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Coronavirus testing is being ramped up in the U.S. as the Food and Drug Administration new regulations allow commercial labs to manufacture and distribute  coronavirus tests. Now many players can now acquire and conduct tests including state and local governments, hospitals, universities, and private companies. so that tracking nationwide distribution is still difficult. Deborah Brx the response coordinator of the White House task force on coronavirus says U.S. has completed 220,000 tests in last 8 days.  In New York the scaled up efforts in a region with over half the coronavirus cases in the U.S., 13,000 were tested on Monday, March 23. Some hospitals in New York such as Mount Sinai expect to do double or triple the tests a day in a scaling up effort by March 30. In Los Angeles a city councilman negotiated with a South Korean company for delivery of 100,000 tests a week, having already secured 20,000 new tests. Additionally swabs and protective equipment are also needed to conduct tests and labs need to process results with speed. ...

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This report shows the level of coronavirus testing as of March 27, 2020 in different states in the U.S. The U.S. testing program and supplies of tests are being ramped up quickly. About 65,000 tests are being done on Americans each day. The need is for 150,000 tests a day say public health officials. Testing is slow in California compared to aggressive testing in New York which has 60% of all coronavirus cases. California with twice the population of New York has done 77,000 tests compared to 122,000 in New York. Texas has done only 21,000 states by comparison. Every week new testing technology is being developed in different labs, medical companies, and universities. Including tests that can be conducted quickly and not requiring health workers or health workers with protective gear. Speed of processing test, least point of testing contact, and the protocol for quarantine, are all part of the testing and isolating of clusters mechanism to tackle the virus. This is critical in the coronavirus action plan being developed by Dr Brx of the U.S. White House team. ...

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Admiral Giroir, Assistant Secretary of Health Services, tells a Senate committee led by Lamar Alexander and senator Murray that the U.S. should have capability for 40 to 50 million tests a month by September. Current testing target for May of the U.S. government is about 12.9 million tests a month. 

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The critical variable in knowing whether lockdowns of cities and countries are working is called the coronavirus RO, or reproduction ratio. This ratio measures the average number of people infected by a carrier A. It could be that he infects 1 person at work and transport call it B people , or in large gatherings call it C people he infects 2 persons, or in other surroundings such as restaurants he infects 1 person call it D people. The people A has infected B+C+D are the ones now not infected by A with the lockdowns such as in New York, Italy, Germany, UK and France. It is determined by global health experts that the number of B+C+D is about an average of 4 persons infected by 1 person A with coronavirus, though it may be much higher in practice in some areas. The natural rate of RO or reproduction ratio is considered by the European Centre for Disease Prevention and Control to be 3.86 or about 4, if no lockdown or social distancing or other prevention is practiced. This in a situation where people behaved as before unaware that the virus was around them. Governments such as New York and France, UK, Germany are including this key variable in their determination of how long a lockdown lasts, and for determining if the reopening is not going the right way or failing. In such situations the lockdown would be reinstated, or if it is a phased reopening such as in the U.S. and other countries go back to the previous phase. In Italy and Germany the RO reproduction ratio for coronavirus is estimated by official experts at 0.8. Germany's RO estimated by the Robert Koch Institute and Italy's by Franco Locatelli, scientific advisor to the government. In New York the margin is thin- with RO of 0.9, estimate from the state's governor. In France which has one of the tightest lockdowns of all with a document required to go outside it is at 0.6, the figure coming from the prime minister Mr. Philippe. In the UK it is below 1.0 but no accurate figure is reported. As Dr. Birx- leading the coordinated response in the U.S. - emphasizes over and over again this is a very contagious virus, about which not much is known. Social distancing, wearing masks, basic prevention measures such as frequent handwashing, and not gathering in large numbers of people, is essential for defeating this virus. This has to be followed up with extensive testing and contact tracing to win this fight.   ...

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The failure to respond quickly with testing and contact tracing has been a major weakness of the response to the coronavirus in Europe and the U.S. Repeated fumbling in contact tracing has been common throughout Europe and in states in the U.S.

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 South Korea has run about 300,000 coronavirus tests, double that in Italy and ten times that in the U.S., says this report in the WSJ. This report shows how the South Korean testing works and the workday of Lee Hyuk-min, a clinical microbiologist at a testing lab of Yonsei University Health System Severance Hospital in Seoul, who is working from 4.45 am to 11 pm. South Korea's effectiveness in controlling the spread is based on a strategy of efficient testing that enables isolating quickly people and areas. South Korea's testing network is a legacy of the MERS coronavirus outbreak in 2015, and the government failure at that time to control it.  It brings together doctors, medical staff, labs, and political leaders in roles following the protocols established since then. Dr Lee and others are the final checkpoint in the system which coordinates a diagnostic operation that combines together 633 test sites and 100 labs. The protocol includes a uniform setup- same testing equipment, same training, same decision making process. At 8 am each day all labs upload results to a shared database, which allows public and private hospitals to monitor patient results and report them to Korea Centers for Disease Prevention and Control. Hospitals upload testing details to an online directory. This surveillance allows South Korea to predict where to concentrate its efforts for controlling spread, says Dr Lee who advises the South Korean government on lab testing issues. Action plan took 2 years for the new rules to be implemented following MERS in 2015. The plan included accelerated bio testing company approval for tests. The first company got approval on Feb 4, followed by 4 other firms. Dr Lee says testing is only part of the equation as labs are needed to process and confirm results. Another key is innovation. South Korea setup testing in drive thru locations, that limit contact and speed up testing, which the U.S. is adopting. Dr Lee says early identification is key, and identifying the first coronavirus patient which was done in South Korea on January 20. Other countries including the U.S. took too long to identify the first patient, says Dr. Lee. ...

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This analysis from The Times of London provides critical information on the strategy for successfully tackling the coronavirus following the example of South Korea and progress in Britain.

The random community testing is key to getting an idea of the scale of infections in the community at large. The critical ratio called reproduction ratio tell one if the virus is under control and how lockdowns can be lifted. For Britain this 0.7 estimated by Imperial College. It has a 2 week lag. 1.0 or close to 1.0 is not good. Germany after being at about 0.7 has moved up to 1.0 with 2 week lag in information says the Robert Koch Institute. This means a lot of work ahead, it won't be easy.

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South Korea has tested about 300,000 people for coronavirus. About 20,000 can be tested daily for coronavirus through 40 drive thru locations. South Korea invented this method of testing. Another feature of the South Korean method is the tracking down of people who have come into contact with those testing positive for coronavirus. The South Korean government is able to do this because it can access the credit card and cell phone information of people in the country. This is possible through laws that were passed after the failures during a previous epidemic of MERs. The government then tracks down and isolates the people who came into contact with infected persons. This includes people who show no symptoms, an important aspect of the South Korean program which needs to be adopted in other countries once the production of test kits and testing is ramped up. The reason is that about 30% of people who tested positive in South Korea were not showing any symptoms but acted as silent carriers. This is similar to the figures for people in the Wuhan region of China. This testing capability is one of South Korea's key strengths, though Germany's Robert Koch Institute says it has a similar capability to test 160,000 people a week. The U.S. has tested about 30,000 people by comparison. The U.S. government is procuring 60,000 test kits under the Defense Production Act. South Korea also enforces social distancing though a $2500 fine and a 1 year prison sentence. Germany now has a 2500 euros fine in some states for curfew violations.  By comparison the fine in Britain is insignificant.  Another difference between China and South Korea with Germany and the rest of Europe, the U.S., is that in China and South Korea self-isolation is monitored, tightening the control over coronavirus spread at every turn.   ...

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Coronavirus testing is taking off in the U.S. for the first time after the U.S. Federal Drug Administration relaxed testing regulations on February 29, and as more universities and hospitals develop their own testing technology and apply it. The FDA has approved more than 15 tests and many more are awaiting approval. 

This includes UC Davis, Washington University School of Medicine, Brigham and Women's, Harvard Medical School, Mount Sinai Medical Center in New York City, centers that are running the tests limited only by the shortage of reagents supplies.

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The head of the U.S. Department of Health and Human Services, Mr. Alex Azar, repeatedly assured the president as early as January 29, that there never had been a better interagency response to coronavirus, says the WSJ. This WSJ report says based on interviews with administration officials and others that Mr. Azar waited for weeks to brief the president on the threat from coronavirus, did not coordinate effectively across the health divisions,  failed to ramp up testing development, and oversold what had been done. Testing is one of the key issues raised at this time about the coronavirus effort. Mr. Trump tweeted on April 12 that Mr. Azar "told me nothing until later." The president was dissatisfied with Mr. Azar's handling of the flavored e-cigarettes ban. This report says Mr. Azar was slow in working with other agencies such as FEMA, and in involving directly the FDA, CDC, and other agencies, to create a strong and effective response to a fast developing public health crisis of enormous proportions. In February White House advisors were critical of Mr. Azar for delays in the testing program. As the delays progressed this report says Mr. Pence and the White House gave more responsibility to FEMA, and Dr. Hahn and CMS's Ms. Verma were made active members of the White House Task Force. FEMA also played a bigger role with greater funding.    ...

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The mistakes  and the right action done in Italy that the world can learn from as Italy tackles the coronavirus. The coronavirus is a dangerous pandemic yet there is one part of it that can be used to take the right action. The timeline of countries affected early in January and February and early March with information from these countries on what worked very effectively and what did not work with bad results is available. The mistakes were made in Bergamo, a town in Lombardy region of northern Italy with the highest number of infections and deaths in Italy. Bergamo had limited testing, no rigorous attitude for quarantining those who had come in contact with people testing positive, and lack of contact tracing. In Vo another town in northern Italy the situation is a complete contrast with resort to mass testing and isolation of clusters which has reduced infections to zero and made it a safe place. Vo is a small rural town 85 miles east of Bergamo in the Veneto region. This was the method used in South Korea, China, Taiwan and other Asian countries that have overcome the virus. Bergamo is an example of what failed in Italy with the worst number of fatalities. The health crisis worldwide has shown this  method of first general quarantine to buy time to build capabilities for testing  and preventing things spiralling out of control,  then mass testing, contact tracing and isolating the people who test positive, and repeating this process again and again till infections are way down,  is the only way to control this crisis. In the early days massive quarantine or stay at home strictly enforced is the best solution till production of tests accelerates to permit mass testing and isolating the clusters of infections. This mass quarantine buys time for accelerated production of tests and building up the capabilities of labs to process these tests, including use of a central national lab centre with national data on computers for microbiologists to monitor the entire country. This was done in South Korea reports in WSJ show. This is vital for everyone involved in the effort to control the virus to understand based on the experience of  countries that have successfully overcome coronavirus. It is the experience in South Korea and Italy that the U.S. White House response coordinator Dr. Brx is looking at and learning from as she and the White House team in the U.S., governors of all 51 states, health officials including CDC, are looking at as they execute their action plan in phases.  ...

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How is it that Britain's regulatory agency approved the Pfizer vaccine before the U.S. FDA agency? This report in the NYT says FDA looks at the raw data. Britain's Medicine and Healthcare Products Regulatory Agency looks at the information provided by the company. It still does the testing batch by batch and has access to the data and looks at thousands of pages of data. What about the European Union? The European Union Medicines Agency meets on December 29. It takes days after it meets to get input of 27 countries so that vaccination cannot start till January. The U.S. president summoned the FDA to the White House to find out how soon the FDA could act. Both Britain and the U.S. are feeling the impact of the second wave of coronavirus.

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The White House event related to the nomination of Amy Barrett to the U.S. Supreme Court that reports suggest may have led to President Trump's infection with the coronavirus. The Rose garden party was attended by guests being at close quarters and many maskless with guests later entering the spaces inside the White House. As a result many of the people in the upper echelons of the Trump administration are now infected with the coronavirus as reported here in The Times. Many testing positive include a University president (Notre Dame), Senator Mike Lee, and others.

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About 60% of Americans think the testing for coronavirus and getting medical supplies to health care workers is too slow, in a poll by Wall Street Journal/NBC News. About 6 in 10 Americans in a new survey say they are concerned that the U.S. would move too fast to loosen coronavirus restrictions to slow the spread, and only 3 in 10 say they are concerned that it is not moving fast enough. About twice as many Americans thinking the risks were higher that public authorites and governors would reopen states too soon. About 75% of respondents in the survey say they are very or somewhat worried about themselves or a family member getting the virus. Mr. Trump's approval rating  remains unchanged from March with 46% approving. Most people place their faith in the governor of their state- 66%, and Mr. Fauci, Director National Institute of Infectious Diseases- 60%, than anyone else. On the economy president Trump is seen as being better at handling the economy 47% to 36% than Democratic nominee Biden, even though Biden has a nine point lead. This confirms the widespread dissatisfaction at the way medical supplies shortages are felt at hospitals, and the way testing for coronavirus is happening with not enough testing. President Trump perceived by business and the public as better at handling the economy is also confirmed in this survey. The dissatisfaction with the president for supplies shortages and testing lagging behind may also be tempered by a sense that the public has not taken aggressive action in supporting an early lockdown with many governors and people not supporting or following strict distancing rules till late March. By contrast the president acted quickly to stop all flights from China. ...

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The University of Washington Institute of Health Metrics and Evaluation has doubled its forecast of coronavirus deaths in the U.S. to 135,000, about twice what it is today at 69,000, by early August 2020. This is based on the assumption that with reopening the economy and return to actively operating in offices and shops, in construction and factories, the social distancing will be relaxed. Factors such as rising temperatures are not seen as offsetting the increased mobility in reopening. Dr. Fauci, top U.S. infectious disease official said on My 4, that the relaxing of social distancing could get a rebound started considering the coronavirus "phenomenal capabilities of spreading like wildfire." There is concern that the cases may be much higher in Brazil where there is not much testing, even higher than in the U.S. according to one university study. Argentina is a contrast having imposed a lockdown much earlier and has only 246 coronavirus deaths. ...

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With about one fourth the population of California Michigan has done approximately 100,000 tests, compared to about 213,000 in California. This is about twice the rate of testing in Michigan- with the help of the U.S. government- compared to testing taking place so far in California. The lack of aggressive testing in California could also mean there is a lot that remains unknown about the extent of the spread of coronavirus in California. 

That Governor Newson ordered New York to shelter in place on March 19, 3 days after the stricter stay at home order in France on March 16 requiring a document to show police to go outside, shows California like the rest of the country was not that much different. Beaches were packed in California on the weekend of March 15. A lot remains unknown at this point about the spread of the virus. The urban sprawl areas in Michigan are as hard hit as Detroit.

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The contrast between lack of effective measures taken in the Lombardy region with the aggressive action in Veneto that has proved effective. Veneto followed the method of quarantining, mass testing for clusters and isolating the affected people.  The Italian government took the first steps to close off northern Italy Feb 22, and it was not till March 10 that a nationwide lockdown was done. The action taken in the Veneto region is shown here in this WSJ report with the town of Vo as an example of steps taken that worked. A microbiology professor and infectious diseases expert at the University of Padua, Dr Crisanti, developed a test for the coronavirus as early as mid-January using the information made public by Chinese doctors. Dr. Crisanti oversaw the testing of 95% of residents of Vo, a town of 3400 people in Veneto region. He found 3% of the population was infected, with half testing positive asymptomatic. Following the aggressive lockdown the tests were done two weeks later and the rate of infection had fallen to 0.1% with only 8 new infections. "The main lesson from VO is that when you have a cluster of infected people, you should do a very aggressive lockdown and then test as many people as possible," Dr Crisanti says. The results from Vo led to Veneto increasing testing in the rest of the region carrying out 80,000 tests, compared to 88,000 in Lombardy, with double the population and 5 times more infections. Lombardy followed government directives to test only those with symptoms. When it spreads it is harder to do the test isolate clusters, test isolate clusters, in a continual loop, yet this remains the method cited by Dr. Brx in the U.S. today as the right way to target clusters in a laser approach. In yesterday's briefing at the White House Dr Brx said this is a method the U.S. is familiar with and has used in Africa to tackle HIV, Ebola Virus. It is possible using GPS to target down to a specific clinic in a specific place, which is how it was successfully done in Africa. ...

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This WSJ report on critical analysis of coronavirus data has a very useful chart of Estimated Range of Symptomatic Cases Reported by Country. Complete coronavirus data for all symptomatic persons who have the coronavirus infection is lacking in most countries. Many people in large populations have symptoms and are positive but are not reflected in the official data collection. This is a big problem as the total number of cases are understated by a magnitude of twice to five times the numbers reported in official tally.   South Korea has done a good job of getting more of the symptomatic people with the infection in its data, as about 53% to 90% of such persons are reflected in official data. Next comes Germany at a range of 38% to 55%.  China comes third and has about 28% to about 38% of such persons reflected in its data, the U.S. currently on April 4 at about 14% to 19%, according to this chart in the WSJ. The source for this is Mathematical Modeling Center at the London School of Hygiene and Tropical Medicine. What this means is that the US. number of cases at 278,000  reported infected people with symptoms (April 4) is only 14% to 19% of the true number. Another way to say this is that the actual infected persons with symptoms is about 5 times what is reported, or over 1 million not the 278,000 reported.  As happens for China data collection agencies may never get the true number. To be comparable to the Chinese numbers, as the U.S. is a large country, the figure closer to the true numbers would be twice the 278,000 reported or over half a million symptomatic infections of coronavirus in the U.S. Why is this data important. With widespread testing as in South Korea one gets data that tells one how many people are infected (the size of the problem) and therefore the resources needed and the point of greatest impact. Also it tells one the typical transmission rate per person, and it helps hospitals in each area know what to expect and what resources are needed to prepare- not find people suddenly turn up in the E.R. in unpredictable numbers. The lack of widespread testing and better reporting in the data to get a grip on the pandemic is shown in this chart for countries hardest hit, less than 5-6% for Italy and Spain. The UK and France at 5-8%.   ...

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The coronavirus surge in southern states in the U.S. is different from the surge earlier in the northeast including New York and New Jersey. More young people are getting the virus. About half of those testing positive are now 18-35 years of age in Texas and Florida. Social distancing and masks is not mandatory with young people not practicing these safety guidelines. Many took the reopening to mean they could go back to the usual summer routines. Not taking it seriously is leading to more infections of young people. Cultural issues with practicing the guidelines and a tendency to not take it seriously has been a problem in the U.S. and parts of Europe since the beginning of the crisis leading to larger number of cases.

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The title may not reflect the content of this report on Admiral Giroir who heads the U.S. coronavirus testing effort. He is a pediatrician who worked for hospitals in Texas before heading a vaccine project at Texas A&M University.  Internal politics led to his resigning from the effort to build a vaccine development capability with pharmaceutical companies at Texas A&M. Most of the rest of this report shows a physician who is determined to pursue big projects such as the one he is tackling today. President Trump appointed him to lead FDA, and to be the Assistant Secretary of the Department of Health and Human Services. With the missteps of Secretary Azar testing suffered in the early months of the crisis as reported in the WSJ. Adm. Giroir has taken a leading role since  this period. He also heads the U.S. Public Health Service Commissioned Corps of 6200 staff playing a vital role. On March 13 he was asked to lead the effort in testing.  He comes to this role with experience in the field of vaccines realizing that "the challenges are not just biological but engineering." New technology would be needed to make massive amounts of vaccine. His idea is that transformational efforts are needed. His idea for a billion dose per month facility in Texas did not work, yet he worked on it for about 5 years from 2010 to 2015 at Texas A&M University, at one point being the vice chancellor. He was selected by Texas Governor Perry as chairman of the task force in Texas in 2014 to oversee the effort to fight the Ebola virus. He now is in a position to bring all his experience and aspirations to tackle the coronavirus, cutting through much of the red tape and bureaucracy, and pulling together the effort combining science of pharmaceutical companies with the technology of manufacturing billions of vaccine doses in a record time. Today he sees capacity for testing reaching 40-50 million tests a month by September 2020.   ...

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Britain recorded the most deaths in Europe. Brazil and Russia have over 10,000 cases of coronavirus each, and the U.S. records cases close to that in the peak in April. Cases were up worldwide for May 6 to 92,000 with a quarter of these cases or about 24,000 in the U.S. The jump in cases takes the total to 3.77 million with a third of them in the U.S., according to John Hopkins database. Russia and Brazil had a slow start but are now registering large numbers of cases showing that India and other countries with limited testing could face the same situation. Russia has ramped up testing, and so have the U.S. and the UK. Moscow's mayor Sergei Sobyanin says for example that about 300,000 of the 12 million people in Moscow have the virus based on sampling surveys, more than 3 times the confirmed cases. Restrictions remain in place in Moscow beyond May 11.  Countries that were hit earlier by the virus such as Spain and France are reopening gradually after May 11. France will use red and green zones to handle restrictions so that the restrictions are customized to each place in the country. ...

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What is the difference between South Korea and the U.S., Europe in the handling of coronavirus? It is tracking and testing.  President Trump and health adviser Dr. Fauci, see South Korea as the successful model to be followed in controlling the coronavirus. What has happened till now it is accepted with shortage of basic medical supplies and equipment, stress on hospital systems, are merely mitigation actions. South Korea was prepared for the coronavirus crisis because of the MERS and other epidemics, and failures resulting in corrective actions. Labs were centralized and better equipped for testing and tracking the infected. One of the key tools is testing. President Trump says the goal is for the U.S. to exceed and far surpass tests per capita in South Korea. Five million tests are planned by the end of April in the U.S. Where the U.S. falls short is in use of multipronged digital tracking using data from people's use of mobile phones, credit card usage, and use of apps designed to separate infected people from others. South Korea is a democracy with a population of 52 million people, about the size of France. People who were student activists in the democratization era in South Korea say the use of digital technology is a need today. We have to adapt in emergency situation they say. Ki Mo-ran, epidemiologist, and adviser to South Korean government says this is a key part lacking in the European and U.S. efforts to control coronavirus. She says in South Korea we know the patient's contacts, where he goes and stays, so we don't have to lock down everybody. Without digital tracking one cannot know which place is contaminated, which place is clean, so that there can be a lockdown of just that area and not the whole country, says Ki Mo-ran. She asks the question- is one person's privacy more important than the lives of a family or other people who are affected. Is it OK to lockdown every child in the country in a home as in Spain for over a month so that particular people's privacy is respected? These are serious questions for western society, are they exceptions or is democracy not just a western idea but equally cherished in Asian societies, people talk about Confucianism in China and the Asian culture forgetting that the biggest democracies are quite large and functioning well in India in addition to South Korea, Taiwan Indonesia, Malaysia, Bangladesh and Japan, far larger in area and population than China. The French government has chosen the app TraceTogether as the least intrusive one adaptable to France for use there. The U.S. is having Google and Apple develop one of its own. India will be developing one of its own. The NYT raises the question will it be watered down so much in France or in the U.S. and UK to be less effective than the  dire need for an alternative to lockdowns? ...

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The asymptomatic coronavirus infected people are a large fraction of the people with coronavirus. This is a huge problem as these people unaware of the danger are unwittingly spreading the virus. This is one of the most unusual aspects of this virus compared to other virus epidemics, and why it has become so dangerous. It is also why social distancing alone is not enough. Strict enforcement of stay at home orders by public health authorites, state and federal governments is essential as the unwitting spread by asymptomatic people who are not following the required guidelines is a huge problem.  Even as the public now calls for stricter action the lax behaviours in March in U.S. Britain, France, Germany, and in Italy in February, have created a population of infected people that acts as a backlog for testing, creating a surge in April. One of the novel features of this public health crisis is that lax behaviours stemming from a lack of understanding of the severe contagiousness of the coronavirus is making it a larger crisis on a scale not encountered before.  The contamination potential of this virus is only now being tackled with experts in fluid dynamics at labs such as the MIT Lab in the U.S. looking into how it can contaminate environments, as shown on BBC News.  With pieces of the contamination puzzle only now being put together. Heeding public health expert warnings and guidelines is all the more essential for this reason. ...