COVID-19 Testing in the United States Stalls, Still Not Widely Available
“We had a patient come in for a dislocated shoulder,” she started, sharing from a recent shift in an emergency room in the Midwest. “Didn’t have any symptoms. We do the X-ray to look atthe shoulder and of course it captures part of the chest. His lung was full of COVID.”
“Did his test come back positive?” I asked.
“We couldn’t test him. We don’t have any tests to give him,” she grimaced.
“How many patients like that do you think you all are seeing?”
“Thousands,” she sighed, a rare eclipse darkening her usually sunny disposition. “We are seeing thousands of people like him.”
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Last week we observed that COVID-19 testing in the United States was showing wildly disparate volume from state to state. Stunningly that disparity continues. New York is still the only state in the union ramping COVID-19 testing aggressively.
Daily throughput on tests nationally stalled Monday last week. The United States averaged 101,733 tests per day over the past 10 days. Only nine states are doing more than 3,000 tests per day which is 873 tests less than the number of people who visited New York City hospitals yesterday presenting COVID-19 symptoms.
New York is doing over nearly 3x as many tests as Florida, the next closest state. The city of Washington D.C is doing more tests than the entire states of Wyoming and Oklahoma. Connecticut is an hour and 45 minute drive from New York City, described as the epicenter of the American pandemic. That state is performing fewer tests per day than Utah, Missouri and Tennessee. Puerto Rico, still recovering from historic natural disasters and located 2,193 miles from the mainland, is managing 20 more tests per day than the Sooner State. I — personally — have received more tests than American Samoa is performing per day.
At this point in the pandemic, containment is not possible. However, positive test results are the leader of the leading indicators in this crisis. ER visits, hospitalizations, ICU admissions, intubations, days on a ventilator and, tragically, deaths all lead off how many people have the disease. Each of those stages of the disease need masks, gowns, gloves, IV pumps, syringes, hospital beds, respirators, ventilators, and the most precious resource in this fight, healthcare professionals. By the time you’re lining up a refrigerated trailer to store the bodies, you know with the conviction of Scripture you don’t have enough of everything else you need.
The necessary equipment and personnel to blunt the progression of COVID-19’s severity can only be estimated by sampling how many people are infected.
If you’re one of the 310 million Americans living outside of the New York, your government has absolutely no idea what they need to get through this.
The remaining available time to find out is small and vanishing.
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An old friend from my time in California is not a huge fan of Facebook. When she does it is frequently about basketball or football and reliable for a good chuckle, but I’ve paid acute attention to her posts over the past two weeks.
She’s a physician working the problem there and California’s COVID-19 testing seems to have struggled worse than any other state. A single private lab was responsible for the most populous state in America for over a week. It was almost immediately overwhelmed by the demand and only once was able to produce release more than 4,000 results in a single day.
Her clinical assessment of their test’s efficacy made my heart sink:
I’m seeing numerous instances where testing is coming back negative, but symptoms are consistent with Covid 19. When CT chests are done, however, they usually are in line with the Covid diagnosis. My point: if you have symptoms, stay the F home and quarantine. The test doesn’t mean much.
I don’t have a ton of friends in healthcare, but they each consistently share the same number unsolicited: “Rob, 30% of them are wrong.”
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I have to conclude with a plug for Alexis Madrigal, The Atlantic and the crew at The Covid Tracking Project. These data are astonishingly bandwidth intensive to get. Every single day before 4pm, Alexis and his team of mostly volunteers are performing journalistic dentistry pulling the necessary teeth from state and local governments for us to have any visibility at all into what is going on with COVID-19 in the United States. To top it all off, they have provided these data in a tastefully designed and reliable API that makes getting it into your Jupyter notebook two lines of code.
I subscribed to The Atlantic this week and will remain one for years to come. This is absolutely information the federal government should be providing. But they’re not, so a few folks rolled up their sleeves and went to work in the biggest public health crisis faced by post-modernity.
A lot of people are saying Alexis Madrigal deserves a Pulitzer for this. I think by the time this is all over you will share my belief it should be the Medal of Freedom.
