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Incomplete Test Data Blurs Full Picture of COVID-19 Outbreak

In a pandemic, what we don't know CAN hurt us.


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On Sunday, the U.S Surgeon General’s Office tweeted: “Not all labs are reporting yet (or promptly), but the ones that do, report that 90 percent of tests (which are usually people exposed or w/symptoms) are #COVID19 negative. That means even among the highest risk people, most don’t have #coronavirus…”

In announcing what appears to be the first edict of its kind in the nation, Santa Clara County Public Health Officer Dr. Sara Cody emphasized how private entities can literally save lives by keeping local governments in the loop.“Commercial and academic laboratories are important partners in providing testing to our community,” she said. “Receiving this critical information from those labs will help local health departments respond to COVID-19 during this unprecedented time.”

Because in a pandemic, what we don’t know can hurt us.

Public officials want more transparency from private labs. - (PHOTO VIA QUEST DIAGNOSTICS)
  • (Photo via Quest Diagnostics)
  • Public officials want more transparency from private labs.

Test Run

Dr. Cody wields sweeping emergency powers that make it a crime to play pickup basketball in a pandemic-related lockdown. But until now, she could do no more than beseech private labs for exhaustive data, which Quest Diagnostics and Stanford Health Care finally provided over the weekend (and which the county has yet to provide to us). As the tally of confirmed cases reached 300,000 among South Korea’s population of 52 million, the United States reported 44,183 positives and a death toll of 544 on Tuesday as Santa Clara County’s ticked up to 400 and 16, respectively.

But until Monday, nine days after San Jose Inside began asking about negative test data, Santa Clara County’s Public Health Department kept those results secret. When it finally unveiled the numbers that evening, they came as a shock.

Just 647 of the county’s 2 million people had been tested. That few out of so many.

Smith says the county’s actual infected population is probably closer to 10,000, an estimate he shared publicly for the first time on Tuesday, rather than the official count of 302 announced two days earlier. With each coronavirus carrier statistically likely to pass it on to at least a few other people, he cautions, the outbreak is no doubt proliferating at a rate beyond what official test results suggest.

“If we had all of the negatives for the entire region, and we were doing testing basically on an as-requested basis so that anybody could get tested, whether they were sick or not,” Smith says, “then we could have some epidemiological data on how much the virus has entered the community.” Since a shortfall of tests makes that all but impossible, he says the next best option is to get the negatives from folks with symptoms or known exposure.

“We’re really trying to guess less,” says Cindy Chavez, president of Santa Clara County’s five-member Board of Supervisors.

The virus has already touched every single hospital in the South Bay, according to the county. And it’s already prompted the CDC to add 250 overflow beds in the Santa Clara Convention Center to brace for the influx of critically sick patients to the local healthcare system. With no way of measuring the extent of the infections, the county must act like it’s already fully encompassed.

“Initially, the focus was on trying to identify and mitigate the disease,” Smith says, “then we switched rapidly to community distancing and now the real issue is trying to prevent the health system from getting overwhelmed.”

Vince Tran balked at the revelation about the county’s low testing numbers. When his 67-year-old mother, Thu Tran, became one of the first few dozen South Bay residents to test positive for COVID-19 after a recent trip to Seattle and Kirkland, Washington, he says the county’s perfunctory contact tracing surprised him. As did Kaiser Permanente’s decision to refuse to test his dad, who fortunately has felt no ill effects yet.

“It’s clear now that the testing systems in place are a complete mess, and are the main reason why there’s so little information to make decisions with,” Tran says. The county’s admission about how little it knows, he adds, shows “the glaring disorganization between testing facilities and between public and private entities.”

With studies emerging about the role of asymptomatic people driving the exponential spread of the virus and reports about increasingly younger and healthier demographics succumbing to lung failure endemic to COVID-19, Tran says it’s more vital than ever for public officials to urge caution.

“That’s all another piece of the puzzle that we only get with more test data,” says Tran, who’s quarantined in his San Jose home with his wife and two young kids. “We can’t really know the magnitude of the problem if we don’t have more testing data. And it sounds like, based on what the county is saying, that they’ve basically had their hands tied this whole time. But still, they should have told us that sooner.”

San Jose Councilman-elect Matt Mahan, who repeatedly sounded the alarm about the shortage of robust test data this past week, applauded the county’s move toward transparency. “It’s a positive step,” he says, “but we shouldn’t be in this position. I’m concerned that we seem to be totally dependent on private testing companies and have not seen enough urgency—at all levels of government—around getting testing to scale.”



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