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| As Virus Spreads, States Face a Truth: ‘We Cannot Test Our Way Out of This’ | As Virus Spreads, States Face a Truth: ‘We Cannot Test Our Way Out of This’ |
| (8 days later) | |
| WASHINGTON — As the United States struggled with coronavirus testing this spring, Tennessee was the rare state that lived up to President Trump’s promise that “anybody that wants a test can get a test.” Gov. Bill Lee announced in mid-April that any Tennessean could get tested — regardless of symptoms — and that the state would pay for it. | WASHINGTON — As the United States struggled with coronavirus testing this spring, Tennessee was the rare state that lived up to President Trump’s promise that “anybody that wants a test can get a test.” Gov. Bill Lee announced in mid-April that any Tennessean could get tested — regardless of symptoms — and that the state would pay for it. |
| “Testing may be the most important thing in addressing the unknown,” Mr. Lee, a Republican, said in an interview in early June. Decisions, he said, should be based on “real information.” | “Testing may be the most important thing in addressing the unknown,” Mr. Lee, a Republican, said in an interview in early June. Decisions, he said, should be based on “real information.” |
| But that real information is now telling the state’s leadership a story it most likely did not want to hear: As in much of the South and West, Tennessee is awash in confirmed cases, and testing has proved no match for the coronavirus once it overwhelms local governments’ abilities to trace an infected person’s contacts and forces those who were exposed to self-quarantine. | But that real information is now telling the state’s leadership a story it most likely did not want to hear: As in much of the South and West, Tennessee is awash in confirmed cases, and testing has proved no match for the coronavirus once it overwhelms local governments’ abilities to trace an infected person’s contacts and forces those who were exposed to self-quarantine. |
| Tennessee is far from the only state to discover that despite Mr. Trump’s hype — he boasted on Monday on Twitter: “our great testing program continues to lead the World, by FAR!” — coronavirus testing is not a miracle path to a safe reopening. As the nation faces a new shortage of tests, Tennessee’s experiences offer a cautionary tale about the limits of testing. | Tennessee is far from the only state to discover that despite Mr. Trump’s hype — he boasted on Monday on Twitter: “our great testing program continues to lead the World, by FAR!” — coronavirus testing is not a miracle path to a safe reopening. As the nation faces a new shortage of tests, Tennessee’s experiences offer a cautionary tale about the limits of testing. |
| In Georgia, Gov. Brian Kemp, a Republican, expanded testing in early May and urged all residents to make appointments; in Oklahoma, Gov. Kevin Stitt, a Republican, did much the same thing. In Ohio, Gov. Mike DeWine announced on June 11 that any Ohioan could get a test; he and his wife, Fran DeWine, along with the state’s lieutenant governor, Jon Husted, took tests at a news conference as a way of encouraging others to do so. Each state has since had a sharp increase in confirmed infections. | In Georgia, Gov. Brian Kemp, a Republican, expanded testing in early May and urged all residents to make appointments; in Oklahoma, Gov. Kevin Stitt, a Republican, did much the same thing. In Ohio, Gov. Mike DeWine announced on June 11 that any Ohioan could get a test; he and his wife, Fran DeWine, along with the state’s lieutenant governor, Jon Husted, took tests at a news conference as a way of encouraging others to do so. Each state has since had a sharp increase in confirmed infections. |
| “This was just as predictable as buying snow tires in June for your car in Minnesota,” said Dr. Michael T. Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “You know December is coming.” | “This was just as predictable as buying snow tires in June for your car in Minnesota,” said Dr. Michael T. Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “You know December is coming.” |
| The Trump administration announced on Tuesday that it would start offering free coronavirus testing in three cities — Jacksonville, Fla.; Baton Rouge, La.; and Edinburg, Texas — as part of a new “surge testing” program to support communities identified as hot spots. | The Trump administration announced on Tuesday that it would start offering free coronavirus testing in three cities — Jacksonville, Fla.; Baton Rouge, La.; and Edinburg, Texas — as part of a new “surge testing” program to support communities identified as hot spots. |
| But even as he made the announcement, Adm. Brett P. Giroir, the assistant secretary of health, sounded a note of caution, warning that testing without other public health interventions — contact tracing, isolating the sick, social distancing and wearing masks — would be of little use. | But even as he made the announcement, Adm. Brett P. Giroir, the assistant secretary of health, sounded a note of caution, warning that testing without other public health interventions — contact tracing, isolating the sick, social distancing and wearing masks — would be of little use. |
| “We cannot test our way out of this,” he told reporters, adding, “Testing alone is almost never the answer.” | “We cannot test our way out of this,” he told reporters, adding, “Testing alone is almost never the answer.” |
| To be sure, some states that have carried out aggressive testing programs are faring well. Rhode Island has been a national leader, testing 236 out of every 1,000 people — far more than any other state, according to the Kaiser Family Foundation. Its positivity rate — the share of tests coming back positive, a key indicator of whether a state is doing enough testing to keep the virus in check — is 1.8 percent, well below the target of 5 percent or less set by public health experts. | To be sure, some states that have carried out aggressive testing programs are faring well. Rhode Island has been a national leader, testing 236 out of every 1,000 people — far more than any other state, according to the Kaiser Family Foundation. Its positivity rate — the share of tests coming back positive, a key indicator of whether a state is doing enough testing to keep the virus in check — is 1.8 percent, well below the target of 5 percent or less set by public health experts. |
| In Tennessee, where 132 out of every 1,000 people have been tested, daily confirmed infections nearly quadrupled between early June and early July, though they have dropped somewhat in recent days. The positivity rate shot up to nearly 8 percent from 5 percent. Last week, the mayor of Nashville, the state’s largest city, rolled back its reopening. | In Tennessee, where 132 out of every 1,000 people have been tested, daily confirmed infections nearly quadrupled between early June and early July, though they have dropped somewhat in recent days. The positivity rate shot up to nearly 8 percent from 5 percent. Last week, the mayor of Nashville, the state’s largest city, rolled back its reopening. |
| “I’m proud of what we’ve done for the most part, but I’m getting worried,” Dr. Alex Jahangir, the chairman of Nashville’s Board of Health and the leader of the city’s coronavirus task force, said in an interview last week. “Normally, in an ideal world, if you test more your positivity rate is going to go down. It blows my mind, but our positivity rate has gone up. That’s really alarming.” | “I’m proud of what we’ve done for the most part, but I’m getting worried,” Dr. Alex Jahangir, the chairman of Nashville’s Board of Health and the leader of the city’s coronavirus task force, said in an interview last week. “Normally, in an ideal world, if you test more your positivity rate is going to go down. It blows my mind, but our positivity rate has gone up. That’s really alarming.” |
| There are some obvious explanations for Tennessee’s travails. The state was among the first to reopen its economy, and many people abandoned social distancing and masks. A country music star, Chase Rice, performed in late June in front of 1,000 people — most not wearing masks — at an outdoor venue in eastern Tennessee and was eventually shamed into delivering what critics called a nonapology | There are some obvious explanations for Tennessee’s travails. The state was among the first to reopen its economy, and many people abandoned social distancing and masks. A country music star, Chase Rice, performed in late June in front of 1,000 people — most not wearing masks — at an outdoor venue in eastern Tennessee and was eventually shamed into delivering what critics called a nonapology |
| Young people jammed into Nashville’s famed honky-tonks and bars; Dr. Jahangir said the biggest growth in cases in the city was among people ages 25 to 34. In a city whose economy thrives on music and drinking, tensions have erupted between businesspeople and public health officials. | Young people jammed into Nashville’s famed honky-tonks and bars; Dr. Jahangir said the biggest growth in cases in the city was among people ages 25 to 34. In a city whose economy thrives on music and drinking, tensions have erupted between businesspeople and public health officials. |
| One of the city’s best-known establishments — Kid Rock’s Big Ass Honky Tonk & Rock ’N’ Roll Steakhouse — lost its permit to serve beer for five days after opening its bar in violation of a city public health emergency order that limited alcohol to tables and booths. Photographs on social media showed a packed house of maskless patrons standing shoulder to shoulder. On Monday, Kid Rock’s was among several bars whose owners sought a temporary restraining order against city and state health officials. | One of the city’s best-known establishments — Kid Rock’s Big Ass Honky Tonk & Rock ’N’ Roll Steakhouse — lost its permit to serve beer for five days after opening its bar in violation of a city public health emergency order that limited alcohol to tables and booths. Photographs on social media showed a packed house of maskless patrons standing shoulder to shoulder. On Monday, Kid Rock’s was among several bars whose owners sought a temporary restraining order against city and state health officials. |
| “We did well, but then stuff started opening up, and there’s not national leadership. I don’t care if you quote me on that, because I’m tired of being P.C. about that,” Dr. Jahangir said, referring to political correctness. “There’s not national leadership, and there’s a lot of pressure to open up the economy.” | “We did well, but then stuff started opening up, and there’s not national leadership. I don’t care if you quote me on that, because I’m tired of being P.C. about that,” Dr. Jahangir said, referring to political correctness. “There’s not national leadership, and there’s a lot of pressure to open up the economy.” |
| Public health experts say they saw this coming and have been warning for months that the country was too focused on testing and not enough on other measures, like contact tracing, that must be paired with it. | Public health experts say they saw this coming and have been warning for months that the country was too focused on testing and not enough on other measures, like contact tracing, that must be paired with it. |
| “I feel like we’ve got attention deficit disorder — we can only focus on one thing: a travel ban, stay at home, testing,” Dr. Thomas R. Frieden, a former director of the Centers for Disease Control and Prevention, recently told reporters. “None of those things are going to work in isolation.” | “I feel like we’ve got attention deficit disorder — we can only focus on one thing: a travel ban, stay at home, testing,” Dr. Thomas R. Frieden, a former director of the Centers for Disease Control and Prevention, recently told reporters. “None of those things are going to work in isolation.” |
| Dr. Osterholm said he, too, had been trying to send the message that “the testing, testing and testing mantra was not going to save us, or even materially change the course of the pandemic.” He said he saw offering tests to anyone, regardless of symptoms, as a waste of precious resources. | Dr. Osterholm said he, too, had been trying to send the message that “the testing, testing and testing mantra was not going to save us, or even materially change the course of the pandemic.” He said he saw offering tests to anyone, regardless of symptoms, as a waste of precious resources. |
| In May, he and his colleagues published an article calling for a national blue-ribbon panel to devise a “smart testing” strategy. | In May, he and his colleagues published an article calling for a national blue-ribbon panel to devise a “smart testing” strategy. |
| But the Trump administration has resisted a national testing strategy, insisting that it be left to the states. And Mr. Trump’s mixed messages about testing are only complicating matters. His claim in April that the United States had “tested more than every country combined” was rated “‘pants on fire’ wrong” by Kaiser Health News. | But the Trump administration has resisted a national testing strategy, insisting that it be left to the states. And Mr. Trump’s mixed messages about testing are only complicating matters. His claim in April that the United States had “tested more than every country combined” was rated “‘pants on fire’ wrong” by Kaiser Health News. |
| Now, the president has taken to blaming the rising caseloads on an increase in testing — an assertion that is also false, given that the percentage of tests coming back positive is also rising. The sharp increase in confirmed infections has created more demand for testing, leaving some governors back where they started: scrambling for scarce supplies. | Now, the president has taken to blaming the rising caseloads on an increase in testing — an assertion that is also false, given that the percentage of tests coming back positive is also rising. The sharp increase in confirmed infections has created more demand for testing, leaving some governors back where they started: scrambling for scarce supplies. |
| “Although we have greatly expanded the amount of testing we have done in the United States, the virus has outpaced those efforts,” said Dr. Jennifer Nuzzo, the lead epidemiologist for Johns Hopkins University’s Covid-19 Testing Insights Initiative. | “Although we have greatly expanded the amount of testing we have done in the United States, the virus has outpaced those efforts,” said Dr. Jennifer Nuzzo, the lead epidemiologist for Johns Hopkins University’s Covid-19 Testing Insights Initiative. |
| Updated July 7, 2020 | |
| The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization. | |
| 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. | |
| Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. | |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | |
| 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. | |
| 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 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. | |
| Throughout the spring, administration officials and public health experts said states needed to ramp up testing and contact tracing to reopen. But very few were doing enough to stay on top of potential outbreaks. Tennessee’s expansive approach stood out, according to a report in May by Kaiser Health News, which wrote that it was ”rare for a community to encourage such broad symptom-free testing.” | Throughout the spring, administration officials and public health experts said states needed to ramp up testing and contact tracing to reopen. But very few were doing enough to stay on top of potential outbreaks. Tennessee’s expansive approach stood out, according to a report in May by Kaiser Health News, which wrote that it was ”rare for a community to encourage such broad symptom-free testing.” |
| Building capacity took time. The state’s health commissioner, Dr. Lisa Piercey, said in an interview that she initially relied on national laboratory vendors, who were slow, before turning to private labs based in Tennessee. | Building capacity took time. The state’s health commissioner, Dr. Lisa Piercey, said in an interview that she initially relied on national laboratory vendors, who were slow, before turning to private labs based in Tennessee. |
| It was a win-win situation, she said: By guaranteeing payment, the state created a ready market for the local laboratories, which were able to purchase new equipment, scale up and deliver test results quickly. Facing outbreaks in prisons and nursing homes, the state also did targeted testing. | It was a win-win situation, she said: By guaranteeing payment, the state created a ready market for the local laboratories, which were able to purchase new equipment, scale up and deliver test results quickly. Facing outbreaks in prisons and nursing homes, the state also did targeted testing. |
| Tennessee’s governor “made two very important decisions that I wish could have been a national model,” said Dr. James E.K. Hildreth, the president of Meharry Medical College in Nashville. “He made testing available to anyone who wanted a test, and he also decided to test nursing homes and prisons.” | Tennessee’s governor “made two very important decisions that I wish could have been a national model,” said Dr. James E.K. Hildreth, the president of Meharry Medical College in Nashville. “He made testing available to anyone who wanted a test, and he also decided to test nursing homes and prisons.” |
| But not everyone has such high praise. Dr. William Schaffner, a professor of preventive medicine and infectious disease Vanderbilt University in Nashville, said he gave the governor a B+ for his management of the pandemic. While Mr. Lee had “modeled wearing masks,” Dr. Schaffner said, the governor opened the economy “earlier than the medical community wanted, and so that knocks him down a little bit.” | But not everyone has such high praise. Dr. William Schaffner, a professor of preventive medicine and infectious disease Vanderbilt University in Nashville, said he gave the governor a B+ for his management of the pandemic. While Mr. Lee had “modeled wearing masks,” Dr. Schaffner said, the governor opened the economy “earlier than the medical community wanted, and so that knocks him down a little bit.” |
| Mr. Lee, a businessman who had never held public office before becoming governor, said the decision to offer free testing grew partly out of his Christian faith; he did faith-based nonprofit work in Haiti, Mexico and Africa, which gave him an appreciation for those confronting disease. Dr. Piercey said they had prayed about it. | Mr. Lee, a businessman who had never held public office before becoming governor, said the decision to offer free testing grew partly out of his Christian faith; he did faith-based nonprofit work in Haiti, Mexico and Africa, which gave him an appreciation for those confronting disease. Dr. Piercey said they had prayed about it. |
| “Our key success factor is you will never pay for a test,” she said in late May, when daily confirmed infections were declining and the positivity rate was about 5 percent. “We couldn’t think of a better way to use our resources than on widespread testing.” | “Our key success factor is you will never pay for a test,” she said in late May, when daily confirmed infections were declining and the positivity rate was about 5 percent. “We couldn’t think of a better way to use our resources than on widespread testing.” |