How An Early Plan To Spot The Virus Fell Weeks Behind

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The government's missed opportunity for surveillance of the crow bias. What slowed scientists down and the loss time that could have been used to give some cities an earlier warning. You're listening to shortwave the daily science podcast from NPR. Okay Lawrence so it least. Six cities were supposed to be using surveillance systems that were originally built for the flu to test for cases of the Corona virus weeks into that effort. Only one had done that. So where's a good place to start? Let's start in Los Angeles. They ran into some issues back in February. They knew that tracking the outbreak through the number of positive cases that were popping up. Just wasn't a great idea. Because testing was so limited right in order to get tested at that time you had to either recently traveled to China or had close contact with somebody else who tested so. It was like a really high bar to get tested. Yeah and that was because almost no state labs could run the CDC's corona virus tests at the time they had sent out faulty test. Kits see no even patients with the right symptoms. Really couldn't get a test. Which makes it really hard to see. What's happening in a community but for this project the surveillance cities they were guaranteed testing by the CDC and they could send their samples to the agency's headquarters in Atlanta. So how did Los Angeles Start? Looking for the corona virus so county health officials starting talking to hospitals about testing these mildly symptomatic patients. You know and they got pretty far with one of them Dr Prabhu Gander of the Los Angeles County Department of Public Health. He told me when the hospital's board discussed it though they declined to be part of it we only had one confirmed cove in nineteen case in La County and they were concerned that if the second case in La County was linked to this hospital. That there'd be a certain stigma that would potentially be bad for the hospital. Okay so they were worried about the hospital's reputation. Do I have that right? Yeah and he says. The hospital was concerned that patients would be anxious and avoid the hospital if they found the corona virus there now county. Health officials declined to name this hospital because they said they agreed to keep discussions confidential. Well okay so how did L. A? Eventually get testing started. Another hospital reached out to county health officials and that was La County USC Medical Center the Chief Medical Officer. There is Dr Brad Spell Berg. And he knew surveillance monitoring was important. This is a leading edge indicator. If you don't look at it you're missing the Canary in the coalmine. You're waiting for the coal mine to collapse on you. Yes Spielberg wanted to do this. But his hospital into one of the biggest issues in this story of the pandemic testing to speed things up they were gonNA use tests from a private lab but there was only a small number of them. That was against huge resistance. The whole system is like you're wasting our tests. Don't do this. But his hospital pushed ahead and began testing at the county's Medical Center and some of its clinics on March twelfth. When the results started coming back it looked as if five percent of the patients they tested positive for corona virus. Bruce People that had been going to work going to social events wandering around in the community for the days and days. They have the right. This was well before we had broad social distancing policies. Yeah we didn't have that almost anywhere in the country at the time but once officials in La county new this you know they realize that people have been walking around with the virus more of them that they knew and this was a really key turning point in how they responded until then it was about trying to contain the virus. Us contact tracing to track down every person who may have been exposed you know but one of viruses spreading undetected epidemiologists will tell you that containment strategy just isn't enough so in the days after those results Mayor Eric. Garcetti issued a stay at home order for Los Angeles your actions matter and they can and will save lives. Okay so that's what happened in L. A. What happened in those five other cities most of them also struggled to get going? You know for example. New York City didn't get results from its sentinel testing until March thirty first. I couldn't get more information about why it took so long. You know the city is obviously overwhelmed right now but at that point the surveillance was too late to be useful. I mean there are already forty thousand cases at that time. Yeah not exactly an early warning at that point and you know Seattle also had struggles Washington state officials had an idea of how they want to do a sentinel surveillance when they first started talking to. Cdc One of the things. I propose very early was that we use samples from Seattle lose steady. Scott Linquist is the state epidemiologist. He wanted to use the Seattle flu study. Which is a research project that was already testing people with respiratory symptoms surveillance? That was up and running. My point was why. Don't we use those samples? It's up and running. Let's do it and that was denied the problem according to the CDC and FDA was that it was a research project and it didn't have the necessary approvals to run clinical tests for patients and they hadn't gotten consent from the patients to do the corona virus testing so the FDA denied the request at that time. Okay actually make some sense to me so was Seattle able to get anything together eventually. Yes about a month after that the Seattle flu studied did get all the necessary approvals. And they're doing testing now but linguists thinks they clearly could have used it earlier. Could've let us know that it was here before we had the community outbreaks and transmission in the long term care facilities but We miss that period so okay. This effort came up short to say the least. These were weeks when we could have been looking for the virus but the system itself didn't work those extra weeks had to have made a difference right. Well it's to say recognize situation where we been passed as wanted to. That's Dr Joseph Z. A deputy incident manager at the CDC said the delays happened because it was an entirely new virus. It took extra. Planning for collecting samples shipping them ensuring healthcare workers had protective gear. But whether that time made any difference question about whether this revolt we delay APP on longer. resulted in losing visibility. In those half thing and it's and I don't think so. Three weeks is an enormous amount of time to allow cases to accumulate without knowing about it. That's Jennifer nozoe an epidemiologist at Johns Hopkins Bloomberg School of Public Health. If it has sentinel surveillance stood up in A number of cities cities where we would expect to see cases. I We possibly could have caught it earlier and possibly intervened before the case numbers exploded. And you know when you look at the data. It's not hard to see that. The places with earlier state home orders seem to have done better there curves are flatter and they avoided a lot of the hospitalizations and deaths according to models. It really wasn't easy for officials to issue those orders. You know if you remember. There was a lot of debate about when to do it. But from talking to these cities the ones that had this hard data from Sentinel surveillance community spread was happening. They were able to act. I write so okay. Obviously this a very useful public health tool does the CDC have any plans to do this in the future. Yes a number of the cities and counties I spoke to are planning on starting sentinel testing again soon because you know as the outbreak starts waning. They're going to need to find the flare ups and spot the new cases before it spreads even more the trump administration is also talking about using it in their plan for reopening the country. So we'll be doing sentinel surveillance throughout nursing. Homes throughout inner city federal clinics throughout indigenous populations to really be able to find early alerts of symptomatic individuals in the community. Dr Deborah Brooks is talking about doing that testing for people who don't show any symptoms but who may still be infected and spreading the virus the epidemiology. I spoke to said you know this is something the country has to get right. This time. You know not just waiting for cove in nineteen cases to walk into an emergency room but designing studies to go out and looking communities and actually get the early warnings that this kind of testing could have provided in the first place.

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