A man gets a drive-through COVID-19 test outside Meharry Medical College April 1. Medical workers gave 80 tests March 31, the first day supplies were available.

NASHVILLE, TN – The numbers tell the story. South Korea has a population of 51.5 million. They responded quickly and effectively to the coronavirus outbreak with drive-through testing stations. By mid-March 300,000 people had been tested, or one out of every 171 residents in the country.

Health officials in South Korea identified more than 8,000 positive cases of COVID-19. They quarantined them. South Korea’s infection curve peaked a month ago at 909 new daily infections. Two weeks later it had only 93 new cases. One hundred sixty-two people have died there.

In contrast, the U.S. completely dropped the ball. The U.S. population is 330 million. We tested 60,000 people by mid-March or one out of every 5,550 residents in the country. Seven thousand positive cases were identified by mid-March. Two weeks later 831,000 Americans had been tested and the number of positive cases jumped to 175,000. “It’s scary,” said Dr. James Hildreth, President of Meharry Medical College.

We now know many more people are infected than previously thought. More than 3,000 people have already died. And the death toll will rise much higher. The virus is spreading rapidly here despite efforts to slow it down with stay at home orders and the closing of bars and restaurants, schools, and non-essential businesses.

Experts say we didn’t start testing soon enough and we aren’t testing nearly enough now.  “One of the reasons why the frequency in Germany is so much lower than other places is because they’ve been doing a hundred thousand plus tests a week. We are only doing a fraction of that so that means their denominator is huge and that’s why the relative percent of their positives is so much less than ours,” said Hildreth.

“The current trouble is a critical shortage of the physical components needed to carry out tests of any variety,” wrote Robert Baird last week in the New Yorker.

Baird itemized the missing links in a public health system failing to respond to the COVID-19 crisis. They include components like viral transport media, which keep the virus suspended on the way to the lab, extraction kits, which isolate the genetic material of the virus, and the reagents that show whether of not the coronavirus is present.

“Perhaps the most prosaic shortage, but also the most crucial, is a lack of test swabs, which look like glorified Q-tips. Specially designed to preserve viral specimens, they’re what a doctor sticks up your nose or down your throat to collect the necessary biological material,” Baird wrote. They are made in Italy at a factory in Lombardy, Italy, which has been reeling from the pandemic but is still making swabs.

A U.S. Air National Guard C-17 cargo plane flew 800,000 swabs from Italy two weeks ago to a FedEx distribution center in Memphis. The New York Times reported the Trump administration wanted to order 1.5 million more swabs every week. The company said it couldn’t fill that order.

Besides not enough swabs, there are other reasons why the U.S. was caught so flat-footed by the virus: a bureaucratic turf war between the CDC and the FDA slowed the availability of commercial and university lab tests that are just now coming on line.

For years in the U.S. research dollars have gone towards vaccines and other novel medical treatments. The profit margins are much higher for therapies and drugs than for diagnostic tests that use a 1970s technology.

Two weeks ago South Korea was testing 10,000 people a day and the U.S. will not do that until at least April 1. “This is no longer about bending the curve in terms of number of infections. We won’t bend the curve of the number of infections. But we might bend the curve of the number of deaths,” said Dr. Gregg Gonsalves, an epidemiologist at Yale University.

This graph shows how quickly the virus spread from March 19-30 in Tennessee.

There are good reasons to screen large numbers of people. “It wasn’t the people with obvious symptoms driving the virus’ initial spread in China. Undetected cases fueled the outbreak and even caused the majority of severe infections that ultimately required hospitalization,” wrote John Anderer a health reporter for Ladders, an online job news website.

Knowing who is infected and where they are located helps allocate resources better.

For example, if hospitals in a county with few infections have extra ventilators they could loan them to a hospital that needs them. Testing saves time and equipment in hospitals because otherwise doctors have to waste time and resources waiting to find out who is and who isn’t infected.

Surveillance testing also makes social distancing more effective because if you don’t know where the virus is spreading, it’s impossible to say which municipalities should be placed in quarantine.

Lastly, testing provides useful data going forward. At some point, we will weather the current crisis and turn towards long-term responses. Treatment and vaccines will need to be developed to protect us from future outbreaks of COVID-19. For all of those things we will need good data about how many people were infected and where. Wide scale testing is the only way to get it.