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.
鈥淭he nurse said I鈥檇 hear back by Tuesday because of the weekend, which seemed a little long to me,鈥� he says. 鈥淚 didn鈥檛 get my results until the next Friday听鈥� and only after I had been calling the clinic for a few days.鈥�
His test result came back negative. But the news didn鈥檛 come as a relief. He was still feeling ill听鈥� and by then his ex-wife and son, who he sees on weekends, had tested positive for the coronavirus. Dupont says he doesn鈥檛 believe his result was accurate. However, he sees no reason to get another test.
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鈥淭he whole testing system is a dismal failure of epic proportions,鈥� he says. 鈥淲ith the labs backed up the way they are, I wouldn鈥檛 get an听answer in a reasonable amount of time anyway.鈥�
He isn鈥檛 the only person in the听US 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 challenges听鈥� 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鈥�19. Even though cases have started to dip a bit, the number is still alarmingly high. 鈥淔lorida is one state that is continuing to see massive spread, but it鈥檚 not the only state that is showing those kinds of numbers,鈥� says Ali Nouri at the Federation of American 杏吧原创s.
鈥淯nfortunately, it all goes to show, across the United States, by听and large, we are not doing as听much as we need to be doing in听order to get this virus under control,鈥� he says.
On 23 July, the US passed an unwanted milestone: . This number makes up more than a quarter of听the global total, despite the US听accounting for just 4.4 per cent of the world鈥檚 population.
That those last million cases were added over a mere 15听days 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 rate听鈥� as well as in public health response听鈥� from state to state that听cannot 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).
鈥淲hile this is a new virus and听we听are learning new things about it every day, one thing we鈥檝e听known for a while is that wearing a听mask, social distancing and handwashing can help limit spread,鈥� says Wen. 鈥淲hen you consider the New York region, they听followed the public health guidance and, as a result, they didn鈥檛 just flatten the curve in their state听鈥� they crushed it. Unfortunately, we aren鈥檛 seeing听the same approach in听other听states.鈥�
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Even within some states, coronavirus mitigation regulations听鈥� such as mandatory face coverings in public or people returning from out-of-state travel having to self-quarantine听鈥� haven鈥檛 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鈥檚 aggressive reopening plan is behind its current high positive test rate, which is 12.1 per cent of tests taken.
鈥淚n New York, they followed public health guidelines and didn鈥檛 just flatten the curve 鈥� they crushed it鈥�
鈥淎s businesses opened back up, there was significant relaxation of听social distancing and other measures, and people went back听to听work, as well as back out to听restaurants and bars,鈥� he says. 鈥淏ut听we also have a lack of testing and contact tracing. It鈥檚 exposed that we haven鈥檛 invested enough in our public health infrastructure so we can identify cases, isolate them and stop little听flare-ups of听infection from turning into forest fires.鈥�
Testing failures
Eric Topol at the Scripps Research Translational Institute in California agrees that a strong testing and contact-tracing programme is required to help听contain spread听鈥� and it is noticeably absent from the US鈥檚 current pandemic strategy.
鈥淭he more testing you do, the better chance you have, regionally, of understanding where infections are,鈥� he says. 鈥淐ontact tracing then lets you see where the virus may be going. The infrastructure for these things is just not in place in听most localities, so sustained suppression remains out of reach.鈥�
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 鈥渢hree to five days from specimen pickup鈥�, 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. 鈥淵ou are most contagious right before you develop symptoms,鈥� says Nouri. 鈥淪o if I start feeling sick today, get a test tomorrow, but don鈥檛 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鈥檓, in fact, positive. That鈥檚 a huge problem.鈥�
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鈥檚 spread, he says.
Yet the adoption of a cohesive, national mitigation strategy听鈥� as听well as consistent messaging about public health initiatives听鈥� could help turn the tide now, says听Topol. Nouri says, too often, the messages coming from both national and state leaders are contradictory at best听鈥� and outright misleading at worst.
In response to increasing coronavirus cases, US President Donald Trump announced on 23听July that due to be听held in Florida in late August at听which he was to have been formally nominated as the party鈥檚听presidential candidate. He听has also made recent comments about how wearing a听face 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 of听hydroxychloroquine, a drug that numerous clinical trials have now shown isn鈥檛 an effective treatment for the virus.
Lack of clarity
鈥淢isleading information has had enormous impact on where we are today,鈥� says Nouri. 鈥淭he 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鈥檛 have accurate information on what this virus can do and what needs to happen to stop it.鈥�
鈥淚t鈥檚 hard for me and other doctors on the front lines to understand why mask wearing is so divisive鈥�
Phillips agrees. He says that his听hospital in Texas, as well as听other medical centres across the听state, have spent millions of听dollars on public information campaigns to help people understand the value of face coverings and social distancing.
鈥淚t鈥檚 hard for me, as well as other听nurses and doctors on the front lines, to understand why something like mask wearing is听such a divisive issue instead of听a听unifying one,鈥� he says. 鈥淏ut as more voices come together with consistent messaging, I鈥檓 hopeful that will change.鈥�
鈥淭his shouldn鈥檛 be political,鈥� says Topol. 鈥淲e 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鈥檚 going to be what gets us to where we need to be.鈥�
