By Dr. Dave Campbell
Morning Joe Chief Medical Correspondent
The United States is behind the 8-ball in the novel coronavirus outbreak spreading across the country. Other countries were quicker to test massive numbers of their citizens utilizing World Health Organization (WHO) test guidelines. The Centers for Disease Control and Prevention (CDC) made the decision early-on to strike a path of their own and develop more comprehensive and broad-reaching tests to identify a range of viruses similar-to the novel coronavirus responsible for the disease COVID-19. The crux of the problem facing the United States today, as community spread progresses and deaths mount is the test chosen by the CDC did not work as expected and caused a delay in “surveillance testing”, so the public health experts could not identify those infected and track their contacts with other people, thus preventing community spread.
The leading world’s expert in this soon to be pandemic, Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases in the National Institutes of Health (NIH) said Monday March 2 on CNN, “My concern is as the next week or two or three go by, we’re going to see a lot more community-related cases. That’s of great concern.” His prescient words speak to the importance of the testing delay in the United States.
The Trump administration has faced criticism for its slow response to the outbreak and the delay in delivering test kits to states. This delay has slowed the detection and isolation process which is essential to controlling the spread of the disease.
The novel coronavirus had infected 79,929 people in China as of March 2nd, and that number rises every day. The number of people in the United States with COVID-19 well-exceeds 100 and grows daily as well.
The WHO reported on Tuesday March 3 the mortality rate worldwide is greater than previous estimates. Dr. Tedros Adhanom Ghebreyeses, the director-general said, “Globally, about 3.4 percent of reported COVID-19 cases have died. By comparison, seasonal flu generally kills far fewer than 1 percent of those infected.”
WHO reported on data from 56,000 patients and found COVID-19 to cause mild symptoms in 80 percent, severe symptoms in 14 percent and critical illness in 6 percent. With the upward estimates for lethality, and increasing community spread in the United States, putting the disease in context is warranted. Every year about 1 billion people across the globe are infected with the influenza virus and ‘catch the flu’. On any given year, between 290,000 and 650,000 people die of the flu.
To show that it is aggressively moving to fight the spread of the disease, the Administration vowed Tuesday that any American can be tested for the virus if a doctor believes it is necessary.
“We’re issuing clear guidance that subject to doctors’ orders, any American can be tested,” Vice-President Mike Pence said. Food and Drug Administration (FDA) commissioner Stephen Hahn’s committed to having over 1 million test kits available by the end of the week. But Democratic Senators are not so sure that that timetable is accurate.
At a closed door lunch Tuesday afternoon on Capitol Hill, Commissioner Hahn was questioned by Senator Chris Murphy of Connecticut. “Tell us why you think by Friday,” Senator Murphy said. “We will have 1 million tests when we have only had 3,000?” Senators Patty Murray and Maria Cantwell, both of Washington State highlighted the importance of making new tests available. They pointed out that people are calling their doctors and are unable to be tested. They were adamant that this situation must be more focused and more transparent. Patients need to know the process to get tested and that tests will be there for them.
This week in South Florida, two local infectious disease specialists said they have concerns about access to novel coronavirus testing for their patients.
“If the test had been put out before there were actual cases, everyone would want to be tested,” Dan Peters, M.D. said. “They may have falsely identified cases leading to a media frenzy and mass hysteria.” Dr. Peters has already seen two patients without COVID-19 where there was overreaction. One tested positive for the common cold but had traveled to a non-endemic region of Europe. The other was an elderly patient with aspiration pneumonia with no risk factors for COVID-19, but radiology reports were “read aggressively”.
“The flu is still the number one respiratory infection we are watching for,” Leslie Diaz, M.D. said. “When a patient presents to our office with viral-like illness, they have a mask placed on them and are isolated in a designated room. The test for the flu is quick, takes only about 20 minutes. We have been told by our health department to send patients to the emergency department rather than to them.”
“The coronavirus test kits are only available in state labs,” Dr. Diaz said. “But, if offices have “Viral Transport Media” test tubes, which are supplied to me by Quest, these can be used to send them what they want. They want two swabs. One nasal swab and one from the oropharynx-the back of the throat.”
As reported by Heidi Przybyla for NBC News, Dr. Matt McCarthy of New York Presbyterian Hospital said, “We are not testing at full capacity and that is a national scandal. We’re being told that things are ok…That’s just not the way we’re talking about it in medical circles.”
To help speed testing for the virus, the FDA announced last month that 46 state public health labs in addition to the CDC are now doing testing. The recent White House and FDA pronouncements are optimistic.
On Wednesday, it was announced after bipartisan congressional negotiations that an agreement was reached on an $8 billion spending bill to combat the virus. The next day, the bill based both the House and Senate and is heading to President Trump’s desk where he is expected to sign it.
NBC News reports the bill includes $7.8 billion to engage the battle against COVID-19. The entire bill is $8.3 billion and includes funding for a remote health care program; CDC funding for prevention, preparedness and response; a public health emergency fund; National Institutes of Health (NIH) for research and development of vaccines, testing and treatment; and funds to protect the health of Americans in foreign countries.
The bill more than triples the spending package presented by the White House last week which was criticized by lawmakers from both parties as being inadequate to combat COVID-19.
Treatment for those infected with the novel coronavirus that develop COVID-19 remains supportive. Dr. Fauci has stated a vaccine is not likely to be available for a year or year and a half. There is at least one anti-viral medication under investigation called remdesivir and hopefully more will follow. It is still recommended that people get flu shots for the seasonal flu. It is also recommended that basic precautions to prevent the spread of infection are practiced by everyone, everywhere. Wash your hands, don’t go to work or school sick, and be aware.
As more testing becomes available, it is helpful to recognize the signs and symptoms of COVID-19. Ranging between a few days and a few weeks after exposure to the virus, those who become infected develop a fever. The elevated temperature may be followed by a dry cough. For those who develop a severe infection, shortness of breath and organ problems may develop.
As COVID-19 spreads through the United States and the world, vigilance is paramount. Monitor cdc.gov for updates. If symptoms develop, avoid transmitting the illness to others while seeking the advice of a healthcare provider. While the many unknowns can be frightening, by working together as a community, we will get through this.