July 13, 2020

Weekly line: My 'suspected' Covid-19 reveals these 3 shortfalls in America's coronavirus response

Daily Briefing

    Last week, I detailed my experience navigating my "suspected case of Covid-19." The ordeal left me with no concrete answers, and it revealed three shortfalls threatening the health of our communities and the country's ability to gain control of the new coronavirus' spread.

    10 takeaways: What America can learn from the world's coronavirus response

    3 shortfalls that threaten America's ability to gain control of its coronavirus epidemic

    Even though I've spent the past seven months tracking and learning about the coronavirus pandemic, navigating my possible case of Covid-19 often left my husband and me with more questions than answers. And along the way, there were three shortfalls that stood out to me as particularly concerning for America's chances of combating the coronavirus epidemic—especially as new cases continue to spike throughout the country.

    1. Limited access to testing, testing delays, and accuracy issues

    While I ultimately was able to receive a coronavirus test, I was surprised at how limited access was. Although America's testing capacity has increased overall, a recent analysis by the Surgo Foundation found that 64% of rural counties don't have any coronavirus testing sites, meaning about 20.7 million Americans live in a so-called "testing desert."

    It's also been staggering just how long test results can be delayed—though I can't say I was completely surprised. HHS Assistant Secretary for Health Brett Giroir, who's currently serving as the Trump administration's coronavirus testing czar, recently warned that "some labs across the country [were] reaching or near capacity." And last week, several commercial labs said the recent surges in coronavirus outbreaks across America were beginning to outpace their ability to both manufacture and process test results. Throughout the country, state and local officials are reporting testing backlogs and limited testing supplies.

    And although I had already known about the accuracy issues plaguing coronavirus tests available in the United States, I didn't fully recognize how the tests' unreliability could make patients feel. Research suggests that America's coronavirus tests miss between 20% and 30% of coronavirus cases, giving false-negative results to people who actually are infected with virus. So I've been left wondering if my test result was inaccurate and, if it was accurate, then what's been causing my symptoms (which haven't yet gone away)?

    One thing I'm certain of, however, is that poor access to coronavirus testing, delays in testing results, and uncertainties about whether those results are accurate all could significantly hamper the country's ability to reign in its epidemic. For Americans who are exposed to the virus or experiencing symptoms of Covid-19, it could be days before they're able to be tested and weeks before they receive results—and that's if they're able to access a test at all. In recent weeks, some states have set new restrictions on who can access coronavirus tests, in most cases restricting testing to those who have symptoms of Covid-19.

    That means there are people who may have been exposed to and could be infected with the new coronavirus, but they have no way of knowing. And unaware of their status, they could unknowingly spread the virus to others. The same holds for people who were tested but face delays in receiving their results—especially if their employer doesn't allow them to isolate at home without proof of infection.

    Saskia Popescu, an epidemiologist at the University of Arizona, recently told the Washington Post, "If you're waiting to go back to work and test results are taking seven to eight days, getting people to stay home is really hard. You worry about people saying what's the point of even getting tested. That would be disastrous."

    And, of course, people who receive false-negative results face a similar scenario: If they interpret those results to mean they no longer have to self-isolate, they could inadvertently spread the virus.

    Ultimately, Jaline Gerardin, an expert in disease modeling at Northwestern University, told the Post, "[N]ationally, we'd likely save tens of thousands of lives" if coronavirus testing in America was more efficient.

    2. Conflicting guidance on when it's safe to stop self-isolating and return to work

    That all ties into a second shortfall that could impede America's ability to quash the epidemic: conflicting and unclear guidance about when it's safe to stop self-isolating and return to work.

    CDC recommends that individuals caring for someone in their household with Covid-19, like my husband was, should stay home for "14 days after their last close contact with the person who is sick … or 14 days after the person who is sick meets the criteria to end home isolation." That criteria includes having three consecutive days with no fever and improved respiratory symptoms, as long as it's been 10 days since symptoms first appeared.

    But states and businesses are able to set their own policies for when employees who had Covid-19 or were exposed to the coronavirus can stop self-isolating and return to work. And some businesses haven't crafted any policies on how to handle these situations.

    After my urgent care visit, my husband informed his employer that I had a suspected case of Covid-19 and we expected to receive my test results within 48 hours. His employer agreed he should remain isolated at home until we got the results. If I received a negative result, he could return to work. It was not clear, however, when he could return if I received a positive result.

    But the 12-day lag in receiving my result raised uncertainty for both my husband and his employer. His employer doesn't have an official policy outlining when employees with family members who have symptoms of Covid-19 can return to work, and—even though my providers knew my husband was my only potential source of infection (though he hadn't shown any symptoms of Covid-19)—we weren't given any guidance from my providers regarding when he should stop self-isolating, or whether he, too, should be tested for the coronavirus. Ultimately, my husband returned to work 10 days after I first developed symptoms of Covid-19, with direction from his employer to practice physical distancing and take other precautions to prevent potentially transmitting the virus to others.

    The lack of consistent guidelines and requirements for ending self-isolation and returning to work put both employers and employees in a tough spot: While they may want to follow the best course of action for keeping workers safe, they're unsure of what that course of action is. And that uncertainty is only compounded when workers aren't sure if they're actually infected with the new coronavirus—whether because they can't access testing, they're facing weeks-long lags in receiving test results, or they can't be sure their test results are accurate. Ultimately, this uncertainty and lack of clarity could lead to infected employees unwittingly spreading the virus to their coworkers.

    3. No contact tracing

    Also concerning was a lack of quick contact tracing.

    Public health officials have said widespread testing for the new coronavirus and contact tracing for those who test positive are crucial to reopening businesses safely and easing social distancing measures. But given the lack of access to testing, delays in getting coronavirus test results, and accuracy concerns, waiting until someone tests positive to initiate contact tracing could be too late.

    Crystal Watson, a public health expert at Johns Hopkins University, recently told the Post that, without adequate and quick coronavirus testing, contact tracing is "almost useless," because "[b]y the time a person is getting results, they already have symptoms, their contacts may already have symptoms and have gone on to infect others."

    My husband, for instance, could have already been spreading the coronavirus to others for days before I started experiencing symptoms. And if my husband hadn't informed his colleagues of our possible infections, they may never have known they were potentially exposed—meaning they, too, could have unknowingly been infected and spreading the virus.

    Thankfully, I was aware of the importance of contact tracing, and my husband and I were able to inform those who may have been exposed on our own, urging them to monitor their own health and take precautions to avoid potentially spreading the virus.

    What alarmed me the most

    I recognize that, because of my profession, I'm uniquely positioned, with access to a wealth of information on the coronavirus pandemic and best practices for mitigating the virus' spread. Had I not been so immersed in tracking the pandemic, I may not have known or understood the importance of self-isolating and contact tracing, and I maybe wouldn't have bothered to seek medical care or testing. And even with the distinctive, broad view I've had of the pandemic over the past seven months, I certainly won't claim that I handled my situation perfectly.

    That's the thing that's alarmed me the most over these past 16 days: Even though I've been head down in nearly all aspects of the coronavirus pandemic for more than half a year, my experience still was mired by questions, uncertainty, and a response with glaring holes. America's had months to get this right, but I'm left fearing the country's coronavirus epidemic has no end in sight.

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