Health officials are
confronting tough questions about testing to intercept the fast-spreading
coronavirus, with scrutiny focused on a four-day delay in screening an infected
California woman despite her doctors’ early calls to do so
By MIKE
STOBBE and ADAM GELLER Associated Press February 27, 2020, 4:37
PM
This
undated photo provided by U.S. Centers for Disease Control and Prevention shows
CDC’s laboratory test kit for the new coronavirus. (CDC via AP)The
Associated Press
NEW YORK
-- Health officials confronted tough questions and doubts Thursday about
testing to intercept the fast-spreading virus, with scrutiny focused on a
four-day delay in screening an infected California woman despite her doctors’
early calls to do so.
The
questions are global: not just who, when and how to test for the illness, but
how to make sure that working test kits get out to the labs that need them. All
those issues apparently came in to play in the treatment of the woman in
northern California, a case officials say may be the first community-spread
instance of the disease in the U.S.
“This was
a clear gap in our preparedness, and the virus went right through the gap,”
said Dr. Ali Khan, dean of the University of Nebraska College of Public Health.
In the
wake of the latest California case, U.S. health officials on Thursday expanded their
criteria for who should get tested, and took steps to increase testing.
The
debate over testing has taken on added urgency as the number of cases worldwide
climbed past 82,000, including 2,800 reported deaths. The rapid spread pushed
officials in Saudi Arabia to cut travel to Islam's holiest sites, triggered
tougher penalties in South Korea for people who break quarantines and ratcheted
up pressure on investors as U.S. stock markets extended their week-long plunge. The Dow
Jones Industrial Average sank nearly 1,200 points Thursday, it's worst one-day
drop since 2011.
With the
illness rippling across 47 nations in every continent but Antarctica,
public health officials emphasized the need for rapid
intervention.
“Aggressive
early measures can prevent transmission before the virus gets a foothold,”
World Health Organization chief Tedros Adhanom Ghebreyesus said. He cited a
study in China of more than 320,000 test samples that enabled health officials
to zero in on the 0.14 percent that screened positive for COVID-19, the disease
caused by the virus.
But
catching the disease early will require countries to invest in rapid
diagnostics, said Dr. Gagandeep Kang, a microbiologist who heads the
Translational Health Science And Technology Institute in India.
Test kits
used by the World Health Organization cost less than $5 each, said Michael
Ryan, the group's emergencies programs director. But that figure does not
include the expense of medical staff and validation screening, and making such
investments effective goes well beyond the expense involved.
"As
we can see from the new sparks on Italy, Iran, Korea, is that early
identification of cases is crucial. There, the first persons with infection
were missed," said Marion Koopmans of the Erasmus Medical Center in the
Netherlands.
Doctors
at the University of California Davis Medical Center were mindful of the need
for early identification when the hospital admitted a female patient on a
ventilator and showing symptoms of a viral infection on Feb. 19. They asked
federal officials to test her for the new coronavirus, but were told she did not fit federal
testing criteria, according to an email hospital officials sent to their
employees. The test was not done until four days later, on Feb. 23, and the
results did not come back until Wednesday, a full week after she was admitted.
Part of
the problem is that the number of people being tested in the U.S. has been
limited to those who, in addition to showing symptoms, have a history of travel
to countries affected by the disease or contact with those who have done so,
said Lauren Sauer, director of operations at Johns Hopkins University’s Office
of Critical Event Preparedness and Response.
“In the
U.S., people are sticking pretty closely to that definition,” Sauer said. But
the increasing cases on other continents “are demonstrating we need to do a
better job than just where the outbreak originated.”
On
Thursday, the U.S. Centers for Disease Control and Prevention updated its
testing criteria on its website — a move that had been in the works for days,
according to a federal official familiar with the change.
The CDC
will continue to advise testing people who have traveled to certain outbreak
areas and have fever and certain other symptoms. But now testing is also
appropriate if such symptoms exist and flu and other respiratory illnesses have
been ruled out and no source of exposure has been identified.
As part
of that, CDC has expanded the list of countries that are red flags for testing
to include not only China but Iran, Italy, South Korea and Japan.
Last
month, the CDC said it had developed a test kit that could be sent to state and
big city public health labs, so they could broaden testing to more people.
Early this month, the agency got authorization to begin distribution of the kit
to government public health labs in the 50 states and some cities and counties.
But most
of the kits proved to be faulty, providing inconclusive results to test samples
that should have tested positive. The problem was blamed on one of three
reagents used in the testing. CDC said it was trying to manufacture new
reagents, but gave no firm timetable for when that would occur.
Only
about a half dozen state and local public health labs had fully functional kits
as of early this week.
As weeks
passed, the problem became more and more frustrating, said Scott Becker, the
chief executive of the Association of Public Health Laboratories.
On
Monday, Becker's organization sent a letter to the U.S. Food and Drug
Administration, basically asking permission for state labs to develop their own
tests. On Wednesday, FDA officials responded that labs would be allowed to rely
on the two other reagents, meaning that as many as 40 state and local labs
could be up and running with their tests in the next few days, Becker said.
The
California case, and remarks by Italian officials that they were rethinking how
to classify people who test positive for the illness but show no symptoms,
highlighted the questions that surround large-scale screening for the disease.
The test
being used by U.S. health officials takes just four to six hours to perform
once it’s in a lab. But up to now, those tests have been sent to federal testing
centers, often significantly extending the time to get results.
“Testing
protocols have been a point of frustration,” California Gov. Gavin Newsom said
Thursday. He said federal officials had assured their state counterparts that
capacity to test will be growing “exponentially” in the next few days, but he
wasn’t more specific.
Federal
official likely limited testing early on because of concerns about a deluge of
false positives, which could panic communities and become counterproductive,
said Khan, a former top disease investigator for the CDC.
But he
suggested that a tiered testing system might be the answer, in which a positive
test would have to be verified by another lab before a case is diagnosed and
counted.
The
challenge is complicated by a slowness to distribute test kits.
Newsom
said Thursday the state had just 200 testing kits on hand and “that’s simply
inadequate.” He said he spoke to CDC officials and they assured him they were
working to make testing more broadly available in California.
In Italy,
where an outbreak has depressed tourism and fueled panic, officials said
Thursday they would change their reporting and testing practices in ways that
could lower the country's reported caseload.
Italian
authorities plan from now on to distinguish between people who test positive
for the virus and patients showing symptoms, since the majority of the people
in Italy with confirmed infections aren’t actually sick. They said they would
follow urging by the WHO and hold off on certifying cases screened only at a
regional level, until they can be confirmed by national officials.
“The
cases that emerge from the regions are still considered suspect and
unconfirmed,” said Walter Ricciardi, a WHO adviser to the Italian government.
But U.S.
experts said the crisis requires more rapid testing, and a willingness by
officials to revise their criteria. Sauer pointed to a case in Canada, where
officials zeroed in on a traveler from Iran with COVID-19 soon after that
country announced its first cases.
“Let our
really smart doctors do what they do really well," Khan said. "If
they are really suspicious that a pneumonia or influenza-like illness does not
quite look like an influenza-like illness, allow them to test!”
Associated
Press writers Lauran Neergaard in Washington, Frank Jordans and Kirsten
Grieshaber in Berlin, Aniruddha Ghosal in New Delhi, Olga Rodriguez in San
Francisco, and Frances D’Emilio and Nicole Winfield in Rome contributed to this
report.
No comments:
Post a Comment