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As coronavirus testing expands, a new problem arises: Not enough people to test

  
Via:  Nerm_L  •  4 years ago  •  21 comments

By:   Steve Thompson, Juliet Eilperin, Brady Dennis (MSN)

As coronavirus testing expands, a new problem arises: Not enough people to test
While some states still face supply shortages, many others are grappling with the challenge of persuading people to get tested.

Sponsored by group News Viners

News Viners


Independent experts have expressed an urgent need for more testing.  The general public hasn't agreed.  What we are seeing is a failure of central planning.

Now governors, like Andrew Cuomo, are trying sell tests since the capacity has become available.  No doubt we will be treated to political carny barkers hawking tests of questionable value.  The nasal swab test doesn't provide useful information.  A negative result means the individual must be repeatedly tested.  And a positive result leads to government enforced punitive measures.

The independent experts have set the wheels in motion without any risk of being held accountable for their demands.  The country has built and is continuing to build capacity for nasal swab testing; based on the science, of course.  But none of the experts have explained the science of testing or its value.  What will testing accomplish?  Why is testing important?  What do the test results really mean?  How will jamming a Q-Tip up their nose help people deal with the pandemic?

Being infected or not doesn't change the need for food, the need for supplies, or the need to pay bills.  And a positive test result could force someone to be hospitalized and face medical bankruptcy for themselves and their family.  The truly sick will die alone and the children of the dead must pay the medical bills regardless of the outcome.  The independent experts aren't at risk. 

No doubt the independent experts are quietly advocating mandatory testing behind closed doors.  The experts must be correct; it's the public that's too stupid to act in their own best interest.  The general public are not experts; they're uneducated hicks who are deplorable.  Squeeze out every nickel possible from those turnips.  It's for their own good.


S E E D E D   C O N T E N T



Four months into the U.S. coronavirus outbreak, tests for the virus finally are becoming widely available, a crucial step toward lifting stay-at-home orders and safely returning to normal life. But while many states no longer report crippling supply shortages, a new problem has emerged: too few people lining up to get tested.

A Washington Post survey of governors' offices and state health departments found at least a dozen states where testing capacity outstrips the supply of patients. Many have scrambled to make testing more convenient, especially for vulnerable communities, by setting up pop-up sites and developing apps that help assess symptoms, find free test sites and deliver quick results.

But the numbers, while rising, are well short of capacity — and far short of targets set by independent experts. Utah, for example, is conducting about 3,500 tests a day, a little more than a third of its 9,000-test maximum capacity, and health officials have erected highway billboards begging drivers to "GET TESTED FOR COVID-19."

Why aren't more people showing up? "Well, that's the million-dollar question," said Utah Health Department spokesman Tom Hudachko. "It could be simply that people don't want to be tested. It could be that people feel like they don't need to be tested. It could be that people are so mildly symptomatic that they're just not concerned that having a positive lab result would actually change their course in any meaningful way."

Experts say several factors may be preventing more people from seeking tests, including a lingering sense of scarcity, a lack of access in rural and underserved communities, concerns about cost, and skepticism about testing operations.

"We know there's a lack of trust in the African American community with the medical profession," said Ala Stanford, a pediatric surgeon in Philadelphia who started a group to provide free testing in low-income and minority communities, which have been hit particularly hard by the virus. The effort, which offers testing in church parking lots, has serviced more than 3,000 people in recent weeks.

"You've got to meet people where they are," Stanford said.

Another major hurdle: lingering confusion about who qualifies. In the earliest days of the outbreak, Americans were told that only the sickest and most vulnerable should get tested while others should stay home. Last month, the Centers for Disease Control and Prevention relaxed its guidelines to offer tests to people without symptoms who are referred by local health departments or clinicians.

Some states have since relaxed their testing criteria dramatically. Georgia Gov. Brian Kemp (R) has encouraged "all Georgians, even if they are not experiencing symptoms, to schedule an appointment." And Oklahoma Gov. Kevin Stitt (R) urged residents earlier this month to "call 2-1-1 and find a location close to you, even if you don't have symptoms and you're just curious."

Elsewhere, officials scarred by shortages have been hesitant to follow suit.

"A lot of states put in very, very restrictive testing policies . . . because they didn't have any tests. And they've either not relaxed those, or the word is not getting out," said Ashish Jha, who directs the Harvard Global Health Institute. "We want to be at a point where everybody who has mild symptoms is tested. That is critical. That is still not happening in a lot of places."

According to the COVID Tracking Project, the nation is currently testing about 330,000 people a day, a rate that, if sustained, would cover about 3 percent of the population a month. That's double last month's average, achieving a goal set by the White House, but still far short of the number most independent analysts say will be needed to avoid another wave of death and illness in the months ahead.

Last week, Jha and other Harvard researchers estimated that the United States should be testing at least 900,000 people a day, or about 8 percent of the population per month. At that rate, they say, local officials would get a clear sense of the spread of the virus, would be able to detect clusters of infection in the early stages and could move to isolate people who test positive or have been exposed, a process known as contact tracing.

A White House estimate, obtained by The Post, shows the nation has sufficient lab capacity to process at least 400,000 tests per day, and potentially many more. But in surveying the states, The Post found that few are testing at full capacity. In 20 states that provided detailed information, the number of tests performed was roughly 235,000 per day lower than their technical capacity, with the biggest gaps in California and New Jersey.

Lab capacity remains untapped for many reasons, including lingering supply shortages. While most states say they are now able to test people in hospitals, nursing homes, prisons and other front-line settings, many continue to be hampered by a lack of personal protective equipment (PPE), nasal swabs and reagents, the chemicals necessary to process tests.

California, for example, has sufficient lab capacity to conduct nearly 100,000 tests a day, but is averaging fewer than 40,000. At a news conference last week, Gov. Gavin Newsom (D) cited continuing "supply-chain constraints."

And in Chicago, a major chain of urgent-care clinics temporarily halted mobile testing last week when it ran out of test kits. "[W]e are currently unable to test for COVID-19 in Illinois," said a message posted Sunday on the website of Physicians Immediate Care, adding that the chain hopes to resume testing Monday.

As states trying to encourage people to return to normal life ramp up testing, experts worry that widespread shortages could return.

"Right now, in some locations in this country, they don't have adequate testing to test all symptomatic patients," said Angela M. Caliendo, a board member of the Infectious Diseases Society of America and vice chair in the Department of Medicine at Alpert Medical School of Brown University. "So when you open up and you start testing people that are asymptomatic, you're going to put a lot of pressure on the supply chain."

The federal government is working to remedy the problem, including by investing $75.5 million through the Defense Production Act to increase swab production. The Food and Drug Administration has eased regulations to permit use of swabs made from polyester in addition to nylon and foam, and the Trump administration has pledged to supply 12.9 million swabs directly to states this month, a promise many governors are banking on.

Last week, President Trump announced that the federal government will distribute $11 billion to help states get additional supplies, part of a $25 billion testing budget approved by Congress.

"I said from the beginning that the federal government would back up the states and help them build their testing capability and capacities, and that's exactly what's happened," he said.

But reagents remain a problem. In the District, health officials have access to a public health lab, a research lab and six hospital labs, which together have the capacity to process at least 3,700 tests per day, said LaQuandra Nesbitt, director of the D.C. Department of Health. But reagents must match the labs' testing machines; in recent weeks, the labs have managed to purchase only enough to conduct 1,500 tests per day.

Still, even that supply has outstripped demand, with only about 1,000 D.C. residents seeking tests each day. In late April, the city expanded its guidelines to permit grocery store clerks and other critical workers to get tested regardless of whether they have symptoms. Further changes prioritized people over 65 and with underlying health conditions. Meanwhile, former first lady Michelle Obama has urged people in robocalls to take advantage of the free service.

Testing has been similarly slow to ramp up in Virginia, where guidelines posted on the state's website limited testing mostly to people with symptoms who were hospitalized, living in communal settings or working as health-care providers.

Hilary Adams, a 28-year-old Web coordinator for the American Society of Clinical Oncology, said her doctor refused to order a test in late April even though she had a sore throat and headache, suffers from asthma and lives with her father, who had tested positive. She was told to stay home and quarantine.

"Just living with that level of uncertainty and anxiety was really, really stressful," Adams said.

After being criticized for low testing rates, Virginia officials posted relaxed guidelines on May 5. That day, Adams's doctor finally ordered a test — which came back negative. Virginia has since reported an increase in testing from about 4,000 per day to nearly 7,000.

"We've said from the very beginning that we needed more PPE. We have that now. Then we said we needed more testing supplies. We have that now," said former Virginia health commissioner Karen Remley, who co-directs a testing task force appointed by Gov. Ralph Northam (D). "Now we're working on education and bringing people to the table."

A national strategy could make that effort more effective, said Danielle Allen, director of Harvard's Edmond J. Safra Center for Ethics, which last week published a $74 billion road map that calls for 24-hour contact tracing and isolation facilities for people who test positive. Although many states are building those services, the patchwork approach means scarce resources may not be efficiently deployed.

For example, inviting anyone to get tested, rather than focusing on hot spots or areas of high vulnerability, is "not going to be that valuable," said Jan Malcolm, the health commissioner in Minnesota, where policymakers are building toward 20,000 tests per day and considering hiring more than 4,000 contact tracers.

Kentucky illustrates the transition many states are making. In the first few months of the pandemic, the state had major shortages of testing materials and had to send many samples out of state for processing. Then in March, Gov. Andy Beshear (D) tapped a pair of local lab companies to scale up operations.

Gravity Diagnostics, a 140-person firm in Covington, blew out a wall to expand its main lab and hired 15 more people. It has processed nearly 40 percent of all tests in the state, as well as tests conducted at Kroger mobile health clinics across the nation.

By last week, Beshear said Kentucky had secured all the components needed to further ramp up testing, including a significant supply of swabs from the federal government. With businesses starting to reopen, Beshear is urging everyone to get tested. The state recorded an average of 5,700 tests a day over the past week, a sharp uptick.

"We can provide all the capacity in the world," Beshear said. "You've got to show up and take a test."

The story is similar elsewhere. In Wisconsin, officials last week listed a daily capacity of 13,400 tests, spread across 52 labs. But daily reported tests have averaged only about 4,800. To bump up the numbers, Gov. Tony Evers (D) has ordered the National Guard to set up mobile testing sites and told doctors to test anyone with symptoms.

In Florida, tests are averaging about half the statewide capacity of 30,000 per day. Jared Moskowitz, director of Florida's Division of Emergency Management, said the state has opened sites to improve access, including one outside Hard Rock Stadium in Miami Gardens, where he spoke at a news conference this month. Still, Moskowitz acknowledged that "less and less people are coming to these sites, and we've seen that decline in the numbers."

And in Arizona, 5,400 people turned out for a Saturday "testing blitz" held May 2 in dozens of community locations for people with symptoms or who think they have had contact with the virus. Health officials had been hoping for 10,000, and have since extended the blitz to every Saturday in May.

Although Massachusetts has tested nearly 6 percent of its population — one of the highest rates in the nation — even Gov. Charlie Baker (R) has been frustrated by a lack of interest in testing. Earlier this month, Baker chastised Bay State residents for refusing tests even in highly vulnerable settings such as nursing homes.

"There's some people who, for whatever reason, don't want to be tested," Baker told reporters. "And we're just going to have to find a way to work through that."

Jenna Portnoy and Chris Mooney contributed to this report.


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Nerm_L
Professor Expert
1  seeder  Nerm_L    4 years ago

Once again, the independent experts have screwed someone else's pooch.  Now it's time to place the blame on the stupid public.

 
 
 
Vic Eldred
Professor Principal
2  Vic Eldred    4 years ago

What I love about testing the people without any symptoms is that 5 minutes after they have been declared "negative" they can go grab some mail that somebody sneezed on and all of a sudden they are infected. 326.7 Million people that we know of, reside in the US. How many test kits would we need to produce for random on demand testing?  

 
 
 
Nerm_L
Professor Expert
2.1  seeder  Nerm_L  replied to  Vic Eldred @2    4 years ago

But the independent experts haven't explained that.  President Trump had to explain the flaw in the testing to the public, in his typically obtuse manner.

Politicians have made a big deal about making decisions according to the science.  But the science of the nasal swab test shows that it's the wrong type of test for what is being expected.  The test doesn't have any value unless someone is exhibiting symptoms.  The odd aspect of the testing is that an individual exhibiting symptoms but tests negative for SARS-CoV-2 virus can be treated.  It's the symptomatic individuals who test positive that can't be treated.

 
 
 
Vic Eldred
Professor Principal
2.1.1  Vic Eldred  replied to  Nerm_L @2.1    4 years ago

So the experts have yet to earn their pay?

 
 
 
Nerm_L
Professor Expert
2.1.2  seeder  Nerm_L  replied to  Vic Eldred @2.1.1    4 years ago
So the experts have yet to earn their pay?

Not in the way people think.  President Joe and President O have certainly embraced the advice of independent experts.  Andy Cuomo carefully informed the public (and voters) that his decision making has been guided by the advice of independent experts.  But those independent experts never assume responsibility for the advice they give; there is always uncertainty, after all.

It's a marvelous circle jerk tailor made for politics.

 
 
 
Vic Eldred
Professor Principal
2.1.3  Vic Eldred  replied to  Nerm_L @2.1.2    4 years ago

Remember this:

Fauci said the goal now is to "blunt" the curve of confirmed cases, keeping the number of those infected low enough so as to not overwhelm the U.S. hospital system.




We prevented that but we were told to stay closed!!!

 
 
 
Nerm_L
Professor Expert
2.1.5  seeder  Nerm_L  replied to  Have Opinion Will Travel @2.1.4    4 years ago
Could you do me a favor and help me understand the comment about the person who is symptomatic and tests positive that can’t be treated.

There isn't any treatment for COVID-19.  There aren't any magic pills or wonder drugs to treat COVID-19.  The regimen for COVID-19 is to keep the patient alive and hope their immune system defeats the virus.

If someone exhibits symptoms but tests negative for SARS-CoV-2 virus then they likely have the flu (or another known disease).  COVID-19 and flu share several symptoms.  And we do have magic pills and wonder drugs to treat the flu.  

So, someone exhibiting symptoms who test negative can be treated while those who test positive cannot be treated.

 
 
 
Split Personality
Professor Guide
2.1.6  Split Personality  replied to  Nerm_L @2.1    4 years ago
The test doesn't have any value unless someone is exhibiting symptoms. 

The test only identities carriers and those who already had the virus and have antibodies or are actively sick.

The odd aspect of the testing is that an individual exhibiting symptoms but tests negative for SARS-CoV-2 virus can be treated.  It's the symptomatic individuals who test positive that can't be treated.

Sounds backwards.

Everyone in my neck of the woods that feels sick and tests positive is admitted to the hospital without exception.

 
 
 
Nerm_L
Professor Expert
2.1.7  seeder  Nerm_L  replied to  Split Personality @2.1.6    4 years ago
The test only identities carriers and those who already had the virus and have antibodies or are actively sick.

The nasal swab test only provides a positive result if the SARS-CoV-2 virus is present; positive for an active infection.  A negative result doesn't indicate whether the individual has not been infected or the individual has developed immunity and cleared the virus. 

A nasal swab can't be used to test for immunity; that has to be done with a blood test.

Everyone in my neck of the woods that feels sick and tests positive is admitted to the hospital without exception.

The only medical care that can be provided after admission to a hospital is to try to keep the patient alive and hope their immune system will defeat the virus.

Exhibiting symptoms with a positive nasal swab test increases the risk of medical bankruptcy.  And the hospital staff have no way to cure the COVID-19 disease.  If a patient lives they will develop immunity and will be responsible for paying an outrageous medical bill.  If a patient dies then their family will be responsible for paying an outrageous medical bill.

 
 
 
Split Personality
Professor Guide
2.1.8  Split Personality  replied to  Nerm_L @2.1.7    4 years ago
A nasal swab can't be used to test for immunity; that has to be done with a blood test.

New Abbott Labs tests for both in under 5 minutes.

Exhibiting symptoms with a positive nasal swab test increases the risk of medical bankruptcy

So does driving a car.  We can't stop living because of what might happen.

And the hospital staff have no way to cure the COVID-19 disease. 

What? You mean HCQ doesn't work?  They are doing better every week, now using Remdisivir and other drugs.

If a patient lives they will develop immunity and will be responsible for paying an outrageous medical bill.  If a patient dies then their family will be responsible for paying an outrageous medical bill.

An insured with a true cadillac plan might have to pay the 1,600 deductible and other costs before/ if Congress ever acts.  Basic plans and Medicare have a deductible around $6,000.  Uninsured are screwed for sure.

It's the American way.  Taxes, bankruptcy and lawyers.

It will be a tall order to change that without being branded a Commie.

 
 
 
Vic Eldred
Professor Principal
3  Vic Eldred    4 years ago

EYUBT-4UEAAuNgb?format=jpg&name=small

"AND THEY NEVER GOT RESCUED". .......James Woods

 
 
 
pat wilson
Professor Participates
3.1  pat wilson  replied to  Vic Eldred @3    4 years ago

Yes they did, in 1978. Wow that google thing is hard ! /s

 
 
 
Vic Eldred
Professor Principal
3.1.1  Vic Eldred  replied to  pat wilson @3.1    4 years ago

Take it up with James Woods

 
 
 
Tacos!
Professor Guide
4  Tacos!    4 years ago

I'd be interested in getting an antibody test to see if I already had it, but unless I feel sick now, I can't fathom why I would go to the trouble and potential risk, of getting tested for infection.

 
 

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