Coronavirus Report: Why Did it Take So Long to Get Rapid Test Kits?

Just across the Golden Gate Bridge from San Francisco is Marin County, where Dr. Matt Willis is in charge of public health. So, of course, he paid attention when he heard reports of a new virus outbreak in China.

“It was the first week of 2020 where [there were] somewhat alarming reports of rapid increases in cases,” Willis remembers. “It was clear that this virus had the characteristics for a global spread.”

Soon, the U.S. had its first case, and the new virus — the novel coronavirus — appeared to hit older adults hardest. About a third of the people living in Marin County are over 60. So Willis went on alert.

“The first step I took was just moving my office down to where my communicable disease team works, kind of knowing that we were gonna be working together pretty hard for weeks or months on this,” he said.

On the last day of January, U.S. Health and Human Services Secretary Alex Azar went on national television and declared a public health emergency: “Beginning at 5 p.m. Sunday, Feb. 2, the United States government will implement temporary measures to detect and contain the coronavirus.”

The federal government evacuated a couple of plane loads of Americans from a cruise ship in Japan and put them in quarantine. Over a hundred ended up at Travis Air Force Base, about an hour northeast of San Francisco.

U.S. airports began screening passengers. Travel — especially to China — slowed way down. The U.S. State Department issued a Level 4: Do Not Travel advisory for all of China, and American carriers – like United and Delta — began to suspend operations there.

But many people had already flown to California from China before word of the virus was widespread. The federal Centers for Disease Control and Prevention told Willis and other public health officials to use airline passenger lists to start tracking people returning to their communities.

“And that was initially, anyone who had returned from China we needed to monitor for at least two weeks for the development of symptoms,” he said.

At this point, the only confirmed cases of what experts began to call COVID-19 could be traced back either to recent travel or direct contact with an infected person. The CDC’s testing guidelines reflected that: If you didn’t meet those two criteria, you weren’t going to be tested, even if you were showing symptoms.

For people who met the guidelines, Willis’ staff could do a test, send it to CDC headquarters in Atlanta and wait for results. But there weren’t enough tests even to cover the CDC’s directive.

“So we were applying more stringent criteria here in Marin County to really limit the tests for those who needed it most,” he said.

Willis suspected more infections were on the way.

“You know, this is what it looks like when an epidemic spreads,” he said. “It is first brought in from identifiable sources on the outside. And then once it establishes a foothold, it starts becoming exchanged between people within the community. And so... we were waiting to see when that would occur.”

And then, it did.

On Feb. 26, a hospital in Sacramento announced it was treating a woman sick with the virus who hadn’t traveled anywhere or been exposed to anyone infected.

“(This) was a sign to us, that we're starting to see community transmission in our region,” Willis said.

It was a turning point: It seemed to be the first case of community transmission in the country. It had taken two hospitals more than a week to confirm her illness, partly because she didn't meet the guidelines to be tested. Finally, a few days later, the CDC expanded its criteria for testing.

Then, on March 4, a man in California died of complications from COVID-19. He had been on a cruise to Mexico.

Gov. Gavin Newsom declared a state of emergency.

Health Care Workers on the Front Lines

The next morning, Sandy Adler Killen went to work. She’s a nurse at a Bay Area hospital. Her first patient that morning: a 92-year-old man with a fever, struggling to breathe — a potential case of COVID-19.

“Honestly, I was really surprised,” she said.

Killen was surprised because she didn’t feel prepared to care for a potential coronavirus patient. She says she and her colleagues that morning hadn’t had any training yet.

“With the coronavirus, they really just reviewed a few things in a huddle for a few minutes and they asked us to watch a video,” she said.

The emergency room buzzed with confusion. The staff decided to test the elderly man. A doctor handed Killen a few test tubes and handful of paperwork to fill out. No one knew how to get the samples to the county lab.

“We ended up not knowing exactly how to handle that,” she remembered. “Were we supposed to call the courier? How were these samples supposed to be handled?”

Killen continued to work, not knowing for several days whether she had been exposed to the virus. A few days later she found out: luckily, no.

But with more suspected cases showing up in the region, workers in some hospitals were sent home to self-quarantine. Testing was too slow to figure out who was actually infected.

The Lag in Getting Rapid Testing in the U.S.

Dr. Seema Yasmin is a public health specialist and epidemiologist at Stanford University, a so-called "disease detective."

“The testing has been such a debacle and it feels like such an unnecessary debacle,” Yasmin said. “I've investigated outbreaks of flesh-eating bacteria, of botulinum toxin, of whooping cough, measles, mumps, all of that regular stuff as well.”

She’s been watching coronavirus management at the national level. It was really unfortunate, Yasmin says, that in early February just as the outbreak had started to spread beyond China, the CDC released faulty test kits.

“So, you think, OK, well, you're making it in a rush. These things happen. That's fine, but we need to quickly iterate,” she said.

But the agency lagged in sending improved tests out to local public health departments. And scientists outside the government had a lot of trouble getting authorization to develop their own tests.

“By the time the CDC was sending out its testing kits to some labs across the states, the World Health Organization had sent out tests to dozens of countries who, by that point, had done hundreds and thousands of tests,” she said.

Dr. Stephen Redd from the CDC publicly defended the U.S. approach saying, “There’s a process of developing a new test when there’s a new disease. We followed that procedure. There was not a need to follow the WHO test.”

Some countries developed their own tests. By mid-March, South Korea had done more than 200,000 of them, according to their health officials. By the CDC’s count, only about 11,000 tests had been done here by that same time. But some question that number, because tracking has been problematic.

Dr. Robert Redfield, director of the CDC, testified in early March that funding is part of the problem.

“Like CDC, the state and local and territory health departments are underfunded,” he said. “Wouldn't it be nice if we had a data system that every health department in this country right now could see in real time, so that we could predict what’s going on, and where to go and where to put assets? We don't have that.”

Yasmin says communication and transparency have been problems from the top down. The White House resisted releasing several advisories from the State Department and CDC, like warning Americans against getting on cruise ships. And in early March, an online tracker of testing numbers unexpectedly vanished.

“So think about all those concerns we had about Chinese officials withholding data, while magically data disappeared from the CDC website,” Yasmin said.

For people who will get mildly ill from this virus, or who have good health care, the lack of tests and information might all add up to just a hassle. But each misstep puts vulnerable people at higher risk, Yasmin says.

About 28 million Americans are uninsured and another 44 million are underinsured.

“This is a story of health inequity, unequal access to health care and about rich people having the means, the resources, the time, the networks to protect themselves while the homeless, the incarcerated, people living on the margins of society,” she said. “Those are the people I worry about the most.”

Still Not Enough Tests

A virus moving around uncontrolled in the community is dangerous for everyone. And with the lack of widespread rapid testing, there was no way to know how many people were infected.

Health officials realized they couldn’t stop the spread of the virus. So, some local governments switched strategies. They moved from trying to contain it to trying to slow it down. Several counties, like Sacramento, which seemed to have had the nation’s first confirmed case of community transmission, called off the automatic quarantines for possible exposure.

Sacramento County’s top public health official, Dr. Peter Beilenson, held a press conference on March 10, saying, “There is no point in quarantining for 14 days a person who's feeling healthy. If they feel as if they feel sick, then they should stay home.”

Theoretically, doing this should help ease the burden on the health care system. If doctors and nurses can keep going to work despite possible exposure, then those who are sick can get the care they need.

This policy shift was also supposed to make it easier to get tested. But there still weren’t enough kits, as Beilenson pointed out.

“It takes a long time because we didn't get the tests from the CDC until a couple of weeks ago. We only have 20 tests that we can do in a given day,” he said.

Coronavirus and The Grand Princess Cruise Ship

Marvin and Ellen Schwartz would love one of those precious tests. The senior couple were on the cruise ship that was held off the coast of San Francisco recently. Marvin realized his holiday was in trouble, “I guess, about the early part of the second week. We started hearing rumors that there were some concerns,” he said.

U.S. officials flew tests out to the ship as it waited to dock. But they only tested 45 people out of several thousand. Many of the passengers are now quarantined at a simple hotel on Travis Air Force Base. On his first day there, Marvin looked out the window as more cruise ship passengers arrived.

“Now I see someone coming off the bus ... bringing someone in a wheelchair,” he said. “You know, this kind of cruise attracts older people.”

Neither Marvin nor Ellen are showing symptoms. But still, they have no idea if they have caught the coronavirus. Ellen really wants to be tested.

“I mean, even the hazmat people who took our temperatures do not know whether we will have the option of being tested,” she said.

Officials say tests are coming, but it’s not clear when. For now, Ellen has a half-read novel, the TV and Marvin to keep her entertained until the government tells her she can go home.