Can The US Manage The Impending Coronavirus Outbreak? 6 Deaths, 101 Infected, 7 Critical, 6785 Suspected Cases, 11 of 50 States Now Affected

A couple of days ago, President Trump announced in public that the coronavirus was of low threat to the US. He had made numerous statements in the past in public that the coronavirus was even milder than the influenza. He then appointed Vice-President Mike Spence to head a task force on the coronavirus, a person who had a tracked record of health management blunders including when he was governor of Indiana and was responsible for the mismanagement of the HIV outbreak among drug users there.
 

The Trump administration and its officials have a record of disregarding medical evidence or the advice of experts, Mike Pence, for example, went against the guidance of public health officials when he opposed a needle-exchange program. (And in 2000, he claimed in an op-ed that “smoking does not kill.”) When the American Academy of Pediatrics and other groups asked the Trump administration not to bar Planned Parenthood and other groups from getting Title X funds, arguing that the move would harm public health,he did it anyway.
 
Only a day before he had appointed Mike Spence, Trump had cut budgets to the CDC and NIH and also impose gag orders on all health officials including those from CDC and NIH, that they were not to make press or media interviews unless with consent and vetting from the coronavirus task force.
 
Fast forward, it is not even a week yet from the day that Trump made all the public announcements, The US has now 6 deaths recorded on its soil, 101 infected cases in 11 out of 50 states and the possibility of thousands of silent spreaders across the country thanks to slow and bureaucratic health professionals in the country and the CDC testing criteria.
 
The 11 of the 50 affected states are now Arizona, California, Florida, Illinois, Massachusetts, Oregon, Rhode Island, New York, Oregon, Washington and Wisconsin. Florida and Washington have declared Health Emergencies in their respective states.
 
Of the 101 cases reported in the US so far, 45 were former passengers of the Diamond Princess cruise ship, 3 were repatriated from Wuhan, 17 were believed to have contracted the virus through travel and 36 people who got sick from another person in the United States, including some who don't know who the source was.
 
There are now almost 6,785 suspected cases all over the US covering  34 states and some are clusters including 120 medical staff from UC Davis in Sacramento (the figure could be more) , 280 staff and patients at the Life Center at Kirkland, Washinton and various other locations.
 
The US CDC despite saying that it has 6 testing facilities in place, only 3 are working efficiently, while there are so much blunders going on with the issue of testing, diagnostic criteria and test kits availability itself.
 
Alex Azar, secretary of health and human services said that there are now have 75,000 tests available out there in the United States, and over the next week that will expand radically. 
 
An on Monday, an audit found that there is in reality only 22,000 test kits in the US and even then most could be flawed.
 
The US Centers for Disease Control and Prevention’s first attempt to produce a diagnostic test kit fell flat, after it had shipped hundreds out to the states. A promised replacement still does not permit state and local laboratories to make final diagnoses. ( news-massive-blunder-us-health-authority-shipped-faulty-coronavirus-test-kits-across-america-and-elsewhere">https://www.thailandmedical.news/news/breaking-news-massive-blunder-us-health-authority-shipped-faulty-coronavirus-test-kits-across-america-and-elsewhere)
 
The same entity also was responsible causing the issue ensured that Americans would be tested in very few numbers by imposing stringent and narrow testing criteria.
 
Dr. Thomas Frieden, former director of the CDC commented, “Clearly, there have been problems with rolling out the test and the  diagnostic tests are not widely available yet. There are a lot of frustrated doctors and patients and health departments.”
 
Dr. Michael Mina, an epidemiologist at Harvard University  said, “The incompetence has really exceeded what anyone would expect with the CDC.This is not a difficult problem to solve in the world of diagnostics and virology.”
 
In the middle of February, the CDC rolled out a three-step diagnostic test kit and distributed hundreds of kits to state and local health laboratories. But the third step in the diagnostic process was flawed, and produced some inconclusive results.
 
Despite promising a full three-step replacement, it never arrived; the agency has not fully explained why, except to say that there was a manufacturing defect. As a result, diagnostic testing was only conducted at the agency’s labs in Atlanta, not state and local labs.
 
More troubling was that getting results took days, and the CDC’s criteria for testing were strict, among them, the patient must have recent travel to China or contact with someone known to be infected.
 
Healthcare professionals across the country complained of a bottleneck, both because of the restrictive test criteria and because of the agency’s limited testing capacity. The CDC said it had the capacity to test about 400 specimens a day but reality was lesser.
 
Asst Professor Dr Lauren M. Sauer from  Johns Hopkins Medicine said, “The test criteria were  too stringent, and people aren’t getting tested. I’ve heard from so many colleagues that tests were turned down.”
 
As the first cases of possible community transmission began to emerge in California and Washington State last week, the CDC decided to broadened the number of patients who qualified for testing to include travelers returning from places like Iran, South Korea, Japan and Italy, and those with symptoms that could not be otherwise explained.
 
The US FDA broke the logjam, authorizing state and local laboratories to do initial testing on their own. The move greatly expanded the nation’s testing capacity, as the CDC also said it was shipping out new tests kits to the states as well. But final confirmatory tests must still be done at the CDC.
 
To date, the CDC had tested roughly 487 citizens with suspected infections identified by public health officials in the United States.
 
Many countries such as China, South Korea and Italy have tested patients by tens of thousands.
 
Medical professionals are also confused as to why the CDC decided to repair its own coronavirus diagnostic kits when there are alternative test for coronavirus devised by German researchers and even more progressive tests kits in Singapore.
 
If the US FDA had approved those test, the CDC could simply have distributed it instead of creating a new one from scratch. There is a huge demand for testing Clinical decisions about caring for a coronavirus patient cannot be made until final positive test results are received.
 
Dr Michael Osterholm, an epidemiologist at the University of Minnesota said, “There has been a silent epidemic of Covid-19 in the United States that is not going to be silent any longer.Testing will show it. This is not a surprise , it shouldn’t have been.”
 
Meanwhile in another blunder, A CDC lab is said to be under investigation after contamination fears, another sign the US botched its rollout of coronavirus testing kits.
 
A CDC lab that was initially responsible for producing coronavirus test kits in the US is being investigated over fears some of the test kits were faulty.
 
The exact nature of an apparent "manufacturing issue" is unclear, but a Food and Drug Administration official who visited the lab last week raised the alarm that the lab itself might be contaminated.
 
US FDA Commissioner Stephen Hahn said that "problems with certain test components were due to a manufacturing issue," without specifying further.
 
The diagnostic tests produced at the lab had been distributed to state health departments and other unspecified locations.
 
The Atlanta lab had manufactured "relatively small amounts" of the kits for labs around the country.
 
Dr Timothy Stenzel, the FDA official who  flagged concerns with the lab to other government officials, is the director of the Office of In Vitro Diagnostics and Radiological Health but is not a lab inspector.

He had traveled to the Atlanta lab to troubleshoot technical issues in production, where he spotted inappropriate procedures and possible contaminants.
 
The new details are an embarrassment for the CDC. It is also a reflection as to whether the US can really manage the coronavirus outbreak as it gradually escalates. Perhaps they should send their teams over to Thailand and Singapore to learn firsthand how to do things efficiently.
 
Thailand Medical News stresses that in trying to control the spread of the coronavirus, diagnostics and testing plays a very critical role. People should be tested and tested over again even if they do not exhibit symptoms. The disease itself can be asymptomatic and although the nucleic acid tests are actually accurate, it cannot detect viral loads of less than 90 copies /ml accurately,  according to medical experts.(quoting a Singapore company that specializes in coronavirus diagnostics.) Extracting proper samples from below the nasal cavities and the throat is also another limiting factor.
 
Diagnostic test kits themselves cost between US$ 60 to US$ 69 for the ones coming from Germany while the ones from the US are at the moment costing about US$ 72 to manufacture while the superior ones from Singapore only cost about US 48. The China ones and WHO kits are cheaper at about US$ 25 to US$ 39 but are inferior and have a high false negative so far. Thailand Medical News has been proposing various Governments like the US, Iran and other Middle-East countries to stockpile on the versions from Singapore. Interested parties can contact us directly.
 
For more on the US coronavirus updates, keeping logging on to: https://www.thailandmedical.news/articles/coronavirus