Top health experts caution against reopening society before coronavirus testing capacity expands

CNN's Dr. Sanjay Gupta walks us through his coronavirus antibody test and highlights key details regarding this type of testing.

Posted: Apr 22, 2020 5:11 PM
Updated: Apr 22, 2020 5:11 PM

States may be planning to reopen businesses and communities despite the continuing coronavirus pandemic, but a group of top public health experts cautioned Tuesday against doing so before testing capacity expands significantly.

The president of Harvard's Institute of Medicine, Dr. Harvey V. Fineberg, said it's not a choice between dealing with the disease or dealing with the economy. "We have to do both," Fineberg told a symposium sponsored by Harvard's T.H. Chan School of Public Health and the New England Journal of Medicine.

Different parts of the country are in different stages of the epidemic with New York well into the first wave and other places just beginning to see the impact of the disease. This matters, said Caroline Buckee, Harvard associate professor of epidemiology and the associate director of the university's Center for Communicable Disease Dynamics.

Knowing where the virus is spreading is key to relaxing social distancing and returning to normalcy, Buckee said.

In addition to different parts of the country seeing different disease curves, there are "important epidemiological timelines here where when you become infected you're spreading the virus, but you don't show any symptoms for about five days or so," Buckee said. "For people who end up in the hospital, that takes another week and then disease progression from there to death takes another week or more," she added.

"So, there's a long time lag between when people are becoming infected and when we're starting to see an uptick in deaths. And I think that really highlights the important problem here of lack of test capacity. This has a been a problem from the beginning and it continues to be patchy," she said.

The lack of testing capacity is a big problem because the disease has "a very broad clinical spread," Buckee said. So even as people show up at the hospital and get tested, there are many more cases in the community, including mild and asymptomatic cases that go undetected.

"And those are the people that are spreading the disease. Right now, we don't have good estimates for where we are on the epidemic curve in different places," said Buckee.

"So discussions of relaxation of physical distance, which do seem to be having an effect, curbing some of the worst impacts of the outbreak, need to be based on the capacity to test people so we know where we are."

It's important to learn whether people who have recovered can still spread the disease, noted NEJM editor Dr. Eric Rubin. "What we really need is some epidemiologic data to tell us are people who have left the hospital going on to transmit the disease," Rubin said. "That's kind of the shoe leather epidemiology, contact tracing, following what happens to the context of those patients, which takes some manpower."

Buckee added that without knowing the answers, the nation could reopen too soon and risk a deadly second pandemic wave.

"Right now, we don't have good estimates for where we are on the epidemic curve in different places. So, discussions of relaxation of physical distance, which do seem to be having an effect, curbing some of the worst impacts of the outbreak, need to be based on the capacity to test people so we know where we are," she said.

A preprint, or non-peer reviewed study, released Friday found that many more people likely had been infected with Covid-19 in Santa Clara County in California than got official diagnoses -- perhaps as many as 50 to 85 times more cases.

There are two types of tests: one that looks for actively circulating virus and another that tests for antibodies to the virus, an indication a person has been infected at some time in the past.

"Until we know how far along the epidemic curve we are, we can't really make informed decisions about opening up and how to do that in sensible way because we simply don't know whether we're close to the first peak or not," Buckee said.

"We could see a second wave that could be even more deadly. So really understanding where we are in the epidemic curve, which will be different in different places, is where we're at. And I think, again, the call for testing is the most important.

The director of the US Centers for Disease Control and Prevention, Dr. Robert Redfield, told The Washington Post that a second coronavirus outbreak could emerge this winter in conjunction with the flu season to make for an even more dire health crisis.

At the White House briefing Tuesday coronavirus task force coordinator Dr. Deborah Birx was asked about Redfield's comments and emphasized the importance of testing, too.

"We were very clear in the guidelines that we believe we can monitor, again, monitor communities at the community level," she said.

The Johns Hopkins University has been keeping track of coronavirus statistics and says so far 4,035,860 tests have been performed in the United States, but it's unclear the exact number of people who have actually been tested as some people have been repeatedly tested for the virus and others just once.

The CDC's own guidelines warn against reopening communities until certain criteria have been met including making sure disease transmission is under control and that health systems are able to "detect, test, isolate and treat every case and trace every contact."

Indiana Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 51079

Reported Deaths: 2756
CountyConfirmedDeaths
Marion12019693
Lake5588248
Elkhart353959
Allen2939134
St. Joseph210669
Hamilton1691101
Cass16449
Hendricks1454100
Johnson1340118
Porter82638
Tippecanoe7709
Vanderburgh7276
Clark69544
Madison67464
LaPorte61628
Howard59858
Bartholomew59745
Kosciusko5754
Marshall5449
Noble51328
LaGrange4849
Boone48244
Jackson4783
Delaware47152
Hancock46736
Shelby45425
Floyd40644
Morgan34231
Monroe34028
Grant31826
Dubois3046
Henry30018
Montgomery29720
Clinton2903
White27410
Dearborn25823
Decatur25632
Lawrence25225
Vigo2528
Warrick25029
Harrison21722
Greene19432
Miami1932
Jennings17912
Putnam1738
DeKalb1694
Scott1649
Wayne1546
Daviess15017
Perry14710
Orange13723
Steuben1362
Jasper1352
Ripley1307
Franklin1278
Gibson1202
Wabash1162
Carroll1142
Fayette1067
Whitley1066
Starke1043
Newton10010
Huntington942
Jefferson862
Wells821
Randolph794
Fulton731
Knox710
Jay700
Washington681
Pulaski661
Clay645
Rush613
Posey570
Spencer541
Owen521
Benton510
Sullivan501
Adams491
Brown431
Blackford402
Fountain352
Crawford330
Switzerland320
Tipton321
Parke270
Martin260
Ohio230
Vermillion200
Warren151
Union140
Pike110
Unassigned0193

Ohio Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 64214

Reported Deaths: 3036
CountyConfirmedDeaths
Franklin11724445
Cuyahoga8979393
Hamilton6781207
Lucas2952305
Marion274539
Montgomery244035
Summit2327209
Pickaway222241
Mahoning1928239
Butler182147
Columbiana137860
Stark1214114
Lorain112069
Trumbull104578
Warren97725
Clark80010
Delaware69815
Fairfield66717
Tuscarawas60410
Lake58923
Medina58232
Belmont56922
Licking56812
Miami50631
Portage49259
Wood48851
Clermont4737
Ashtabula44744
Geauga42543
Wayne37253
Richland3715
Allen35641
Greene3439
Mercer29910
Erie27122
Holmes2595
Darke25626
Huron2402
Madison2169
Ottawa17324
Sandusky16015
Washington14620
Ross1443
Coshocton1423
Athens1391
Crawford1385
Putnam13715
Hardin12312
Morrow1201
Auglaize1094
Jefferson1092
Muskingum1001
Union931
Preble901
Monroe8917
Hancock861
Lawrence830
Guernsey823
Clinton811
Hocking809
Williams762
Shelby744
Logan711
Ashland672
Carroll673
Fulton670
Scioto670
Wyandot635
Brown611
Fayette550
Defiance533
Knox531
Champaign511
Highland501
Van Wert471
Perry441
Seneca412
Henry330
Paulding300
Jackson280
Pike280
Adams261
Vinton232
Gallia201
Noble140
Harrison131
Meigs130
Morgan110
Unassigned00
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