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Doctors: Access to tests is limited

Outbreak:

By Lisa M. Krieger

lkrieger@bayareanewsgroup.com

As coronavirus cases escalate across the country and a marooned cruise ship with 21 confirmed cases aboard — and potentially many more — waits to dock, the procedure for routine testing remains murky, despite White House assurances that anybody can get a test, anytime.

Community doctors say they don’t have test kits and have been told to go through government health officials for testing, which can take precious time.

“We have no local testing available,” said Dr. Walter Mills, president of the California Academy of Family Physicians. “No one has been trained to do the test, as it is not available in the community.”

That means the vast majority of people who experience just minor symptoms, such as low fever, cough and shortness of breath, might go untested, inadvertently infecting others and spreading the potentially deadly disease. Broader testing can also pinpoint viral “hot spots” in the community.

For example, the man suspected of igniting the outbreak on the Grand Princess cruise ship that sailed from San Francisco last month was not aware of his infec-


tion and didn’t show symptoms until the trip had begun, according to cruise company officials. He has since died.

To control coronavirus within a year, 80% of symptomatic patients would need to be tested and isolated within a day of symptoms appearing, according to a recent Harvard analysis.

Yet there has been no guidance about how to correctly swab the patient’s nose and throat or where to ship the sample, doctors say.

Los Altos geriatric specialist Dr. Mehrdad Ayati said that “ the information for physicians is so limited, almost zero.”

“If there is a patient that we are suspecting that has COVID-19, we can call our county department of health to see if they can send someone to do the test,” he said.

Frustrated by the limits, as well as the rules and restrictions, some academic medical centers like Stanford, UC San Francisco and Harvard are skipping the gantlet and have enlisted their own virologists to design in-house tests.

The need for faster, accurate turnaround was made very clear by the case of a Solano County woman now critically ill with coronavirus. She was hospitalized for 11 days before her infection was detected, raising the prospect of uncontrolled community exposure to the dangerous respiratory disease.

Despite doctors’ suspicions that she had the virus, she was not tested sooner because the federal Centers for Disease Control and Prevention’s early guidelines were very narrow, focusing only on patients who had traveled to China or had been in contact with anyone with the illness. They have since been broadened.

Also, at the time, the state had only 200 test kits, and all samples had to be shipped back to the Atlantabased CDC for processing and confirmation, a timeconsuming process.

California was among a handful of states that received early CDC screening kits and were authorized to use them, but many were faulty and produced inaccurate results. That problem has since been fixed, but the delay has been costly.

Now, more than nine weeks after the virus was first detected in the U.S., federal government labs have tested specimens for only 1,583 people, federal health officials said Saturday, according to Politico.

During the briefing, Health and Human Services Secretary Alex Azar and Food and Drug Administration Commissioner Stephen Hahn said the Trump administration does not have figures for the numbers of people tested at state and local labs. They said the CDC shipped out 1.1 million tests to states Friday, according to Politico.

“They’ve simply lost time they can’t make up. You can’t get back six weeks of blindness,” said Jeremy Konyndyk, who oversaw the international response to Ebola during the Obama administration and is a senior policy fellow at the Center for Global Development, according to The Washington Post.

On Saturday, the California Department of Public Health said it could not disclose the number of tests it has conducted. It also could not say if it has an adequate supply.

“ We have asked the CDC for more tests and, when asked, they provided them as needed,” said a spokesperson. “That will continue to increase as we take more tests.”

If people have mild symptoms, they should “self-isolate” at home, the spokesperson said, and they can also call their health care provider or local public health department to request testing.

The spokesperson said physicians can send their swabs directly to the state’s Richmond-based testing lab but couldn’t describe the proper handling and shipping procedures to do that. The spokesperson also suggested that people with severe symptoms should go to urgent care or an emergency room or call 911, if necessary.

Last week, at least three U.S. academic medical centers — UCSF, Stanford and Harvard Brigham and Women’s Hospital — started using their in-house tests to screen all suspect patients who arrive at their emergency departments or urgent care centers.

“ We can cast a wider net. … And we can quickly rule it out or rule it in,” said Dr. Maria Raven, chief of emergency medicine at UCSF. “ We don’t have to unnecessarily quarantine, or risk unknowingly infecting another person who is vulnerable.

“ Up until now, any test we wanted to get on a person with COVID-19 has to go through our infection control (office), which contacts the Department of Public Health and then contacts the Centers for Disease Control, who has to give approval for the test,” she said. “There were forms to fill out that took hours away from caring for others.”

At Stanford, “ we have to protect the front line workers,” said Dr. Yvonne Maldonado, infectious disease specialist and director of Inspection Control at Stanford Children’s Health.

It’s essential to catch infections quickly — on site — so that sick people can be isolated before they spread the virus to health care workers, other patients, family members and friends, she said. Then the patient could be quickly directed to a special isolation room, far from crowded waiting rooms, and treated by experts in protective gear.

But the tests developed by university and state labs are difficult to scale up or distribute widely, according to a Feb. 26 Harvard report by Devabhaktuni Srikrishna, Ranu S. Dhillon and David Beier. Those labs use a molecular technique called polymerase chain reaction, which requires special laboratory machines and highly trained technicians to operate them.

“As the virus spreads out into the general community,” they wrote, “people need to be tested in clinics and perhaps even at their doorsteps.”

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