Intended for healthcare professionals


Covid-19: US testing ramps up as early response draws harsh criticism

BMJ 2020; 368 doi: (Published 23 March 2020) Cite this as: BMJ 2020;368:m1167

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  1. Owen Dyer, freelance journalist
  1. Montreal, Canada

Daily testing for coronavirus infection in the United States is finally approaching levels seen in other developed countries. This follows nearly two months in which tests were difficult to obtain even with a doctor's request.

The US detected its first person with covid-19 on 12 January. Yet by 25 February, according to Centers for Disease Control and Prevention (CDC) data, only 426 tests had been conducted across the country. By 9 March, the total was 8554, fewer tests than South Korea was then doing each day.

The CDC opted to create its own test, but a design flaw rendered 160 000 tests the agency sent out all but unusable, and until this month the government enforced stringent approval requirements that prevented private and foreign providers stepping in to fill the gap.

This week multiple providers began testing, including at the first drive-through sites. By the evening of 22 March the number of tests had surged past 235 000, more than 80% of them carried out in the past seven days. But the country faces a severe shortage of masks and gloves, and many hospitals have already run through their supplies.

Confused advice

Trump has adopted a new tone in recent days, after his administration was alarmed by the Imperial College report that drove a change of policy in the UK. It projected 510 000 deaths in Britain and 2.2 million in the US if governments took no social distancing methods.1

But Trump and his allies have struggled to distance themselves from previous comments downplaying the risk.2 Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who is widely seen as the government’s most trustworthy and apolitical spokesperson on covid-19, was telling Americans to “avoid eating and drinking at bars, restaurants, and public food courts.” But one of Trump’s closest allies in Congress, Republican Devin Nunes of California, told Fox News: “It’s a great time to go out and go to a local restaurant. Likely you can get in easy … Go to your local pub.”

Nunes later claimed he had been referring to takeout and drive-through restaurants. The Republican governor of Oklahoma, Kevin Stitt, tweeted a photo of his family at a crowded restaurant, saying that he “encourages Oklahomans to do the same.” The tweet was deleted after Trump changed course.

Sean Hannity, anchor of the country’s most watched news opinion show, said on 10 March: “They’re scaring the living hell out of people, and I see it again as like, ‘Oh, let’s bludgeon Trump with this new hoax.’”

Nine days later on his Fox News show, he said: “This programme has always taken the coronavirus seriously and we’ve never called the virus a hoax.”

Fox News medical correspondent Marc Siegel, a physician, said on 6 March: “At worst—worst case scenario—it could be the flu.”

The result has been a marked partisan split in perceptions of the risk, with Democratic voters far more concerned and willing to practise social distancing. A poll from National Public Radio, PBS NewsHour, and Marist found last week that the number of Republicans who believe the virus is a real threat has fallen over the past month, from 72% in February to just 40% now.3

This has been reflected in the patchwork of local regulations and advice. Gavin Newsom, California’s Democratic governor, ordered the state’s 40 million citizens to stay home on 20 March, the country’s strictest measure yet. But in Utah, the Republican governor Gary Herbert ordered health officials in two counties to rescind orders banning groups of more than 10.

The disease is now in all 50 states, with New York, Washington, and California the hardest hit. “We’re about to be overwhelmed,” said Los Angeles mayor, Eric Garcetti, on 20 March, “which means people won’t get into our hospitals; people who don’t just have covid-19 could lose their lives.”

Many younger adults in hospital

A CDC report found that although deaths are so far concentrated in people aged over 65, more young and middle aged adults than in China are requiring hospital treatment.4 Only 53% of people with covid-19 in intensive care units and 45% of those admitted to hospital are aged 65 and older. Patients younger than 55 account for 38% of admissions. This correlates with anecdotal reports last week from France’s health ministry and a Netherlands seminar of intensive care specialists, which also reported a younger profile of severely ill patients.

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