International Efforts to Strengthen Test Capacities in Response to Coronavirus

2019-nCov (also known as the novel coronavirus or just coronavirus) is a virus that causes respiratory disease. Testing patients in order to detect the virus and treat the infected people is now crucial given the virus has been spreading worldwide since earlier this year.

What Exactly is the Coronavirus?

This coronavirus belongs to the virus’s wider family of coronavirus, first identified in the mid-1960s. Among the latest identified stumps there are the MERS-CoV (Middle East Respiratory Syndrome), SARS-CoV (Severe Acute Respiratory Syndrome,) and the novel Coronavirus.

According to Na Zhu et al., authors of the report published in The New England Journal of Medicine in December 2019, and the Chinese Center for Disease Control and Prevention (China CDC), many health centers in Hubei province in China started detecting cases of pneumonia among patients whose cause was unknown. The China CDC further investigated the situation in the Hubei province and reported that the cause of such pneumonia cases was a new form of the coronavirus. On January 9, 2020, the World Health Organization (WHO) declared that Chinese authorities identified the novel coronavirus after the first detected cases in late December 2019.

Initially, the first patients in China were found to have frequented the Wuhan’s South China Seafood City Market, the reason why it was supposed that the virus was transmitted from animals to humans. However, when the China CDC identified the novel coronavirus in early January, it also confirmed that the virus can be transmitted among humans. On February 11, 2020 the WHO named the 2019-nCov as COVID-19.

Tracking European Cases of Coronavirus

On March 11th of 2020, the European Center for Disease Prevention and Control (ECDC) published the latest data about the COVID-19: there are 118,619 confirmed cases that have been tested in the laboratory worldwide. According to The New York Times article reporting data from the United States Center for Disease Control and Prevention (US CDC) as of March 11, 2020, countries with over 500 cases confirmed in the European area include:

– Italy with 10,149 cases and 631 deaths;
– France with 1,784 cases and 33 deaths;
– Germany with 1,622 cases and 3 deaths;
– Spain with 2,089 cases and 47 deaths;
– Switzerland with 613 cases and 3 deaths.

In the United States, the confirmed cases are 1,015 as of March 11, 2020. Many are arguing that Italy is one of the most affected countries and although numbers do not lie, it behooves us to look at both the test capacity and the number of tests performed. For the latest figures, World Meters updated the related data on March 9, 2020, with a total number of tests performed in Italy of 60761. It is important to note that in the United States, as of March 2 of 2020, only 472 tests were performed (this, in part because of the lack of authorization for private labs to perform their own tests). This number jumped to 8554 on March 10, the day after the green light from the United States Food and Drug Administration (FDA).

Why Test Capacity and Genome Sequences are Crucial in This Phase of the Public Health Emergency

These numbers show that in times of a public health emergency of global scale as the novel Coronavirus, countries’ test capacity is crucial to detect cases, contain the virus spreading, and eventually understand when switching from a phase of containment into one of mitigation. It should be evident that higher numbers of tests correspond to a higher number of cases. It can be also argued that the number of tests is related to the evolving spread of the virus which motivates higher numbers of tests performed. However, the question here is very simple: are all countries performing an adequate number of tests? Are these countries able to have an adequate test capacity?

In an interview aired on the CNBC’s Squawk Box on March 2, Dr. Matt McCarthy, Infectious Disease Physician at the New York-Presbyterian Hospital, stressed that despite working in one of the busiest hospitals in New York City, even emergency rooms are not equipped with at-hand tests for diagnosing coronavirus. Dr. McCarthy told that it was still necessary to “plead” the US Department of Health for a test kit. This situation had two main implications: not only it delayed the assessment of infected patients, but it also constituted a threat to the public health since contagious patients were not isolated in a timely manner, thus potentially increasing the spread of the virus. That is why, as Dr. McCarthy noted, patients were often isolated while waiting for the test to be performed; this was an uncomfortable yet required measure in an overall condition of inadequate test capacity demonstrated by the fact that the first detected case of coronavirus was identified in the State of New York after having performed 32 tests.

WHO Response to Lack of Testing Capacity

In an article that appeared on Nature Biotechnology on February 19, the diagnosis of coronavirus was already presenting an issue when it came to identifying the sequence of the virus’ genome to support laboratories performing the diagnostic test in absence of reliable at-hand tests. WHO decided to ship 250,000 kits all over the world to face the emergent need of performing reliable tests.

The United States declined to use WHO’s test and, according to one of the latest articles that appeared on Politico, no explanation for the refusal was provided by the current administration. Among the most affected countries, Italy is also among those performing the higher number of tests and among the firsts in isolating the virus in the laboratory at the Lazzaro Spallanzani Hospital in Rome on February 2, 2020. A team of researchers in Rome isolated the virus after 48 hours from detecting it in two Chinese tourist patients that were hospitalized in Rome, stressing the need of a molecular diagnostic in addition to the isolation and entire genome sequence that was obtained after the research of Chinese authorities. The Istituto Superiore di Sanità (the technical and scientific research entity of the Italian national health service) and Policlinico Militare Celio in Rome (the military hospital in Rome) have also sequenced the virus’ genome of additional two patients in Italy, and soon that of a third patient, on March 2, 2020. Isolating and sequencing the genome is crucial to observing the evolution of the novel Coronavirus over time and space.

American Efforts to Prepare for Coronavirus

With the recent cases of Coronavirus spreading on the West Coast of the United States, especially Washington State and California, the US authorities are already moving towards a mitigation phase while trying to strengthen test capacities of hospitals. However, as reported in a New York Times article on March 3, for several weeks, the United States did not have reliable tests since many companies that were working to finalize test kits reported to be weeks away from a formal approval of such diagnostic tools.

In addition to that, there is concern about the US health care system being based on private insurance, which makes people afraid of not being able to seek appropriate care because of a lack or partial lack of health insurance coverage. To face the issue, on March 3, the State of New York announced that some fees will be waived for expenses related to testing and treatment of illness attributable to the novel coronavirus. Other states all over the United States have considered joining these efforts.

As public health emergencies evolve worldwide, continuous updates and developments will become available. In the meantime, the international community’s efforts have been joined by the United Nations (UN). On March 1 under the direction of the UN Under-Secretary-General for Humanitarian Affairs and Relief Coordinator Mark Andrew Lowcock $15 million was disbursed to the WHO and UN Children’s Fund (UNICEF) from the Central Emergency Response Fund (CERF) to support the containment of the novel coronavirus.