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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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By expanding reporting requirements to include negative results, the new Bay Area-wide disclosure mandate will give the public a clearer picture about whether the growing case numbers indicate ramped-up diagnostic assays or the spread of the outbreak.

Doctor’s Orders

The evening before Dr. Cody unveiled her disclosure mandate, Betty Duong—who leads the county’s communications team after PR chief María Leticia Gómez tested positive for the coronavirus—sent a letter thanking San Jose Inside for questioning the paucity of data. “We are doing our best,” she wrote in a 2,000-word missive at Smith’s behest, “but realize the demand for detailed information on everything that is happening is understandably insatiable.”

Of course, the opacity comes from the top down. As has been thoroughly documented by investigative journalists in national news reports, President Donald Trump’s now-famously-botched response to the coronavirus as early as January put the whole nation behind the curve in preparing for the inevitable. The absence of testing, Duong wrote, has “hampered our ability to monitor the epidemic, to focus mitigation measures and to inform individual people of their infection status.”

Unfortunately, according to Duong, the county and state have “very little control over this situation” because most of the authority and resources needed for testing come from the U.S. Centers for Disease Control (CDC) and Prevention.

The CDC didn’t authorize the county to test until Feb. 26, already well over a month into the global outbreak, and the initial test kit didn’t even work. Though the CDC provided the reagents needed for accurate readings that same week, testing resources have yet to scale to what the county needs, public health officials say.

“The role of the local public health laboratory is limited: it serves as a specialty reference laboratory offering testing for emerging infections such as COVID-19 while other laboratory sectors (commercial and academic) come on-line to test for those new diseases,” Duong explained in her letter. “For example, at the beginning of the West Nile Virus epidemic, only public health laboratories were able to test for West Nile Virus, but West Nile Virus testing was very soon offered widely in the commercial sector. In the United States, unlike in some other countries, high-volume testing is done exclusively by commercial private sector labs.”

Santa Clara County’s public health lab can run up to 100 tests a day, officials say, and can only use resources provided by the CDC. With a critical shortfall, the county says it has to triage the highest-need patients.

“The lab is not structured, physically and otherwise, to scale to commercial-volume testing,” Duong says. “As a result, the current focus of the public health laboratory testing is to ensure that hospitalized patients get tested, as well as people who live or work in high-risk settings such as long-term care facilities, healthcare professionals and first responders, while we continue waiting for large-scale testing capacity to come on line through the commercial labs.”

The whole nation missed its chance to contain the virus, which puts the county—like its peers—on the defense. And the whole nation grapples with a shortage of swabs, vials and other tools needed to collect and test specimens.

“Because of limited testing capacity, the public health laboratory has focused its very limited testing capacity on testing patients with more severe illness and in high-risk, critical roles like healthcare workers and first responders,” according to Duong. “Because of this, and because we are not testing people without any symptoms, the number of cases that we detect through testing are only a small portion of the total number of people infected in the county. In addition, because we are primarily testing hospitalized patients, the cases we detect are more likely than the total number of infected persons to be seriously ill and are more likely to be hospitalized.”

That’s why Thu Tran’s husband—Vince Tran’s father—was never screened, even though he lives with a COVID-19-sickened wife. “He stays healthy,” Thu Tran says in a phone call from her Gilroy home, where she’s still bedridden and tethered to an oxygen tank.

But she says the dizzying nausea, gut-twisting pain and gasping breathlessness she experienced make her worry about passing it on to anyone else.

“Especially the people who have a health problem already,” Thu Tran cautions. “Because it’s a very, very strong virus. It multiples quickly and sticks to the air sacs in your lungs. You know? It’s a tough virus to fight.”

For the Tran family, uncertainty about endangering others adds another layer of anxiety over concerns about the economy and prolonged physical isolation.

In the face of so many unknowns, Mahan says, the public needs frank, detailed communication from the experts. “Going forward, I’d hope to see frequent reports from the [county] detailing our testing goals, daily metrics, plans for scaling, barriers they’re working to break down, requests for public and private sector help, and so forth,” he says. “Transparency will only increase focus, speed, and results.

After all, understanding the present outbreak will prepare us for its inevitable return.

“We need to have a full scope of data to deal with this crisis,” Cruz says. “We need that Silicon Valley thinking, to go big, go bold and then scale it out because that’s what we do. This won’t be the last pandemic, so we should learn as much as we can from it.”



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