Top news, reports and insights for today:
- Spotlight on California: testing backlog clouding surveillance
I thought I would shine a spotlight on the situation in California to highlight what is happening in a number of states and is likely to become more common moving forward. The graphic below shows a screen capture of the latest numbers posted on the California Department of Public Health website. It shows that as of Monday, California had 6,932 cases and 150 deaths. There are a number of striking things here. First, COVID-19 is affecting men and women similarly in California (in contrast to reports of more men among cases). Second, half of confirmed cases are under age 50! That’s right, 52% to be exact. While it remains true that older people get more severe symptoms, the virus is impacting younger adults. Further, one quarter of confirmed cases are hospitalized and 1-in-10 are requiring intensive care unit (ICU) treatment. But the truly astonishing thing about these numbers is that 2/3 of California’s hospitalized COVID-19 patients and half of those in ICU beds are “suspected” cases (as opposed to confirmed cases). Given the importance of knowing whether a patient is COVID-19 positive in the hospital, why have 2/3 of patients not been tested? And how is it that half of the COVID-19 patients in ICU beds haven’t been tested?
What does this mean? It is certain that all of these suspected cases have in fact been tested; the results of those tests are not known. How could that be? The CDPH office of public affairs tells us that as of March 30, more than 86,100 tests have been conducted in California, but results have been received for only 33% of them. Even though there are 22 state and private labs processing tests, 2/3 of those tests are backlogged and waiting in a cue to be processed! This is extrapolation on my part, but that means that instead of 6,932 cases, California actually has at least 20,793 cases just among the people that have been tested (assuming the same fraction of tests are positive). If California had all those test results, they are probably dealing with almost 14,000 more cases than they know about. That’s why 2/3 of their hospitalized COVID-19 patients are “suspected” cases. It also means that our national surveillance is severely clouded by the lack of adequate bandwidth in our testing labs. We have to be increasingly cautious about interpreting the slowdown in cases that has been seen in the last week. The backlog in testing is likely to be most severe in the hardest hit states, but it is those states that are driving our overall picture of the epidemic. There is evidence that what is happening in California is happening in other states. Washington state for example has not reported any new cases for the last 3 days. An article today in the Atlantic suggests that private testing labs are primarily responsible for the rising backlog of test processing. Combined, the system is doing only about 2,100 tests a day in California, so it will take weeks to catch up with the tests that have already been performed. When the big private labs (Quest Diagnostics and Labcorp) entered the fray, there was a belief that the cavalry had arrived to save the day. But the Atlantic article suggests that both companies have had major problems ramping up their capacity and that this has left huge numbers of samples in testing “purgatory”. For all these reasons, we simply do not now have a good handle on where we are in this epidemic.
- U.S. Intelligence says China is fudging their numbers
To follow up on point 4 from yesterday’s briefing, a story from Bloomberg News by Nick Wadhams and Jennifer Jacobs says that US intelligence officials now believe that China has “concealed the extent of the coronavirus outbreak in its country, under-reporting both total cases and deaths”. This is based on a classified report sent to the White House according to three U.S. officials who have not been named.
Why this matters? The reporting from China has influenced the WHO and other nations in shaping their responses to the outbreak. If their numbers have been skewed, the world may have learned the wrong lessons about what does and does not work. It is believed that China is not alone and that other countries such as Iran, Russia, Indonesia and North Korea may be hiding cases. - As cases rise, infections among health workers setting off alarm bells
Today NBC News is reporting on rising concerns about infections among U.S. health care workers on the front lines. Problems in testing and tracking, and lack of national data on the true depth of the epidemic are making life more difficult for medical workers in the cross-hairs. As noted above, California doctors and nurses are in the dark about the test results of two-thirds of their hospitalized COVID-19 patients. States like Ohio and Minnesota are reporting that up to 20 percent of their COVID-19 cases are health care professionals. Similar numbers have come from Italy where the virus has been especially deadly. U.S. health care workers lack sufficient supplies, or PPE, to protect themselves. Front line workers are routinely given more advanced PPE in South Korea and other Asian nations such as full-body Tyvek suits and N95 masks. In many US hospitals, staff are only given standard surgical masks and cloth gowns. And even those are running low in many places. Hospitals have fired personnel for complaining publicly about these shortages and workers are increasingly feeling frustrated and abandoned.
The bottom line: As the U.S. braces for new waves of cases in many states, we can and must do better at providing adequate information and equipment to our health sector or face the prospects of thousands of unnecessary deaths in the coming weeks.
Thomas A. Glass, Ph.D. 