The discovery that a California woman was likely infected with the novel coronavirus by a previously unrecognized case in her community is proof of an enormous problem the country is facing at the moment, according to public health experts. It’s clear that the virus is spreading undetected in the United States — but how broadly it’s spreading is an utter mystery.

Before Thursday, a perfect storm of problems in the Centers for Disease Control and Prevention’s development of test kits — and the agency’s reluctance to expand its recommendation of who should be tested given the limited availability of kits — meant very little testing has been done in the country. As of Wednesday, the CDC said that 445 people had been tested — a fraction of the number of tests that other countries have run.

The new case in California makes it clear the virus is spreading undetected in at least one area of one state. The woman is not believed to have traveled outside the country and had no contact with a known case. As her condition worsened — she is on a ventilator — health officials in California asked the CDC to test her for the virus. Because she had not been to China and had not been a contact of a known case, the agency said no.

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Eventually, more than 10 days after she went into hospital, the CDC agreed she could be tested. Dozens of health workers who may have come into contact with her at NorthBay VacaValley Hospital, in Vacaville, Calif., are now being monitored.

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California Gov. Gavin Newsom was critical of the testing debacle in a press conference on Thursday. His state has only 200 kits to test for the new coronavirus, he said.

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“Testing protocols have been a point of frustration for many of us,” Newsom said. He added that, based on conversations with the CDC, states have been informed new protocols are coming and they have been promised an “exponentially” increased capacity to test.

Indeed, on Thursday the CDC announced a new testing protocol that will greatly expand the number of people who should be tested.

Requests for comment from the CDC on Thursday went unanswered. The New York Times reported that the Trump administration has ordered that all statements on the coronavirus be funneled through the office of Vice President Mike Pence, who was named to head the administration’s coronavirus response on Wednesday by President Trump.

Experts said it has been long past time to broaden the testing protocol beyond people who traveled to China. Outbreaks are gathering speed in Italy, Iran, and South Korea, and dozens of other countries are reporting cases.

On Thursday afternoon the agency did just that in new guidelines for the medical community on who to test for Covid-19, the disease caused by the virus. People with symptoms compatible with Covid-19 and who have recently traveled to China, Iran, Italy, Japan, or South Korea should be tested for the virus, the new guidance says.

The CDC’s own advice to travelers warns Americans not to travel to South Korea because of the coronavirus risk and urges people with medical conditions to avoid traveling to Italy, Iran, and Japan at this time.

“It is accurate to say that we have recognized 60 cases in the U.S. from returning travelers and one now unexplained by travel in California. But it’s not accurate to say that we have 60 cases,” said Tom Inglesby, director of the Center for Health Security at Johns Hopkins School of Public Health. “We don’t know how many cases we have. We can’t estimate that until we’ve done clinical testing and surveillance testing.”

The new guidance also frees up hospitals to test patients with ARDS — acute respiratory distress syndrome — for which there isn’t a diagnosed cause to see if they are infected with the new virus, a move Inglesby had also called for.

The CDC developed and sent test kits to state and local labs in early February. Even then, those labs were clamoring for the ability to test and questioning why it was taking so long to develop assays for the new coronavirus.

Because the federal government declared the coronavirus outbreak an emergency, state and local laboratories are prohibited from using tests developed in-house. They could only use tests that had received an emergency use authorization from the Food and Drug Administration. In this context, that means the CDC test.

When laboratories start to use a new CDC-designed test, they have to first assess their own ability to run the tests accurately, and report back to the CDC if they are having problem getting the tests to work in their hands. It quickly became apparent that a lot of the state and local laboratories were having trouble with one part of the test, Health and Human Services Secretary Alex Azar told the House Ways and Means Committee on Thursday, adding that the CDC “probably, in retrospect, maybe over-engineered [the test] a bit.”

The CDC told the few states that weren’t having a problem to continue testing and pulled back the kits from the others, which meant that any time those states had a patient who needed to be tested, they had to send the sample to the CDC.

The organization that represents state and local labs — the Association of Public Health Laboratories — was so concerned that on Monday it asked the FDA in a letter if local labs could begin to use in-house tests, executive director Scott Becker said.

“That’s really what led us to reach out to the FDA in really a very public way saying: ‘What else can we do? Because we’re hamstrung here. We’re between a rock and a hard place,’” he told STAT.

Becker said state and local labs have now been told that those that can run all three parts of the test should do so; those that can’t get the third part to work properly can now drop that part. Meanwhile, a next-generation test is being readied.

“I expect it to go very quickly in the next few days,” Becker said. “I really feel like yesterday” — Wednesday — “was a pivotal point and there’s some positive movement.”

Having more laboratories able to test will only solve part of the problem, however. Giving doctors and hospitals more leeway to test more patients who look like they might have Covid-19, regardless of whether they’ve traveled or not, will help further define the level of transmission in this country, experts said.

Inglesby called for a surveillance effort — designating certain hospitals or cities to test more broadly for the virus to try to assess whether there is undetected spread.

The CDC said several weeks ago such a program would be launched in six cities. But the testing problems have delayed the rollout.

Megan Thielking contributed reporting.

  • The fact that people are saying they went to the doctor with symptoms but cant get tested because they didn’t travel or aren’t critical.

  • Looking at numbers, data and news.

    CoVid has not a single occurrence in New York!!!!
    May I ask how and why? The probability that noone is infected in NY right now is highly improbable. Not only because this is the ONE city in US that accepts tourists. Not only because, we are already 5 weeks into the CoVid. Not only because California has infections, Texas has infections, Illinois has infections and New York hasn’t.

    But simply because Fashion Shows in Milan had attendance from New York FOR SURE. And Europe data shows that who ever went to Milan 10 days ago for these shows went back home ill.

    Now unless, “the miracle that we were waiting happened”, NY has infections. Let’s find them before they spread.

  • We have enough data to approximate the death rate with the current trend.
    We have 2994 deaths in 90682 cases. The death rate as is: 3.3%
    We also have 7569 severe critical cases until now. with a death rate of 20% approximately. So if the infections were to stop now, we would have another 1500 deaths.
    This means 4500 deaths approximately in 90000. and this is 5%.

    We either have triple infections ( the announced death rate is 1.7%), that of course is assumed, or the death rate is projected to 5%.

    If we have these many more more infections, then do what it needs to be done to stop the spread.

    If the death rate is so high, then … do what it needs to be done to stop the spread.

    And STOP downplaying the deaths among the ill and old. Anyone who gets older gets also ill. It is disrespectful and unhuman, to discard the deaths of Older people.

    And after all decide, the NHS wants to bring back retired doctors to help, they are OLD, do we care for them or NOT?

    • With the death rate, that’s providing they take the same steps China did. The below link is a must read, its how they slowed it right down. (keep refreshing and stopping the page to load to read it, takes a bit some days)
      https://www.nytimes.com/2020/02/15/business/china-coronavirus-lockdown.html

      And providing it does not get out of control, swamping the health care system. At best the virus has 20% on average for serious cases atm(out of that 5% critical), if the health care system becomes overwhelmed it will be catastrophic. Its what is happening in Iran right now as to why the death rate is so high, their health care is not up to par with the rest of the world.

  • In Chicago news, there is a confirmed new CoVid Case with no travel history since yesterday night. CDC results are waiting, but Illinois has the test kit to test since last week.
    Noone refers to this, since the only 2 patients have been released more than 14 days ago, this means that CoVid is spreading in Chicago.

  • This thing seems to spread by contact really. The Italians greet each other by kissing both cheeks. The virus survives on surfaces, including your hands and then you touch your face. Avoid cash. My neighbours OCD cleaning of door handles seems like a good idea now though. Florence Nightingale’s big revolution in nursing was the use of soap. Rhymes with hope.

  • Well I don’t usually follow this stuff, but I just returned last Sunday from a two week vacation traveling the US by train. I did have some sinus problems near the end of the trip but recovered quickly. This past Wednesday I became so ill that I could barely get out of bed. I did have concerns that it could be Coronavirus, not so much for myself but for those I work with and people I come into contact with every day. I went to Kaiser on Thursday and I was tested for the flu and the test came back negative. When I was asked by the doctor if I recently traveled to China, I said no. However, on 5 plane connections, the six train segments and the 8 hotels I stayed in, I received no manifest of who occupied those seats or hotel rooms before me. They may have been occupied by Chinese or people returning from China. I don’t know. None of the hotels asked if I traveled to China, nor do I think they asked other guests. Since I didn’t travel to China, I wasn’t eligible for the test. In my 51 years, this is the sickest I’ve been. I suspect that it isn’t the Coronavirus, but for those sick as me who do think they have the Coronavirus, they can’t get tested. For those who are infected will probably transmit it to their families, co-workers, and friends. With an incubation period of up to 14 days and not testing the general population, I suspect the news cycle will be even more grim in two weeks time.

    • Hi, they are starting to use CT scans of the lungs to look for ‘crushed glass’ pneumonia to diagnose it. The Chinese doctors had to widen their diagnostic criteria because of so many negative test results before the positive for covid 19. Meanwhile I wash my hands singing happy birthday two or 3 times over. We’ve all got vulnerable family and friends. Wishing you a speedy recovery.

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