As the United States navigates one of the most serious pandemics in history, much of the country has been shut down to prevent devastating local outbreaks that threaten lives and can overwhelm hospitals.
A breakdown in the federal disaster response delayed state and local responses, allowing SARS-CoV-2 to spread rapidly in New York, New Jersey, Michigan, Louisiana, and other states. Only astute early interventions in Seattle and the San Francisco Bay Area seem to have stemmed a potential tide of cases and deaths.
Covid-19 has taken more American lives in 1 month than the Vietnam War claimed over 8 years. Other countries, such as Australia, South Korea, Germany, Singapore, and Taiwan, managed to contain the virus early and are working hard to keep it suppressed as they reopen their economies.
Tragically, the United States, unable to match other countries’ response, has tallied the most cases and deaths in the world — and recent data suggest that those tallies are underestimates. Why has the U.S. response been so ineffectual?
One key answer is testing, which has been a cornerstone of Covid-19 control elsewhere. U.S. testing to identify people infected with SARS-CoV-2 has been slow to start and to this day has not sufficiently ramped up.
Testing was delayed in January and February as the Centers for Disease Control and Prevention (CDC) distributed faulty test kits, then failed to approve a working test developed by the World Health Organization or those developed by local public health laboratories. Since March, the number of tests per day has never reached the number needed because of shortages of reagents, materials, and personal protective equipment (see graph).
Having failed to test early enough to contain outbreaks, the country has fallen back on two mitigation strategies: accelerating drug and vaccine development and an unprecedented strategy of nonpharmacologic interventions (NPIs) involving draconian school and business closures, stay-at-home orders, and physical distancing. Drugs and vaccines are extremely unlikely to alter the early course of the pandemic.
In the short term, only NPIs have slowed the spread of disease. Yet NPIs carry a heavy economic price as well as their own health burdens, as people fail to receive care for other conditions or suffer mental health consequences from isolation, unemployment, and sudden poverty. Whether NPIs are maintained or not, serious health consequences appear inescapable.
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Schneider EC. Failing the Test — The Tragic Data Gap Undermining the U.S. Pandemic Response. New England Journal of Medicine 2020. https://doi.org/10.1056/NEJMp2014836