Medical graphic

ARIZONA — We blew it. Big time.

The continuing lack of tests for COVID-19 has hobbled the response across the nation, especially in Arizona, according to medical experts.

The lack of tests for weeks prevented doctors from checking people with mild symptoms and no history of travel to infected areas or significant contact with someone who has tested positive. The tests have all gone through the state health department until just recently, with some private labs now offering testing.

The lack of tests has made it more difficult to identify people who may spread the virus as well as understanding the full dimensions of the infection, according to doctors.

The number of confirmed cases in Arizona jumped to 254 on Monday, including at 4 in Apache County and 25 in Navajo County. So far Gila County’s one of four in the state with no confirmed cases. Two people in Arizona have now died.

Other rural counties still have only a handful of cases, including 17 in Coconino, 3 in Yavapai, 2 in Graham and one in Yuma, one in Cochise, and one in Santa Cruz. Gila, Greenlee, La Paz and Mohave have reported no cases.

However, Maricopa has reported 81, Pinal 16 and Pima 17.

The state health department’s website indicates just 400 tests have been processed, with 87 tests still pending. Private health labs have conducted an unknown number of additional tests, but they do report posistive cases to the state health department.

As of Monday morning, the US reported more than 35,000 cases and 428 deaths. The numbers have been increasing by about 4,000 per day.

Worldwide, the tally on Monday stands 354,000 cases and 15,400 deaths, according to a website maintained by Johns Hopkins University.

So far, that’s still far less than the flu – which last year caused an estimated 300,000 and 600,000 deaths worldwide — an estimate since most people with the flu don’t get tested. The U.S. suffers 16,000 to 61,000 flu deaths annually.

The U.S. has lagged far behind other nations in testing to contain COVID-19. Consider the contrast with South Korea, now lauded internationally for its success in containing the outbreak.

South Korea, as of March 19 had tested 316,00 people. The nation has a population of 60 million, 9,000 confirmed COVID-19 cases and 94 deaths. However, new cases have gone from 1,000 per day to 84 per day, according to figures released by the World Health Organization

By contrast, the U.S. as of March 19 had done about 45,000 tests, in a population of 330 million. The U.S. on March 19 had 10,400 cases and 150 deaths. That’s one-seventh as many tests with six times the population.

Both Korea and the U.S. reported their first cases at roughly the same time and both received the genetic sequence of the virus released by China in early January. Both moved to develop their own test for the virus, which is common in advanced countries in coping with a potential epidemic.

From there, responses differed dramatically.

South Korea quickly enlisted industry and private health labs to ramp up to mass-produce the test. South Korea opened 600 testing clinics and dozens of drive-through testing sites so anyone with concerns could get tested. The single national health care system streamlined the process.

By March 12, the U.S. had tested some 10,000 people – while South Korea was testing 12,000 per day.

The lack of test kits in the U.S. has forced health officials to abide by guidelines that only send tests to the state lab if a patient has symptoms or significant contact with someone who has tested positive. Private labs are also now doing tests, but most have backlogs. Often, it takes days to get results.

However, the system has started to ramp up. Banner Health Systems this week announced it will start four drive-by test centers in Maricopa and Pima counties. People must still get an appointment to get a test and the health system is not disclosing the locations of the test centers.

In the meantime, health officials are urging people with milder symptoms to stay home and phone in for advice from their doctor, since they don’t want people showing up at a doctor or hospital waiting room and possibly infecting others.

How did this happen?

The US initially played down the seriousness of the epidemic, insisting that restricting travel to the US from China by non-US citizens would keep the virus from coming ashore.

In the meantime, the federal Centers for Disease Control developed its version of the test from the sequence released by China. However, that test proved flawed when distributed to state health labs. The US therefore lost several weeks in fixing the test and redistributing it again.

The US delayed calling together all of the manufacturers and private medical labs, which is essential to producing the hundreds of thousands – or millions – of tests needed to offer widespread testing. This combination of factors put the US at least a month behind South Korea when it came to producing all the tests necessary to adequately track the virus and ensure that even people with few symptoms were quarantined so they would not continue to spread the disease.

As a result, the epidemic here so far appears to be following the pattern in Italy rather than South Korea.

The US government is now scrambling to make test much more widely available, but the nation may find the delay will make it much harder to contain the virus, with widespread infections in many areas.

Arizona still has a modest number of cases, but the numbers are doubling every couple of days.

The Arizona Medical Association on Friday issued a statement saying, “The Arizona Medical Association has heard from several of its physician members over the past few days with concerns of being properly prepared and having enough equipment to collect COVID-19 samples. We have been working with appropriate local and state agencies to ensure that Arizona’s physicians receive the proper amount of support as we prepare for an increase in needed tests for diagnosis of COVID-19.”

The state promised to open more test centers. The expansion of testing will probably result in a big spike in documented infections.

Until now, people have needed a doctor’s order to get a test. State Health Director Dr. Cara Christ last week said Banner Health and Sonora Quest Laboratories have already been given the clearance to test anyone with symptoms.

However, it’s unclear whether patients will be charged for the cost of the test if they don’t have a doctor’s recommendation. Some labs charge about $50 for a test. The federal government covers the cost of testing samples sent to the state labs.

The state lab will continue to focus on samples sent from county health departments, which still prioritize people with more serious symptoms and known contacts with someone who has tested positive.

The testing sites will likely end up mostly in Maricopa, Pinal and Pima counties — with the bulk of the state’s population. However, rapid identification of infected people with minimal symptoms will likely do the most good in places like Gila, Apache and Navajo counties, where the virus is apparently not yet widespread. The early identification of people with mild symptoms followed by prompt quarantine and contact tracing was the key to South Korea’s success.

Peter Aleshire covers county government and other topics for the Independent. He is the former editor of the Payson Roundup. Reach him atpaleshire@payson.com

Peter Aleshire covers county government and other topics for the Independent. He is the former editor of the Payson Roundup. Reach him at paleshire@payson.com

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