Lack of Tests Means We Still Don't Know the Full Scope of Outbreak 

Despite mobilization by states and private industry, U.S. is woefully behind on testing.

click to enlarge Linda Barman, MD, at Stanford’s drive-through testing express clinic.

Photo by Steve Fisch, via Stanford

Linda Barman, MD, at Stanford’s drive-through testing express clinic.

After seven years on disability, Chris Lierle's new job at a South Bay financial institution marked the start of an exciting new chapter. "This was my big triumph in life," he said.

The 52-year-old corporate trainer packed his belongings in a 16-foot rental truck for the 1,900-mile trek from Texas. By the time he reached Palo Alto on March 1, he didn't feel quite right. "I wasn't sure if I was even sick," Lierle recalled in a recent interview. "I didn't think much of it and went to my first day of work."

That was March 2. As the day wore on, he came down with a fever. "They cut me loose at 3 p.m.," he said. "And the next day."

March 4, he stayed home. The fever persisted and he developed a deep, throaty cough.

By then, California announced its first COVID-19-linked fatality, bringing the nationwide death toll to 11. Global cases from the virus approached 93,000. California Gov. Gavin Newsom declared a state of emergency as a Princess cruise ship exposed to the virus approached Oakland.

Given his history of cross-country travel, Lierle figured that the responsible thing to do was to get tested and work the rest of the week from home. He reached out to his healthcare provider, Standard Health, which insisted on a telemedicine screening. Despite a clear mapping of COVID-19 symptoms, Lierle said they seemed to lack urgency and went by the Centers for Disease Control (CDC) and Prevention's outdated standard of limiting tests to people who had traveled internationally.

By the end of that first week on the new job, Lierle's boss got sick for about 12 hours before the symptoms subsided. So did Lierle's immunocompromised girlfriend. With anxiety mounting about having potentially subjected other people to a highly contagious disease, he called Santa Clara County's Public Health Department for help getting tested, to no avail.

Next, he tried One Medical, a membership-based primary care practice, which initially denied him because of the same CDC criteria, before finally relenting after he pushed back.

Even so, another full week passed before the test transpired. On the day of his appointment, Lierle donned a Hawaiian shirt — because, he said, "when the going gets tough, the tough get tropical" — and left his self-imposed quarantine to drive to a private doctor's office all the way up in San Francisco.

At the clinic, in a stripped-down room, a nurse dressed in head-to-toe protective gear — goggles and all — swabbed one of his nostrils for a flu sample and the other for COVID-19, the disease caused by a novel coronavirus called SARS-CoV-2. Results from the flu test came through by the time he reached Palo Alto: negative.

But as of March 18 — 18 days since he fell sick — Lierle had yet to hear back about the other diagnosis. He chalks up the long wait to "TDTS: Trump Delayed Testing Syndrome," referring to President Donald Trump's botched testing rollout, which caused the rapid spread of the pandemic by people with the disease who don't even know they have it.

"If I can't get a test result even in my situation," Lierle said, "then how do we as a population have any idea what our sick people are sick with?"

The short answer? We don't. While other countries deploy massive testing operations, the United States lagged so far behind that it's barely mapped out the scope of the problem.

South Korea had tested at least 274,000 people as of March 18. The U.S. reported testing just 25,000 specimens, according to figures from the CDC, which failed to specify how many specimens it tested per person. Crowdsourced data puts the actual figure for the U.S. total closer to 60,000 tests on as many patients, with about 6,000 positives. A problem with initial batches of tests and a delay in approving commercial kits set the nation back in controlling COVID-19.

Now, faced with uncertainty over the actual breadth of the pandemic, the only choice left is to try to slow its spread. That's what's driving the kinds of draconian shutdowns that so dramatically changed everyone's way of life last week.

California, with a population of about 40 million, initially received just 8,227 kits from the CDC but could only use a fraction of them because of missing compounds. Other states reported similar issues. California has since been trying to transfer the missing test components to its 18 labs as officials try to ramp up testing capacity by other means.

Still, slowly but surely, it looks like testing capacity is increasing. Stanford University recently started offering drive-through tests for patients referred by a health care provider based on symptoms or exposure to SARS-CoV-2, the virus that causes COVID-19. Unlike the test taken by Lierle, Stanford promises results in just 24 hours. On Tuesday, the county launched similar drive-through testing setups with help from Verily, a subsidiary of Google's parent company Alphabet, which created an online triage questionnaire called Project Baseline. Earlier this week, federal officials said they would also set up more drive-through testing nationwide and pick up the pace by processing more samples in commercial labs. The CDC estimates that it there should be 1.9 million tests available by the end of the week.

That's little help to Lierle, who's coming up on three weeks since he first felt his symptoms. And anxiety about the results isn't just personal. He wants to know whether he compromised anyone else on his road trip, at his new job or in his own house.

"I've been living in a small world just to keep everyone else safe," he says. "At this point, my test results aren't just for me — they're for everyone at my office, for my boss and my girlfriend. That's why early testing is so important. A test delayed is a test denied."

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