Hundreds in Sacramento may have coronavirus. A ‘ridiculous’ lack of tests masks true figure
Sacramento’s top health official says testing for the coronavirus in the region is so far behind where it should be that the actual number of people infected with the virus here could be 20 to 100 times higher than what’s been reported.
The federal government has been “woefully inadequate” in delivering test materials like swabs and reagents, county health director Peter Beilenson said, forcing public health officials and healthcare providers to ration tests to the most vulnerable cases.
Beilenson’s comments echo those repeatedly made in the last week by Gov. Gavin Newsom — although Newsom offered a small note of hope in a video broadcast Wednesday night, saying testing is increasing, albeit haltingly. Drive-through public testing for thousands of residents could be available at several sites in the county late next week, Beilenson said.
Meanwhile, Newsom, Beilenson and health officials in other California counties have issued dramatic orders to residents to shelter in their homes indefinitely to reduce person-to-person contact that spreads the virus.
The testing issue has been an ongoing failure both nationally and in California, some government leaders say.
Health leaders worldwide have repeatedly argued that testing is one of the first lines of defense for understanding and slowing the spread of the coronavirus. COVID-19, the potentially deadly disease caused by the virus, has now swept across more than 150 countries and was officially declared a pandemic last week by the World Health Organization.
“I don’t know how (the federal government) can’t have prepared for this,” Beilenson said. “You knew that swabs were necessary for this virus in January, you’d think they could produce in a couple months enough swabs.
“It’s ridiculous.”
‘We know we have more than 53 cases’
Beilenson said Saturday that 53 people have tested positive for coronavirus, “but we know we have we more than 53 cases.” So far the county has tested hundreds of people out of a population of 1.5 million, he said.
Beilenson said he suspects many more residents have been infected, and some of them are contagious without knowing it.
As the pandemic intensifies, health officials in different areas are struggling with how to deal with the acute shortage of tests. The Los Angeles Times reported that Los Angeles County officials have advised doctors to test patients with symptoms only if a positive diagnosis would change how a patient is treated or “inform public health response.”
Also, the Washington Post reported that hospitals in hard-hit cities like New York are rationing the tests, too.
“The default assumption is yes — anyone who comes in with any kind of fever, cough, respiratory symptom, flu-like illness, we’re making the assumption that they have this,” Jolion McGreevy, at New York’s Mount Sinai Hospital, told the Post. “It’s very likely you have it. There’s no benefit for you to test.”
In Sacramento County, Beilenson said the public health lab only has the capacity to perform 50 tests a day. Given that limitation, the lab is only testing those “who are seriously ill” or are health workers who may have been exposed to the coronavirus.
Private testing is available through doctors’ offices, but the volume of those tests is limited as well. “The doctors screen (before testing). You have to be symptomatic,” he said.
Beilenson is hoping a major change on the horizon may help turn the tide — Sacramento County is organizing drive-through testing at several sites to begin next week, using test materials supplied by commercial labs. Beilenson didn’t disclose where those sites would be and said county officials are still deciding whether everyone would have access to the tests or just those with severe symptoms.
“But that’s dependent on getting enough testing through Lab Corp, Quest Diagnostics and or Roche,” Beilenson said. “We’re hopefully going to have a lot of tests so we’ll be able to serve everybody.”
How many tests will be available for the drive-through program?
“Ask me next week,” Beilenson said.
Testing is ‘backbone’ of pandemic response
The situation unfolding in the capital region reflects a growing crisis across the state and country. Weeks after the first case of the novel coronavirus was reported in California, just 25,200 people in a state of 40 million have been tested in public and commercial labs, the state Department of Public Health reported Saturday. Results are still pending for about half of the tests.
Despite weeks of complaints from local and state officials about limited testing capacity, the state department told The Sacramento Bee on Wednesday that public health labs currently had enough tests for about 9,000 individuals. As of Saturday, 1,224 people had tested positive in California and 23 have died.
Newsom’s office projects more than half of all Californians could be infected with coronavirus within the next two months, according to a letter the governor sent to President Donald Trump on Wednesday.
The number of tests available for people living in California is likely larger than 9,000 when accounting for commercial or academic labs, but it’s unclear by how much. Health care providers and doctors are reporting those tests are still “very limited,” Beilenson said, and often take longer to get results.
A shortage of tests from the U.S. Centers for Disease Control and Prevention has forced local public health officials to restrict testing to high priority cases: Those with the most severe respiratory infection symptoms that require hospitalization, those with symptoms who have had known exposure to the virus, health care workers and first responders, and people living in congregate living situations.
“Understand that our advice may change as our testing capacity increases locally and statewide, but right now it’s important to reserve our hospital space and our doctors’ time for those who need it most,” said Placer County public health officer Aimee Sisson in a video statement Monday.
State public health officials say the number of people reportedly tested in California is expected to grow, as the agency continues to collect data from additional labs that are now testing for coronavirus. Trump also announced last week testing by commercial labs would ramp up in the next few weeks, as the administration has faced growing pressure from international health groups.
Two pilot drive-up test sites conducted by Google’s sister company Verily in San Mateo and Santa Clara counties have been going well, Newsom said Wednesday. Verily tests require people to pre-qualify for testing by taking an online questionnaire.
He said he hopes it would soon expand drive-up testing to Sacramento County and Riverside County, then possibly expand to additional counties. But he offered no timetable, and Beilenson said he has not received word on when Verily drive-through testing may come to Sacramento, calling it a “red herring.” In an email, a Verily spokesperson said the company would not comment on specifics regarding future testing sites.
World Health Organization Director-General Tedros Adhanom Ghebreyesus called testing, isolation and contact tracing “the backbone of the response” to the pandemic, during a virtual press conference Monday.
“All countries should be able to test all suspected cases,” Tedros said. “They cannot fight this pandemic blindfolded; they should know where the cases are.”
More test kits in California
Since last week, four county public health labs — in Long Beach, Riverside, San Joaquin and San Mateo counties — have received test kits from the U.S. Centers for Disease Control and Prevention, which include important materials and equipment to analyze swab samples from potential coronavirus cases. Including the state’s lab in Richmond, there are now 21 public health labs testing for the virus.
Earlier this month, medical schools, hospitals and commercial testing facilities announced plans to accept samples for coronavirus testing. Newsom said Wednesday that four hospitals are currently testing for the virus, with three more hospitals coming online soon.
Kaiser Permanente has begun piloting a drive-up testing program at one of its local facilities in Sacramento, as well as at several other facilities in the Bay Area, Washington state and more. Those tests, however, are not open to the public and are appointment-only, for patients who meet pre-determined protocols by Kaiser health professionals. No ad hoc drive ups are allowed.
But problems have plagued the start-up process for commercial and hospital testing, and those tests often take longer to return results than those administered at public health labs.
Beilenson told The Bee last Thursday that UC medical schools “are ready with the materials” but lacked positive samples of the coronavirus required for testing. Swabs and chemical reagents are backordered. Coronavirus testing capabilities at a Sacramento-based Quest Diagnostics lab won’t be operational until the end of the month, though the company’s San Juan Capistrano lab has been running samples since last week.
Local county public health labs frequently run samples from neighboring counties, in addition to cases within their borders. Monterey County’s lab can run up to 60 specimens daily, according to Rawni Lunsford, a senior public health microbiologist. Shasta County’s lab runs tests for about five people a day, county spokesman Tim Mapes said last week.
Solano County’s public health lab was running swab samples from 20 to 25 people a day, as of last Friday, according to county health officer Bela Matyas.
“We’re good so far,” Matyas said. “Our issue is going to be when we run out of reagent.”
Newsom said Wednesday that California is still facing a problem of a lack of reagents, and that the state is planning to buy some directly through manufacturers. The Trump administration also announced Thursday that it had purchased more swabs and would distribute them to states based on need.
How long will coronavirus last?
Predictions on the number of people in the United States who will eventually contract the virus have varied, but virtually all public health officials have estimated it will likely be in the tens of millions.
James Lawler, an infectious diseases specialist and public health expert at the University of Nebraska Medical Center, estimated about 96 million people in the United States would be infected, the New York Times reported. And Congress’ in-house doctor told staffers on Capitol Hill he expects between 70 and 150 million people in the United States would contract the virus, Axios reported.
With many supplies required to analyze samples currently on back order, people with COVID-19-like symptoms — fever, cough, shortness of breathing — should self-isolate and only seek medical care if they need it, Shasta County Public Health Branch director Brandy Isola said during a press conference Wednesday.
“At that time, their medical care provider or the hospital, whoever they’re interacting with will decide whether they will need a kit,” she said. “As long as everyone is doing that, the shortage of testing kit components that we’re experiencing, the impact will be able to be lessened.”
President Trump said Monday during a press briefing that the coronavirus crisis will likely continue through July or August — and possibly longer. A federal government plan to combat the spread of the virus warned policymakers last week that a pandemic “will last 18 months or longer,” the New York Times reported.
Adm. Brett Giroir, the Assistant Secretary for Health at the U.S. Department of Health and Human Services, said more than 1.9 million tests, produced by Roche and Thermo Fisher, would become available this week.
Trump also announced last week that drive-through testing sites to help distribute the tests will soon be set up in the parking lots of retailers such as Target and Walgreens. Ten states — including Florida, New York, Washington state and Texas — already run drive-through testing.
“I’ll say it over and over again: When you’re dealing with an emerging infectious diseases outbreak, you are always behind where you think you are, if you think that today reflects where you really are,” Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told reporters on Monday.
This story was originally published March 20, 2020 at 5:00 AM.