Extracting the truth

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Testing, as yesterday's Popular Information detailed, is a key tool in limiting the spread of coronavirus. You need to know who has contracted the virus so those people can be isolated, and others they have come into contact with can be tested as well. 

South Korea, a country of about 51 million people, conducted nearly 200,000 tests as of Monday. In South Korea, you could get tested for coronavirus in a drive-thru lane, without ever getting out of your car. The strategy appears to be working. "[T]he country has seen a steady decline in new infections over the last few days," NBC News reports. 

Initially, the United States conducted very few tests because the Trump administration decided to develop its own test kit rather than using functional kits from the World Health Organization or commercial suppliers. That test did not function properly. 

But that problem appears to be solved. Last Friday, Vice President Pence said 1.1 million tests would be delivered to labs by the weekend. Another 1 million tests were to be distributed this week. 

So how many Americans have been tested? The CDC is not releasing comprehensive data on testing, so the best information comes from three guys updating a Google Doc. Aggregating state data, they've found only 7,695 Americans have been tested, as of Wednesday evening.   

As a result, coronavirus is still spreading undetected in many communities. There are currently 1001 confirmed cases of coronavirus in the United States, which have resulted in 31 deaths. (You can find the latest figures here.) The lack of testing increases the chances that things will get much worse. 

As it turns out, having a functional test kit isn't enough to perform a coronavirus test. You also need something called an "RNA extraction" kit to "prepare samples for testing." And there is a shortage of these RNA extraction kits in labs across the country. 

CDC Director Robert Redfield admitted to Politico that the shortage of RNA extraction kits was a major roadblock. “I’m confident of the actual test that we have, but as people begin to operationalize the test, they realize there’s other things they need to do the test,” Redfield said. Asked what he would do to address the shortage, Redfield replied, "I don’t know the answer to that question.” 

The American Society for Microbiology is sounding the alarm:

One challenge that has come to light is the supply shortage for SARS-COV-2 PCR reagents. We are deeply concerned that as the number of tests increases dramatically over the coming weeks, clinical labs will be unable to deploy them without these critical components. Increased demand for testing has the potential to exhaust supplies needed to perform the testing itself.

The main supplier of RNA extraction kits is Qiagen, a Dutch diagnostics company. Qiagen "confirmed that its product is backordered due to 'the extraordinary pace' at which the world has increased coronavirus testing over the last few weeks." In other words, other countries obtained the supplies they needed to conduct testing faster than the United States. Now that Trump administration officials realize that testing needs to accelerate quickly, the supplies are no longer available. 

Improvisation during a pandemic

On Wednesday, the World Health Organization officially declared the coronavirus outbreak a pandemic. In the United States, the wealthiest country in the world, hospitals are being forced to scrounge for the basic supplies they need to conduct testing. 

The Brigham & Women’s Hospital, a Boston-area facility, wants to start offering coronavirus tests, but can't obtain the RNA extraction kits. An email sent to all Harvard Medical School faculty, obtained by Popular Information, requests that the faculty send any kits they have on hand for research to the hospital for use in testing. 

The email notes that the shortage is not limited to this particular hospital but is a problem in "labs around the country."

In other cases, labs are having "trouble getting virus samples that are needed to validate the tests to make sure they are properly identifying positive samples."

Spotlight on Pence

The catastrophic management of the coronavirus outbreak in the United States puts a spotlight on Pence, who Trump put in charge of the administration's response. Here is what Dr. Marc Lipsitch, a professor of epidemiology at Harvard, had to say about the inability of the United States to conduct testing at scale:

The lack of testing in the United States is a debacle. We’re supposed to be the best biomedical powerhouse in the world and we’re unable to do something almost every other country is doing on an orders of magnitude bigger scale.

Recall that the administration had people with the relevant background and expertise to handle this precise situation. Trump fired them in 2018 and never replaced them. 

In 2018, the Trump administration ousted Rear Adm. Tim Ziemer, who served as the Senior Director of Global Health Security. Ziemer was a member of the National Security Council, where he was responsible for coordinating "responses to global health emergencies and potential pandemics." Ziemer was lauded as "one of the most quietly effective leaders in public health." His work on Malaria during the Obama administration helped save 6 million lives. 

"Admiral Ziemer’s departure is deeply alarming," Congressman Ami Bera (D-CA) said in May 2018. "Expertise like his is critical in avoiding large outbreaks." Beth Cameron, who served on the National Security Council in the Obama administration, said that Ziemer's ouster was “a major loss for health security, biodefense, and pandemic preparedness” and noted that it "is unclear in his absence who at the White House would be in charge of a pandemic."

John Bolton, who was serving as Trump's National Security Adviser at the time, did not just remove Ziemer. He decided to eliminate the position, and "the NSC’s entire global health security unit." Bolton also forced out Tom Bossert, a highly regarded expert who was Ziemer's counterpart at the Department of Homeland Security. "Neither the NSC nor DHS epidemic teams have been replaced," Foreign Policy reported in January. 

Asked about the reduction in expert staff, Trump defended the decision and said he could get the experts back "quickly" if needed. 

Republicans block paid sick leave legislation

All the experts agree that an important part of curbing the spread of the coronavirus is making sure people stay home when they feel sick. But millions of Americans lack paid sick leave and are faced with the choice of going to work sick or not earning a paycheck. 

Senator Patty Murray (D-WA) has a bill that would automatically extend 14 days of paid sick leave to everyone during a public health emergency. Murray attempted to fast track the legislation on Wednesday, but Republicans, led by Senator Lamar Alexander (R-TN), blocked the effort.

"[I]t’s not a cure for the coronavirus to put a big new expensive federal mandate on employers who are struggling in the middle of this matter," Alexander said.

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