Virus-Test Divide Exposes Government Successes—and FailuresBy Marc Champion - 13.
Huge variation in testing regimes from U.S. to Singapore
Cost, health system and past experience all determine practice
One barometer of competence for the world’s governments and health-care systems as they battle the coronavirus pandemic lies in the testing itself.
How nations handle the most basic aspect of disease detection may be as important for the trust in governments, and even the survival of some administrations, as it is for the wellbeing of the populations they serve.
In the U.S., a top medical official acknowledged on Thursday that the slow roll-out of tests to track down early carriers, and so contain the spread of Covid-19 across a nation of 330 million, was a “failing” for a medical system that’s poorly designed for the task.
“The idea of anyone getting it [a test] easily, the way people in other countries are doing it, we’re not set up for that,” Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, told the House Oversight and Reform Committee. “Do I think we should be? Yes. But we’re not.”
Early, aggressive testing, shoe leather detective measures and so-called social distancing have been key to the success of countries such as Singapore, which have largely managed to prevent the spread of the virus into the wider population. Tests there are free, the government developed a kit it says produces results in three hours at 99% accuracy, and even the police get involved in administering them at checkpoints.
South Korea has created drive-through facilities to help test as many as 20,000 people a day. Australia, where actor Tom Hanks and his wife, Rita Wilson, recently tested positive (Hanks was on a shoot for an Elvis Presley movie), said on Wednesday that it will roll out 100 pop-up clinics to extend free testing coverage, in a $1.6 billion effort to stop the coronavirus.
For China, testing in the community outside the epicentre in Hubei province is thought to have helped slow the disease to other parts of the country.
The contrast with the U.S. is stark. Anger has exploded over reports of faulty test kits, exorbitant charges and the inability of those fearing they have the disease to access them at all. The administration has sent mixed signals, with President Donald Trump saying tests are widely available while some health officials and lawmakers speak of shortages or restricted eligibility. The Centers for Disease Control and Prevention says testing rose from 100 per day last month to 1,200 by March 5.
“Yes, I think it is a test” for governments and health systems, said William Hanage, an associate professor of epidemiology at Harvard University. That isn’t because the ideal way to fight Covid-19 has been found or that testing offers a panacea -- far from it, he said. It’s because you can’t wait until you know these things for sure to act, or until people show obvious symptoms. By the time they do, the disease has already moved on.
The message is clear for governments as they deliberate over whether to close schools, test widely, have people work from home or dedicate entire hospitals to treating the virus: “It is going to happen to you, stop agonizing and waiting for data,” Hanage said.
Making the wrong choices on coronavirus could have significant human, economic and political consequences.
“We know that governments will shake as citizens judge them to have fumbled in their response,” to the virus, Jon Alterman, Brzezinski Chair in Global Security and Geostrategy at the Washington-based Center for Strategic and International Studies, said in a March 12 call with reporters. “We know that economies will be disrupted, and some economies are likely to collapse.”
The U.S. is not alone in being slow to roll out timely, accurate and widely-available tests. A dearth of kits is thought to have contributed to the rapid spread of the virus in Iran, where medical personnel believe the official accounting of cases and deaths to be understated.
In Mexico, where President Andres Manuel Lopez Obrador has downplayed the threat from the disease - he said Wednesday that people should hug more, not keep their distance - only 278 people had been tested by March 10, according to the health ministry. That’s spurred fears the disease could be spreading undetected in a country with a population of 127 million.
India, with a population of 1.4 billion, announced its first fatality on Thursday and medical experts have called for more testing, fearing the potential for the virus to move rapidly through the community.
Having lost the battle to contain Covid-19 – always a tough ask given it can be passed on before showing symptoms – nations have responded very differently to the value of further testing to slow the disease.
South Korea stands out for ramping up mass testing after the disease had already exploded in the community. Forty-two companies have submitted 64 test kit samples for accreditation. Tests are free for anyone exposed or showing symptoms. Others can choose to be tested for $130, compared to thousands reportedly charged in the U.S.
An official at South Korea’s Centers for Disease Control and Prevention who asked not to be identified said there was no doubt of the importance of mass testing. Queries had come from counterparts in the U.S., Japan, Singapore, Israel and countries in Europe, the person said.
Israel, which currently has no coronavirus deaths reported, tells anyone with a fever of 38 degrees Celsius (100.4 Fahrenheit) or other symptoms to call an emergency service which dispatches someone with a testing kit. That’s happening hundreds of times a day, according to the health ministry. On Thursday the ministry announced it would quadruple the level of testing.
Yet by no means all are following suit, including the U.K., a country with a centralized universal health-care system that has limited testing to those seen to be at risk.
That should have included a 24-year-old Vietnamese woman living in London, who sought medical help after traveling in Europe with a friend who contracted the virus. She was sent home twice without being tested, according to the Vietnamese health ministry.
Her parents, who founded a luxury retail company in Vietnam, hired a private plane to bring their daughter home, the government said. After landing in Ho Chi Minh City on March 9, she was placed in a special field hospital built in February, tested and found positive.
The U.K. government changed its protocols this week as it moved from attempting to contain the coronavirus to mitigating it. It will now focus testing efforts on diagnosing those sick in the hospital.
Prime Minister Boris Johnson and his government stress they are relying heavily on scientific advice in their relatively relaxed response, treating it as a flu that’s here to stay and which people will need to develop immunity to. Japan, too, has decided not to focus resources on mass testing.
Testing everyone who has flu-like symptoms “would require a huge budget. So, we’re trying to come up with the best allocation of resources,” Takuma Kato, director of the virus control office in Japan’s health ministry, told reporters on Monday.
Decisions, as U.S. infectious disease head Fauci said on Thursday, can have as much to do with the systems that are available as they can the science. Hong Kong, Singapore, South Korea, Vietnam and other countries in Asia have responded aggressively due to their previous experience with SARS and MERS and the infrastructure they put in place for a pandemic – infrastructure that many other countries just don’t have.
Australia’s government is still smarting from the political beating it took over accusations of a lax response to catastrophic fires that swept the country, and is anxious to avoid a repeat. The starting point for U.K. officials, meanwhile, is to protect a hospital system that lacks emergency room beds and struggles to cope with the common influenza strains that rip through the population every year.
Once coronavirus is out in the community, even if someone is detected as having it “there isn’t much to do about it,” said Rosanna Peeling, Chair of Diagnostics Research at the London School of Hygiene and Tropical Medicine, who previously ran diagnostics research at the World Health Organization. “You have to allocate a lot of resources to testing that can be better used diagnosing and treating people who get very ill.”
— With assistance by Sohee Kim, Kanga Kong, Xuan Quynh Nguyen, Faris Mokhtar, Isabel Reynolds, Josh Wingrove, Drew Armstrong, Robert Hutton, Dandan Li, Sharon Chen, Dong Lyu, Claire Che, Jason Scott, Andrea Navarro, Juan Pablo Spinetto, and Jing Li