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Coronavirus Diagnosis in California Highlights Testing Flaws Coronavirus Diagnosis in California Highlights Testing Flaws
(3 days later)
Already in deep distress, the patient was rushed last week to a hospital in Northern California, severely ill and unable to breathe on her own.Already in deep distress, the patient was rushed last week to a hospital in Northern California, severely ill and unable to breathe on her own.
Doctors at the University of California, Davis Medical Center, near Sacramento, provided the woman with critical care but also considered an unlikely diagnosis: infection with the coronavirus.Doctors at the University of California, Davis Medical Center, near Sacramento, provided the woman with critical care but also considered an unlikely diagnosis: infection with the coronavirus.
Hospital administrators said they immediately requested diagnostic testing from the Centers for Disease Control and Prevention, but the procedure was not carried out because the case did not qualify under strict federal criteria: She had not traveled to China and had not been in contact with anyone known to be infected.Hospital administrators said they immediately requested diagnostic testing from the Centers for Disease Control and Prevention, but the procedure was not carried out because the case did not qualify under strict federal criteria: She had not traveled to China and had not been in contact with anyone known to be infected.
The announcement on Wednesday that the woman was indeed infected left health officials in California searching for people she may have exposed to the virus and testing the medical workers who have treated her. The case has raised difficult questions about whom to test and whether the nation is prepared to keep the virus under control.The announcement on Wednesday that the woman was indeed infected left health officials in California searching for people she may have exposed to the virus and testing the medical workers who have treated her. The case has raised difficult questions about whom to test and whether the nation is prepared to keep the virus under control.
The California woman’s case may also offer the first indication that the virus has spread beyond Americans who traveled outside the country, or had contact with someone who had.The California woman’s case may also offer the first indication that the virus has spread beyond Americans who traveled outside the country, or had contact with someone who had.
Even before the announcement on Wednesday, frustration had been mounting among health providers and medical experts that the agency was testing too few Americans, which may slow preparations for an outbreak and may obscure the scope of infections.Even before the announcement on Wednesday, frustration had been mounting among health providers and medical experts that the agency was testing too few Americans, which may slow preparations for an outbreak and may obscure the scope of infections.
“I think the diagnostic issue is the single most important thing that keeps me up at night right now,” said Lauren Sauer, director of operations at the Johns Hopkins Office of Critical Event Preparedness and Response in Baltimore.“I think the diagnostic issue is the single most important thing that keeps me up at night right now,” said Lauren Sauer, director of operations at the Johns Hopkins Office of Critical Event Preparedness and Response in Baltimore.
C.D.C. officials said on Thursday that they had been unaware that doctors in California made an urgent appeal for diagnostic testing of the woman. But by the end of the day, the agency had revised and broadened its testing criteria, adding to the number of Americans who qualify.C.D.C. officials said on Thursday that they had been unaware that doctors in California made an urgent appeal for diagnostic testing of the woman. But by the end of the day, the agency had revised and broadened its testing criteria, adding to the number of Americans who qualify.
In California, health officials are tracing close contacts of the woman, who lives in Solano County but has not otherwise been identified. Health care workers who have treated her are being monitored for the infection, and some employees at the medical center have been told to stay home.In California, health officials are tracing close contacts of the woman, who lives in Solano County but has not otherwise been identified. Health care workers who have treated her are being monitored for the infection, and some employees at the medical center have been told to stay home.
Officials are bracing for a larger outbreak in Northern California. “There’s almost assuredly going to be a significant number of people testing positive,” said Dr. Peter L. Beilenson, the director of Sacramento County’s Department of Health Services.Officials are bracing for a larger outbreak in Northern California. “There’s almost assuredly going to be a significant number of people testing positive,” said Dr. Peter L. Beilenson, the director of Sacramento County’s Department of Health Services.
The case has heightened concerns about the nation’s ability to test large numbers of people. Only the C.D.C. performs the tests that confirm a novel coronavirus diagnosis, a process that often takes days.The case has heightened concerns about the nation’s ability to test large numbers of people. Only the C.D.C. performs the tests that confirm a novel coronavirus diagnosis, a process that often takes days.
The C.D.C. had distributed diagnostic testing kits to state health departments, but they turned out to be flawed. Replacement kits have not yet been distributed.The C.D.C. had distributed diagnostic testing kits to state health departments, but they turned out to be flawed. Replacement kits have not yet been distributed.
Ms. Sauer said Johns Hopkins had treated several patients who did not fit the testing criteria, and for whom it requested coronavirus testing. In all but one case, the hospital was able to persuade the C.D.C. to run a test, or eventually identify another cause for the patient’s illness.Ms. Sauer said Johns Hopkins had treated several patients who did not fit the testing criteria, and for whom it requested coronavirus testing. In all but one case, the hospital was able to persuade the C.D.C. to run a test, or eventually identify another cause for the patient’s illness.
The C.D.C. is “pretty much the only place we can access testing,” she added, and the agency has been unwilling to grapple with cases that do not fit its criteria.The C.D.C. is “pretty much the only place we can access testing,” she added, and the agency has been unwilling to grapple with cases that do not fit its criteria.
“The idea that we would have to really fight to get that test done, when C.D.C. is saying they have capacity, is alarming.” Ms. Sauer said. “It is a challenge when the most important piece of information — does this person have this disease, yes or no — is not accessible, and there’s no timeline for improved accessibility.”“The idea that we would have to really fight to get that test done, when C.D.C. is saying they have capacity, is alarming.” Ms. Sauer said. “It is a challenge when the most important piece of information — does this person have this disease, yes or no — is not accessible, and there’s no timeline for improved accessibility.”
After the diagnosis in California, the C.D.C. has pledged to greatly expand the state’s ability to test patients for the coronavirus, officials said.After the diagnosis in California, the C.D.C. has pledged to greatly expand the state’s ability to test patients for the coronavirus, officials said.
“Testing protocols have been a point of frustration for many of us,” Gov. Gavin Newsom said at a news conference on Thursday. California had just 200 testing kits left, he added.“Testing protocols have been a point of frustration for many of us,” Gov. Gavin Newsom said at a news conference on Thursday. California had just 200 testing kits left, he added.
The governor said Dr. Robert R. Redfield, the director of the C.D.C., promised that state physicians would have a much greater ability to test patients who were showing symptoms, a change the governor said “can’t happen soon enough.”The governor said Dr. Robert R. Redfield, the director of the C.D.C., promised that state physicians would have a much greater ability to test patients who were showing symptoms, a change the governor said “can’t happen soon enough.”
The C.D.C. has committed to sending a team to California to help track people and make sure they are contacted by health officials about their possible exposure, Mr. Newsom said.The C.D.C. has committed to sending a team to California to help track people and make sure they are contacted by health officials about their possible exposure, Mr. Newsom said.
“They are being interviewed — points of contact, family members and others,” he said.“They are being interviewed — points of contact, family members and others,” he said.
Experts said they were perplexed by the C.D.C.’s inability to fix the test’s flaws.Experts said they were perplexed by the C.D.C.’s inability to fix the test’s flaws.
“The obvious observation is that many countries are capable of testing rather widely,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville. “Why can’t we?”“The obvious observation is that many countries are capable of testing rather widely,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville. “Why can’t we?”
Updated June 12, 2020Updated June 12, 2020
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
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The C.D.C. operates two laboratories that test for the coronavirus and can handle approximately 400 specimens per day. Agency officials say there is no testing backlog, but it is unclear whether the labs will be able to keep up with demand if the need — and eligibility — increases testing substantially.The C.D.C. operates two laboratories that test for the coronavirus and can handle approximately 400 specimens per day. Agency officials say there is no testing backlog, but it is unclear whether the labs will be able to keep up with demand if the need — and eligibility — increases testing substantially.
Under the new federal criteria, people with respiratory symptoms who traveled to Iran, Italy, Japan and South Korea should be tested — not just those who traveled in China. So should severely ill patients with acute lower respiratory symptoms who are hospitalized and in whom other diagnoses have been ruled out.Under the new federal criteria, people with respiratory symptoms who traveled to Iran, Italy, Japan and South Korea should be tested — not just those who traveled in China. So should severely ill patients with acute lower respiratory symptoms who are hospitalized and in whom other diagnoses have been ruled out.
A criticism of the new criteria, however, is that doctors will have to wait until someone is extremely ill to test for the virus if that person did not travel to the affected regions or have contact with a known case.A criticism of the new criteria, however, is that doctors will have to wait until someone is extremely ill to test for the virus if that person did not travel to the affected regions or have contact with a known case.
“If we could identify these people earlier who don’t specifically meet one of the two criteria, or some sort of broader travel criteria, we could get them tested,” Ms. Sauer said. “You have to wait until someone’s really sick to push that test now, even with this new criteria.“If we could identify these people earlier who don’t specifically meet one of the two criteria, or some sort of broader travel criteria, we could get them tested,” Ms. Sauer said. “You have to wait until someone’s really sick to push that test now, even with this new criteria.
Kenneth E. Raske, president of the Greater New York Hospital Association, said he planned to appeal to Vice President Mike Pence — whom President Trump named to lead federal preparations — “to order the C.D.C. to develop a rapid point of care test” that hospitals could use to screen patients.Kenneth E. Raske, president of the Greater New York Hospital Association, said he planned to appeal to Vice President Mike Pence — whom President Trump named to lead federal preparations — “to order the C.D.C. to develop a rapid point of care test” that hospitals could use to screen patients.
In the meantime, Mr. Raske said, the Wadsworth Center, New York’s public health reference laboratory, should be certified to do these tests.In the meantime, Mr. Raske said, the Wadsworth Center, New York’s public health reference laboratory, should be certified to do these tests.
If more community-acquired infections turn up, and the disease cannot be contained, the strategy will have to become one of mitigation, said Dr. Neil Fishman, associate chief medical officer for the University of Pennsylvania Health System.If more community-acquired infections turn up, and the disease cannot be contained, the strategy will have to become one of mitigation, said Dr. Neil Fishman, associate chief medical officer for the University of Pennsylvania Health System.
“That’s a little difficult to do when you don’t have a readily available test, and when the turnaround time for the test can be days instead of hours,” he said.“That’s a little difficult to do when you don’t have a readily available test, and when the turnaround time for the test can be days instead of hours,” he said.
Thomas Fuller contributed reporting from Solano County, Calif., Nicholas Bogel-Burroughs from New York and Michael D. Shear from Washington, D.C.Thomas Fuller contributed reporting from Solano County, Calif., Nicholas Bogel-Burroughs from New York and Michael D. Shear from Washington, D.C.