Part 5 in a series tracking how the nation, the state, and Nashville responded to the COVID-19 pandemic.
By Peter White
NASHVILLE, TN — The number of new cases in Nashville peaked July 7 and 411 Davidson County residents tested positive July 30-31 (12.5%). ICU bed capacity is down to 12%; 16% of hospital beds are unoccupied. A total of 199 people have died here.
Tennessee had a total of 110,636 confirmed cases, 1092 deaths, and 1,009 new cases were reported August 3, according to the Novel Coronavirus Unified Command. The number of cases continues to rise in Tennessee and 34 other states.
In Washington last week Rep. James Clyburn, the chairman of the Select Subcommittee on the Coronavirus, slammed the Trump administration for a failed response to the pandemic and he called for a national plan to combat it.
“Now we are at more than 4 million with at least a million Americans infected in the last two weeks. Hospitalizations and deaths are unacceptably high,” Clyburn said.
Reporting in Vanity Fair, Katherine Eban, claims politics has kept the U.S. from mounting a full-scale response to the virus. President Trump’s son-in-law, Jared Kushner, led a secret task force charged with designing an “aggressive, coordinated national COVID-19 response”—including a federal testing regime. The plan was ready to be rolled out last April but suddenly fell out of favor and mysteriously dropped off Trump’s desk, according to Eban.
“Most troubling of all, perhaps, was a sentiment the expert said a member of Kushner’s team expressed: that because the virus had hit blue states hardest, a national plan was unnecessary and would not make sense politically.
“The political folks believed that because it was going to be relegated to Democratic states, that they could blame those governors, and that would be an effective political strategy,” said the expert. Politicizing the pandemic made perfect sense to the Republicans because if the virus killed thousands of Democrats, they wouldn’t be around to vote against Trump in November.
Eban said that the plan Trump announced on April 27 bore almost no resemblance to the one Kushner’s group designed. It shifted the problem of diagnostic testing almost entirely to individual states, which, with some exceptions, have failed to keep the virus in check. Kushner has refused to respond to Eban’s story but it explains why so many Governors in red states like Tennessee marched in lockstep with the President.
Republicans were seriously wrong about the pandemic. The virus has attacked red states as well as blue. Clyburn said that hospitals in some states are at risk of running out of beds and have reported that they may be forced to choose which patients to treat and which to send home to die. He said experts are now predicting another 150,000 Americans could die from coronavirus by the end of the year.
“The administration has failed on testing, while they were given warnings, including from this committee, that millions more tests were needed. At least 11 states, including my home state of South Carolina, are currently conducting less than 30% of the tests they need to control the virus. The state cases surging, states now face severe testing shortages, wait times are a week or longer in many places, and some states have been forced to ration scarce tests, limiting them to only the sickest patients,” Clyburn said.
That’s the way things were in Nashville back in the Spring. (see Officials Can’t Control the Virus so They Control Information Instead, The Tennessee Tribune, July 30-August 5, B7)
Dr. Deborah Birx, coordinator for the White House Coronavirus Task Force, flew to Nashville last week to meet with Governor Bill Lee, health officials, and Mayor John Cooper. Birx said Tennessee has entered a new phase of the pandemic. “What we are seeing today is different from March and April. It’s extraordinarily widespread. It’s more widespread and it’s both rural and urban,” she said.
While health officials hope infections have peaked and will level off or start to decline, some experts predict there will be a series of future peaks. They point out that while the U.S. is testing 800.000 people every day, backlogs of a week or more are now common at some of the biggest labs. Quest Diagnostics does about 20 % of all COVID-19 tests in the U.S. Quest has an average wait time of a week with some people waiting up to two weeks for results, according to a company statement.
A delay of more than 4-5 days to get test results is like shutting the door after the cows have left the barn. Experts say the virus is so fast moving, contact tracing is pointless after about 48 hours. The virus is winning because of testing delays.
Some scientists say we are testing too many people and should prioritize who gets tested: the sick, elderly in nursing homes, and medical workers. Currently labs just process as many samples as they can handle without prioritizing someone with active symptoms over someone who just wants to be tested before going on vacation. The sheer volume of samples has led to backlogs and sometimes labs run out of swabs and reagents so that also causes delays.
The most common test uses polymerase chain reaction (PCR) to look for an active infection. It’s a reliable method but doubly inefficient. Most of the tests come back negative and samples have to be stored and shipped to the lab and that adds to the turnaround time.
“The average test delay is too long,” said Dr. Francis Collins on NBC’s “Meet the Press.” “You do the testing to find out who’s carrying the virus, and then quickly get them isolated so they don’t spread it around. And it’s very hard to make that work when there’s a long delay built in,” he said.
A paper published last month in The Lancet Global Health argues that if test results were provided the same day — and contact tracers immediately went to work — about 80 percent of new transmissions could be prevented and the virus would stop spreading.
Collins said health officials are pushing for point-of-care testing to speed turnaround times. Similar to pregnancy tests, they can be done in a doctor’s office or at home in less than an hour. The tests are simple and good for nursing home populations and rural populations who lack reliable health care. The Food and Drug Administration has approved a handful of point-of-care tests for emergencies.
The Centers for Disease Control and Prevention released a study in June that found coronavirus infections were 10 times higher than reported in six regions of the country. If the U.S. employs more point-of-care tests, the backlogs piling up at labs would be reduced. Such a dual-approach to testing could be central to a national plan but, as Rep. Clyburn pointed out last week, we don’t have one yet.