, Italy and other countries. “South Korea is able to process tests in an hour, and in the U.S. it takes more than two days — that’s not adequate,” s aid Sen. Ben Sasse (R-Neb.), who c alled on o fficials to “get to the bottom of why those problems are there.” In South Korea, more than 10,000 per d ay a re tested. Both in the Oversight Commit- tee hearing and the closed-door congressional briefings, Fauci sought to address the disparity with the South Korea model — noting that the Asian nation has embraced a “drive-up” testing model where individuals do not need to seek the approval of doctors or public health officials to take a test. In t he U nited S tates, testing has been tightly rationed in the f ace of

a lack of t esting capacity and guidance from the Centers for Disease Control and Prevention. The government agency has asked clinicians to prioritize patients exhibiting symptoms of respiratory ill- ness who are in hospitals and nursing homes or belong to high- risk groups, such as the elderly and those with compromised im- mune systems. At the hearing with Fauci, Rob- ert Redfield, the CDC’s director, created confusion about whether the costs of tests will be covered for all Americans, including the uninsured. Initially he said yes to lawmakers’ questions, but at the end o f the h earing, Redfield took i t back, saying the administration “is currently examining all ave- nues” for the uninsured to afford tests and treatment. In the meantime, he recommended that they go t o community health centers. [email protected] [email protected] [email protected]

Jeff stein contributed to this report.

Testing lag ignites political uproar as Trump insists process is ‘very smooth’

was responding “with great speed and professionalism.” “Testing and t esting c apability a re expanding rapidly, day by day,” he said. “We are moving very quickly.” States determine who is eligible for public covid-19 testing in ac- cordance with CDC guidelines. In the e arly weeks of the outbreak, a s the C DC struggled to roll o ut tests, the agency strictly limited testing to those most likely to be infected and most in need of acute care. Even a person with a fever and a cough w ho had t raveled to a country with widespread community transmission — such as China, Iran or Italy — could not g et t ested unless they were sick e nough to be hospitalized. Amid mounting criticism, Vice President Pence declared last week that with a doctor’s orders, “any American can be tested.” Trump took that message a step further a fter a tour of the CDC l ast Friday, c alling the t ests “beautiful” and twice declaring anybody needing a test would get it. T he CDC l oosened its r ules, giving states and clinicians more dis- cretion. The number of medical profes- sionals and patients who are denied access to tests is not tracked nationally. But in interviews, people from states as varied as Wis- consin, North Carolina, Washing- ton, Indiana and New York said their doctors sought but were unable to get testing approval from local or state health officials. Coeytaux, a 56-year-old family doctor and professor at Wake For- est School of Medicine in Win- ston-Salem, N.C., c ame down with a fever, shortness of breath, a dry cough a nd a deep a che i n his lungs last Tuesday, he said. Two days later, he tested negative for flu and 15 other common respiratory viruses. He believed he was proba- bly infected with the new coronavirus. A county public health nurse agreed and called the state health department. She handed over her cellphone to Coeytaux, and he ex- plained his situation. “They wouldn’t t est me,” he said, because he didn’t meet the eligibility criteria. Coeytaux said he wanted to get tested not only to protect his own patients, but also to protect his partner, who is a registered nurse,

and her patients. Kelly Haight Connor, a spokeswoman f or the North Carolina De- partment of Health and Human Services, said the state is f ollowing CDC guidance and sent Web links to state documents that s eemed to offer conflicting descriptions of who would be eligible for testing. She did not respond to a request for c larification. “It’s very infuriating for us who work in this world,” said Amy Schabel, a public health worker in Milwaukee. “The messaging out there is c ompletely i naccurate and inconsistent with what’s happening.” Schabel, 32, returned last week from a vacation to Spain and northern Africa that included a trans-Mediterranean ferry ride with passengers who were notice- ably ill, she said. Over the week- end, she developed a high fever, difficulty breathing and other symptoms consistent with the virus, she said. On Monday morning, she went to an urgent-care center in down- town Milwaukee. Her flu test came back negative, and her doctor s aid he wanted her to get tested for c ovid-19. B ut after more than a half-hour of trying to reach city and state health officials to get approval, she said the doctor gave up. “Unfortunately, he wasn’t able to get a response from them,” s he said Tuesday, sick and self-quar- antined in her home. By Wednesday, her condition had deteriorated. She went back to the urgent-care center, and this time, she was able to get a test. It would take at least 24 hours to get a result, s he was told, and still w as waiting a s of midday Thursday. A spokeswoman for the Wis- consin Department of Health Ser- vices called the situation “unfortu- nate.” On the same day Schabel was turned away, the state in- structed doctors they no longer needed government approval to order tests, Jennifer Miller said. A spokesman for the hospital did not respond to requests for comment.

Increasing pressure on labs Experts say public health laboratories are generally not de- signed to do high-volume testing. Commercial and a cademic labora-

tories — which can test people who don’t meet CDC criteria — have begun processing samples only in the past few days and are still ramping up their capacity. The federal government does not have a way to count the tests that those labs are running, which means federal officials do not know how many Americans have been tested. Limited testing in the early days of disease transmission not only increases the risk of the disease being spread by people who don’t realize they have it, but also affects the ability of public health officials and h ospitals t o plan for a prolonged outbreak. “It’s difficult to predict the im- pact on the health-care system in the coming month because we don’t h ave any precision about t he burden of disease around the country,” s aid To m Inglesby, director o f the C enter for H ealth Securi- ty of the Johns Hopkins Bloomberg School of Public Health. “We’ve got to close that gap a s quickly as we can.” It i s not just positive r esults that matter, but negative results, too. The negatives help researchers understand whether increasing numbers of covid-19 cases are a result of an epidemic or arise sim- ply b ecause t esting expanded. “When we monitor the flu, one of the indicators is the proportion of people who test positive versus negative. T hat positive proportion gives a very important number in terms of tracking how the e pidemic is moving,” said Justin Lessler, an associate professor of epidemiology at Johns Hopkins and lead writer on a recent study estimat- ing the incubation period of the coronavirus. Administration officials have tried to reassure the public they’re rapidly expanding access to tests. Last Friday officials said they had shipped 1.1 million tests to labs across the c ountry. But nationwide, as of Wednes- day, the nation’s public health, ac- ademic and commercial laboratories had t he ability t o process only about 16,530 patients per day, according to an estimate compiled by former Food and Drug Admin- istration commissioner Scott Got- tlieb and researchers at t he A meri- can Enterprise Institute. That fig- ure is growing as labs bolster ef-

forts and is expected to reach 20,000 per day by the end of the week, a ccording t o Gottlieb. In the meantime, some large research hospitals are trying to bypass t he bureaucratic logjam. “Our access to testing was en- tirely based on what the state would allow,” said Daniel Varga, chief physician executive at Hack- ensack Meridian Health in northern New Jersey. Researchers at the hospital be- gan developing an in-house test several weeks ago. The hospital planned to start using it this week. Varga estimated that “a hand- ful” of patients exhibiting signs of the virus had been turned down for testing by the state because they did not m eet the criteria. In I ndiana, an emergency-room doctor at a community hospital said she had tried to get three patients tested, two of those after the C DC liberalized its guidelines. Both patients had flu-like symptoms and CT scans that showed lung problems consistent with covid-19, and both were in severe enough distress that they needed to be admitted to the hospital. B oth also tested n egative f or a panel of 20 common respiratory viruses. But neither had a history of travel or been in contact with a confirmed infected person. In the two cases after the loosened guidelines, when the d octor called the state health department to request testing, the request still was denied. “ Since I watched all three cases get denied, it made m e realize that they weren’t testing anyone,” s aid the doctor, who spoke on the condition of anonymity because she did not have permission from her employer to speak to a reporter.

Sick and chasing a test In early March, Marcy Klein of New Rochelle, N.Y., came down with a fever and a dry cough, just as a coronavirus cluster trans- formed her Westchester County town into the nation’s first con- tainment zone. A week later, still hacking and taking Ty lenol to keep her t emper- ature down, she sought a test for the coronavirus. Though her symptoms were mild, the 6 4-year-old worried about her husband, a 71-year-old physician

BY SHAWN BOBURG, EMMA BROWN, DEREK HAWKINS AND AMY GOLDSTEIN

Many Americans who are sick
and seeking a coronavirus test
continue to be turned away, creat-
ing a vexing problem for patients
and health officials as the virus
spreads. The problem persists,
doctors and patients across the
country say, despite increased
production a nd d istribution o f the
tests in recent days.
At a time when U.S. fatalities
from the virus have risen, there
remain limited numbers of tests
and the capacity of laboratories is
under strain.
The constraints are squeezing
out patients who don’t meet rigid
government eligibility criteria,
even if their doctors want them
tested, according to dozens of in-
terviews with doctors and pa-
tients this week.
The gap between r eal-life obsta-
cles to testing and President
Trump’s s weeping a ssurances that
“anybody that needs a test gets a
test” has sown frustration, uncer-
tainty and anxiety among p atients
who have symptoms consistent
with covid-19, the disease caused
by the virus, but h ave been unable
to find out whether they are in-
fected.
“It’s really been unbelievably
infuriating,” s aid Remy Coeytaux,
a North Carolina physician with a
doctorate in epidemiology who
tried to get tested for covid-19 but
was turned down by the state pub-
lic health department. He had not
traveled abroad, was not sick
enough to be h ospitalized and had
no known contact with an infect-
ed person.
At the time Coeytaux tried to
get tested, t here was only one con-
firmed case of covid-19 i n the s tate.
“It’s out there,” he said. “But we
just haven’t been testing.”
The federal government’s han-
dling of testing erupted as a politi-
cal issue Thursday, with even
members of the president’s party
venting about not b eing able to get
answers on when the nation
would see more commercial tests,
faster testing and more widely
available t ests.
Sen. James Lankford (R-Okla.)
acknowledged that Trump’s re-
cent statement a bout tests for any-
one who wants them is “not con-
sistent right now” with what is
actually happening.
A s of Thursday evening, more
than 1,600 people were infected in
the United States, and more than
40 had died, according to re-
searchers at Johns Hopkins Uni-
versity.
Since mid-January, the Centers
for Disease Control and Preven-
tion and other public health labo-
ratories have tested about 11,
specimens for the disease. The
number of people who have been
tested is likely far lower than that
tally, however, because l abs usual-
ly test at least two specimens per
person, experts said. In contrast,
South Korea has been running
10,000 tests per day.
“The system is not really geared
to what we need right now, to what
you are asking for. That is a fail-
ing,” Anthony S. Fauci, director of
the National Institute of Allergy
and Infectious Diseases and a
member of Trump’s coronavirus
task force, said Thursday, testify-
ing before the House Oversight
Committee. “The idea of anybody
getting it easily the way people in
other countries are doing it, we’re
not set up for that. Do I think we
should b e? Yes.”
In an address from the Oval
Office on Wednesday evening,
Trump said his administration

with diabetes. O n Wednesday, a hospital nurse told her she didn’t meet the testing criteria: She hadn’t traveled outside the country recently and she hadn’t had a ny k nown c ontact with someone who tested positive. T he uncertainty has left Klein feeling paralyzed. “ I don’t want to feel like I’m giving the virus to anybody,” she said.” A spokeswoman from Westchester County declined to comment on Klein’s e xperience. A spokeswoman for M ontefiore Health System, Laura Ruocco, said the hospital has had t o prioritize patients given the limited access to testing. In Washington, D.C., doctors re- peatedly d eclined t o test a woman who got sick after spending three days with a delegation visiting from her company’s home office i n northern Italy. “I realize health care is an im- perfect process, but this is just kind of ridiculous,” said David Johnson, w hose wife has been sick for 1 ½ w eeks with s ymptoms akin to covid-19. H e spoke on the condition that his wife, an Italian living in Wash- ington, not be identified to avoid complicating her application f or a green card. On March 2, days after t he visit, his wife came down with a fever, body aches, congestion and a cough. Since then, she has gone three t imes to an emergency room at MedStar Georgetown Universi- ty Hospital. She has been unable to persuade anyone there to test her for the virus because she had not traveled to Italy and could not confirm she had been in close contact with anyone who had tested positive, her husband said — though she later learned that an unidentified person from the home office had. She tested positive for a trace amount of the H1N1 virus — a form of flu. But when the couple asked whether that meant she could not have covid-19, they said they did not g et a n answer. To ld of the w oman’s attempts, a MedStar Georgetown spokeswoman, Debbie Asrate, said Thursday that the facility “has been working closely” with the CDC and the District’s health department and following their guidelines. In the District, people can be te sted by the public health laboratory when they are showing symptoms and have a known exposure to a laboratory-confirmed case of covid-19, or have t raveled to one of several countries with widespread transmission, o r are living i n long- term care facilities, said D.C. Health Director LaQuandra Nes- bitt at a news conference Wednes- day. She said health-care provid- ers can get other people tested by sending t heir samples t o commercial labs. “From an epidemiological risk perspective, she absolutely should have been tested,” said Jeanne Marrazzo, director of the Division of Infectious Diseases at the Uni- versity of Alabama at Birming- ham. “She was in close contact with visitors from the e picenter of the e pidemic.” O n Wednesday, 10 days after she fell ill, she was finally able to get tested at a D.C. urgent-care clinic. She was told it would take about four days to learn the results. [email protected] [email protected] [email protected] [email protected]

andrew Ba tr an and Fenit nirappil contributed to this report.

After Trump’s assurances, frustration grows over real-life obstacles to testing

Kena Betancur/agence France-Presse/getty Images A Hackensack Meridian Health researcher in New Jersey works to develop an in-house test for the novel coronavirus on Feb. 2 8.

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The Washington Post - 13.03.2020

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