Intended for healthcare professionals


Covid-19: US governors call for government help to secure more tests

BMJ 2020; 369 doi: (Published 21 April 2020) Cite this as: BMJ 2020;369:m1585

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  1. Janice Hopkins Tanne
  1. New York, USA

US governors have called on the federal government to help them get more covid-19 testing kits as well as personal protective equipment for healthcare workers after complaining that they were competing with each other and with the federal government to buy supplies in international markets.

President Donald Trump said at his press conference on 20 April that the states had enough tests but they just weren’t using them. He complained in a tweet that governors were asking for help when it was up to the states to take charge of testing.1

Experts said the US needed to greatly increase its testing capacity. A panel of economists, social scientists, lawyers, and ethicists said the US needed to conduct 20 million tests per day before the economy could fully re-open. The US has conducted 3.7 million tests to date, about 120 000 tests daily.2

On 20 April Larry Hogan, the Republican governor of Maryland, announced that he had bought 500 000 covid-19 test kits from South Korea, enlisting the translating help of his wife Yumi, a Korean immigrant.

The governors said the tests were needed to diagnose covid-19 infections and to identify people who had antibodies to the virus, indicating that they had previously been infected, to help gauge the true number infected and the fatality rate.

A preprint of a study from Stanford University suggested that the actual number of covid-19 infections might be far greater than the reported number of cases.3 The study, which was not peer reviewed, tested a 3000 person representative sample of nearly two million residents of Santa Clara county in California.

The researchers said, “The most important implication is that the number of infections is much greater than the reported number of cases. Our data imply that, by 2 April (three days before the end of our survey) between 48 000 and 81 000 people had been infected in Santa Clara County. The reported number of confirmed positive cases in the county on 1 April was 959, 50 to 85 fold lower than the number of infections predicted by this study.”

New York State governor Andrew Cuomo said that this week his state was beginning a statewide seroprevalence study to assess the proportion of people previously infected with covid-19. Laboratory confirmed cases represent only a fraction of the total number of covid-19 cases in the population. An unknown number are mild or asymptomatic, and not everyone seeks medical care even if symptomatic, a health department spokesman said.

The test will use a fingerstick blood sample from 3000 people from geographic locations around the state, a representative sample of the state’s 19.5 million inhabitants. Patrons of grocery stores at various locations will be recruited. The samples will be tested at the state’s Wadsworth Public Health Laboratory in Albany using its IgG immunologic test with results available two to three days later.

The tests are needed before states can move toward Trump’s plan to reopen the economy. This calls for states to report steadily declining rates of infections, cases, and positive tests for two weeks. The states must also treat all patients with flu like and covid-19 like symptoms and have a test programme for at risk healthcare workers, including an antibody test.4

No state has met that goal, although the president has contradicted his own advice and supported protesters who have demanded an end to the lockdowns and restrictions. He said the decision to reopen was up to state governors.

The governor of Georgia, Republican Brian Kemp, announced on 20 April that his state would allow gyms, barbershops, hair and nail salons, bowling alleys, tattoo parlours, and massage therapy locations to reopen, perhaps as early as this Friday. Bars and nightclubs were to remain closed.

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