WHEN Antoine Dupont started to feel under the weather in mid-July, he immediately wanted to be tested for the coronavirus. Unable to find a facility where he could get this done near his home in West Palm Beach, Florida, a friend told him about an urgent care clinic with a handful of appointments in Boca Raton, 30 minutes away. He secured a test for the next Friday.
“The nurse said I’d hear back by Tuesday because of the weekend, which seemed a little long to me,” he says. “I didn’t get my results until the next FridayĚý– and only after I had been calling the clinic for a few days.”
His test result came back negative. But the news didn’t come as a relief. He was still feeling illĚý– and by then his ex-wife and son, who he sees on weekends, had tested positive for the coronavirus. Dupont says he doesn’t believe his result was accurate. However, he sees no reason to get another test.
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“The whole testing system is a dismal failure of epic proportions,” he says. “With the labs backed up the way they are, I wouldn’t get anĚýanswer in a reasonable amount of time anyway.”
He isn’t the only person in theĚýUS struggling to get a test. Individuals in other states that have been hit hard by the virus, like Texas, Louisiana and Georgia, are facing the same challengesĚý– and it is damaging the ability of those places to effectively control the spread of covid-19.
As of 4 August, Florida had over 490,000 confirmed coronavirus cases and more than 7100 deaths related to covid‑19. Even though cases have started to dip a bit, the number is still alarmingly high. “Florida is one state that is continuing to see massive spread, but it’s not the only state that is showing those kinds of numbers,” says Ali Nouri at the Federation of American żěè¶ĚĘÓƵs.
“Unfortunately, it all goes to show, across the United States, byĚýand large, we are not doing asĚýmuch as we need to be doing inĚýorder to get this virus under control,” he says.
On 23 July, the US passed an unwanted milestone: . This number makes up more than a quarter ofĚýthe global total, despite the USĚýaccounting for just 4.4 per cent of the world’s population.
That those last million cases were added over a mere 15Ěýdays makes the number even more distressing, says Leana Wen at the George Washington University in Washington DC. She says there is remarkable variation in infection rateĚý– as well as in public health responseĚý– from state to state thatĚýcannot just be explained by the size and diversity of the US.
Inconsistent strategies
By 29 July, 28 states along with Washington DC were showing a rise in the seven-day averages of new coronavirus cases, with only five boasting the opposite trend (see map, below).
“While this is a new virus andĚýweĚýare learning new things about it every day, one thing we’veĚýknown for a while is that wearing aĚýmask, social distancing and handwashing can help limit spread,” says Wen. “When you consider the New York region, theyĚýfollowed the public health guidance and, as a result, they didn’t just flatten the curve in their stateĚý– they crushed it. Unfortunately, we aren’t seeingĚýthe same approach inĚýotherĚýstates.”
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Even within some states, coronavirus mitigation regulationsĚý– such as mandatory face coverings in public or people returning from out-of-state travel having to self-quarantineĚý– haven’t been applied consistently from county to county or city to city. That can have dangerous results.
Rob Phillips at Houston Methodist Hospital in Texas says it is likely that the state’s aggressive reopening plan is behind its current high positive test rate, which is 12.1 per cent of tests taken.
“In New York, they followed public health guidelines and didn’t just flatten the curve – they crushed it”
“As businesses opened back up, there was significant relaxation ofĚýsocial distancing and other measures, and people went backĚýtoĚýwork, as well as back out toĚýrestaurants and bars,” he says. “ButĚýwe also have a lack of testing and contact tracing. It’s exposed that we haven’t invested enough in our public health infrastructure so we can identify cases, isolate them and stop littleĚýflare-ups ofĚýinfection from turning into forest fires.”
Testing failures
Eric Topol at the Scripps Research Translational Institute in California agrees that a strong testing and contact-tracing programme is required to helpĚýcontain spreadĚý– and it is noticeably absent from the US’s current pandemic strategy.
“The more testing you do, the better chance you have, regionally, of understanding where infections are,” he says. “Contact tracing then lets you see where the virus may be going. The infrastructure for these things is just not in place inĚýmost localities, so sustained suppression remains out of reach.”
And that is before you consider that some people in viral hotspots are waiting as long as two weeks for test results. North Carolina-based LabCorp, which runs one of the largest networks of diagnostic laboratories in the US, says that as demand for tests rises, so does the time it takes to process them. A spokesperson says the company has reduced the average time to deliver results to “three to five days from specimen pickup”, and is continuing to actively decrease the turnaround time.
The longer it takes for patients and public health agencies to get test results, the harder it is to track and manage new outbreaks. “You are most contagious right before you develop symptoms,” says Nouri. “So if I start feeling sick today, get a test tomorrow, but don’t get my results for another 10 to 14 days, I have potentially infected a large number of people before I even get word that I’m, in fact, positive. That’s a huge problem.”
Turning the tide
Despite the systemic failures that have led the US to this dire point, Topol says he is optimistic that things can still be turned around. The development and deployment of faster coronavirus tests, as well as advances in vaccine development, should help future efforts to contain the virus’s spread, he says.
Yet the adoption of a cohesive, national mitigation strategyĚý– asĚýwell as consistent messaging about public health initiativesĚý– could help turn the tide now, saysĚýTopol. Nouri says, too often, the messages coming from both national and state leaders are contradictory at bestĚý– and outright misleading at worst.
In response to increasing coronavirus cases, US President Donald Trump announced on 23ĚýJuly that due to beĚýheld in Florida in late August atĚýwhich he was to have been formally nominated as the party’sĚýpresidential candidate. HeĚýhas also made recent comments about how wearing aĚýface covering is patriotic.
But only a week later, Trump retweeted several accounts attempting to discredit Anthony Fauci at the National Institute of Allergy and Infectious Diseases, one of the most trusted public health officials in the US. Those tweets also promoted the use ofĚýhydroxychloroquine, a drug that numerous clinical trials have now shown isn’t an effective treatment for the virus.
Lack of clarity
“Misleading information has had enormous impact on where we are today,” says Nouri. “The lack of clarity from the White House on simple measures like wearing a mask, as well as the spread of misinformation on social media, means that the public doesn’t have accurate information on what this virus can do and what needs to happen to stop it.”
“It’s hard for me and other doctors on the front lines to understand why mask wearing is so divisive”
Phillips agrees. He says that hisĚýhospital in Texas, as well asĚýother medical centres across theĚýstate, have spent millions ofĚýdollars on public information campaigns to help people understand the value of face coverings and social distancing.
“It’s hard for me, as well as otherĚýnurses and doctors on the front lines, to understand why something like mask wearing isĚýsuch a divisive issue instead ofĚýaĚýunifying one,” he says. “But as more voices come together with consistent messaging, I’m hopeful that will change.”
“This shouldn’t be political,” says Topol. “We just need to follow the science. Our strategy should be coordinated by public health experts that know what needs to happen and have the authority to get it done. They need to be building the right infrastructure for effective testing and contact tracing. They need to be the ones giving the briefings every day. They need to show us the way forward. That’s going to be what gets us to where we need to be.”
