The Washington PostDemocracy Dies in Darkness

The Health 202: The U.S. now has the capacity to carry out 40 to 50 million monthly coronavirus tests. But that's not happening

with Alexandra Ellerbeck

The United States should be able to conduct 40 million to 50 million coronavirus tests a month by now, according to a prediction by a top Trump administration health official in June.

Medical manufacturers and labs insist the capacity is there — although it’s increasingly hard to determine how many covid-19 tests are actually being performed in this country.

Quest Diagnostics, one of the nation's largest laboratories, said it now has the capacity to perform 200,000 tests a day. Companies that make coronavirus testing supplies are shipping between 32 million and 35 million molecular tests every month, Scott Whitaker, president of the Advanced Medical Technology Association, told me. Another 20 million rapid antigen tests which detect specific proteins on the surface of the virus rather than its genetic material will be shipped out by the end of the month, he said.

“If you’re talking about just supply and capacity, it appears we are in that 40 to 50 million a month range by now,” Whitaker told me.

A much smaller figure — around 9 million tests — appear to actually have been performed in the United States so far in September.

But that’s likely an undercount. It's also not clear why there is a gap between testing capacity and the actual number of tests being performed with so many complex factors at play.

Websites tracking testing data, such as the widely referenced Covid Tracking Project, aren’t always capturing rapid antigen tests, which are increasingly used in nursing homes, schools and doctors’ offices. This type of test is somewhat less accurate but attractive because results can be obtained in 15 minutes without shipping it to a lab for analysis.

The data on antigen tests is spotty, the Atlantic’s Alexis C. Madrigal and Robinson Meyer reported. They found only six states “make separate antigen-test data readily available.” Reports indicate only 1.4 million antigen tests have been conducted in the United States, below the tens of millions of such tests companies have reported shipping since June, they wrote.

The U.S. testing picture could continue getting murkier as the federal government and states invest heavily in antigen tests. Maryland Gov. Larry Hogan (R) announced last week that his state has ordered 250,000 rapid tests to be used in nursing homes. At the end of August, the White House said it had struck a deal with Abbott Laboratories to produce 150 million rapid tests.

The Trump administration said the U.S. had capacity to complete as many as 48 million tests in August.

A spokeswoman for the office led by Giroir told me the country “has excess and unused capacity for testing," considering just 24 million tests were conducted that month. She said the capacity is nearly doubling this month.

“We have the capacity to test approximately 90 million in September,” the spokewoman said.

The 40 million to 50 million prediction came from Brett Giroir, assistant secretary for health at the Department of Health and Human Services. He told Congress at a June hearing that there would be a dramatic ramp-up in the nation’s testing capacity, after supply chain shortages had dogged the process throughout the spring.

“Even without any major technical advances, I estimate the nation will have the capacity to perform between 40 to 50 million tests per month by fall,” Giroir said.

Giroir is known for making far-fetched promises. A senior HHS official told me Giroir’s exaggerated promises have caused some in the agency to coin the term “Giroir math.”

“It is widely known among senior staff in the department that the assistant secretary for health often exaggerates successes and plays with data to tell the story he wants,” the official said. 

President Trump has continued boasting about U.S. testing:

Giroir had promised in March that 27 million coronavirus tests would be completed by the end of the month. The actual total was around 750,000 and a month later, totals had reached just 4 million tests. 

Giroir might be right about testing capacity, but how many tests are being carried out is a different story.

Daily testing, on average, has appeared to diminish somewhat in recent weeks, after hitting a high point in July. Somewhere between 500,000 and 800,000 tests are typically carried out in the United States every day although that figure doesn’t include many of the newly popular antigen tests.

In a puzzling move last month, the Centers for Disease Control and Prevention revised its testing guidelines to say people exposed to the virus don’t need to be tested if they don’t have symptoms even though the agency has estimated 40 percent of people testing positive for the virus have no symptoms.

Its previous guidance had said everyone who had been in close contact with an infected person should get tested.

It’s still unclear whether the administration is redirecting testing supplies because of shortages.

Whitaker insisted there are plenty of supplies for carrying out both molecular and antigen tests. Yet some medical centers and schools have alleged HHS is redirecting supplies away from them to higher-need areas. (We wrote last month about how Louisville’s largest hospital system cut down on testing because of supply shortages.)

Sen. Richard J. Durbin (D-Ill.) is asking HHS Secretary Alex Azar to explain the administration’s reported use of the Defense Production Act to direct tests produced by Quidel away from Loyola University Chicago and Illinois State University.

“The sudden and haphazard intervention by HHS to cut in front of these universitieshas unacceptably left these universities with substantial delays and gaps in their testing plans,” Durbin wrote.

Ahh, oof and ouch

AHH: Senior HHS aide Michael Caputo accused CDC scientists of ‘sedition’ and warned of an armed left-wing revolt.

“A top communications official for the administration’s coronavirus response urged President Trump’s supporters to prepare for an armed insurrection after a contested election and accused government scientists of ‘sedition’ in a Facebook Live chat that he described in detail to The Washington Post on Monday,” The Post’s Yasmeen Abutaleb, Lena H. Sun, Josh Dawsey and Rosalind S. Helderman report

Caputo, the HHS assistant secretary of public affairs, made the comments during a live video hosted on his Facebook page. Caputo deleted his Twitter and Facebook accounts on Monday.

Caputo, who lacks medical experience but is a Trump loyalist, was installed by the White House in April and has since faced criticism for efforts to interfere with CDC scientific reports. Democrats on the House Oversight and Reform Select Committee on the Coronavirus Crisis on Monday said they were investigating the scope of this interference.

Several Democratic lawmakers, including Sen. Patty Murray (Wash.) and Rep. Rosa L. DeLauro (Conn.) yesterday called for Caputo’s resignation.

The Facebook video ran through a long list of conspiracy theories, including that Trump would win the election and Biden would refuse to concede, that left-wing hit squads were being trained across the country, and that there was a “resistance unit” in the CDC aimed at undermining Trump. There is no basis for these claims.

Caputo also expressed fear that he could be in personal danger. He has said that he has received death threats since taking on the HHS job.

“I don’t like being alone in Washington,” Caputo said in the video, describing feeling fear from shadows in his apartment.

OOF: States that have reopened bars experienced a doubling in the rate of coronavirus cases three weeks later, on average.

That's according to an analysis by The Washington Post, conducted as bars and restaurants have reopened in most states and cities. New York City, one of the last holdouts, will open indoor dining with limited capacity at the end of the month. Most Florida bars could reopen at 50 percent capacity on Monday.

“The Post analysis — using data provided by SafeGraph, a company that aggregates cellphone location information — found a statistically significant national relationship between foot traffic to bars one week after they reopened and an increase in cases three weeks later,” The Post’s Rachel Weiner, Chris Alcantara and Andrew Ba Tran report.

The analysis did not find a similar effect for restaurants or for bars over time. But the CDC recently reported that in a study of nearly 300 adults who tested positive for the coronavirus, they were more than twice as likely to have dined in a restaurant or bar. The same effect was not seen in visits to salons, gyms and houses of worship, or in the use of public transportation.

“You’re sitting there for a long time, everyone’s talking,” said Linsey Marr, an environmental engineer at Virginia Tech, told The Post. “And that’s just a recipe for spread.”

OUCH: Fifteen scientists are raising doubts about the data from Russia’s covid-19 vaccine trial.

A group of scientists sent a formal letter to the medical journal Lancet expressing doubts about the accuracy of early data on Russia’s covid-19 vaccine, which was published in the journal, Reuters’s Emilio Parodi reports.

The move “highlights growing concern among scientists about the safety and efficacy of the Sputnik-V vaccine, which the government approved for use before completing full human trials,” Parodi writes.

Reuters did not see the contents of the letter, which was signed by 15 scientists from five countries, according to one of the authors of the letter.

Last week, a larger group of scientists signed an open letter to the international medical journal expressing similar concerns about the early-stage trial results from Moscow’s Gamaleya Institute, saying that some patterns in the data appeared “highly unlikely.” 

The Gamaleya Institute issued a statement in response to the open letter last week defending the accuracy of the data.

Naor Bar-Zeev, deputy director at Johns Hopkins Bloomberg School of Public Health, who peer-reviewed the Russian vaccine study data, defended his analysis of the study and called the results “plausible.”

Ignoring public health orders

Nevada’s governor is criticizing Trump for an indoor rally where few attendees wore masks.

“Shortly before President Trump took the stage on Sunday night in Henderson, Nev., for his first indoor rally in months, Nevada Gov. Steve Sisolak blasted the president for flouting the state’s coronavirus restrictions by packing hundreds of supporters, many without masks, into a building,” Timothy Bella reports.

Nevada, which has reported 73,500 cases of coronavirus and 1,450 deaths, has a ban on gatherings of 50 people or more. The Democratic governor tweeted that the rally at Xtreme Manufacturing was “reckless” and “an insult to every Nevadan who has followed the directives.”

But that wasn't the only indoor campaign event held by Trump. The president yesterday held an indoor rally for about 100 in Phoenix in which many of the attendees didn't wear masks. Aides told my colleagues the president himself was bent on holding these events, which health officials warn could spread the coronavirus.

“Trump’s speech appeared to be a gamble that his defiance would energize his most loyal supporters, even at the risk of alienating more moderate voters he needs to win. Many around the president are acutely aware that a potential surge in coronavirus cases and deaths close to the election could be disastrous, according to campaign and White House aides, but they are mostly bowing to Trump’s desire to pack the house.” Anne Gearan and Josh Dawsey reported of the Nevada event.

“Two advisers close to Trump, who spoke on the condition of anonymity because they were not authorized to discuss the matter on the record, said the return to indoor rallies may not be a permanent one. ‘I wouldn’t expect to see one of those every week,’ one of the officials said. 'It’s not an ideal situation,'” they report.

The Trump campaign said that supporters were subject to temperature checks and urged to wear masks. Trump also told the Las Vegas Review-Journal on Sunday that he did not think the restrictions applied to him.

But many at the event were not wearing masks.

President Trump touted his response to the pandemic during a packed indoor campaign rally in Henderson, Nev., on Sept. 13. (Video: The Washington Post)

This Nevada event was the first indoor rally Trump has held since June. Though public health officials have said the coronavirus can spread in any large gathering, the lack of ventilation in indoor spaces further increases the risk. Public health officials have linked Trump’s last indoor rally in Tulsa, Okla., to a spike in coronavirus cases. 

Biden’s campaign has said it has been following public health guidelines at events.

This isn’t the first time Trump has defied state and local public health measures: At an event last week in Winston-Salem, N.C., he refused to wear a mask and mocked restrictions on crowd size.

Going home to die

A Louisiana hospital system sent patients home to die.

“The Louisiana Legislative Black Caucus has called for an investigation into the practice of sending infected coronavirus patients into hospice facilities or back home to their families to die,” ProPublica’s Annie Waldman and Joshua Kaplan report.

The call for an investigation comes after ProPublica reported that Ochsner Health, the largest hospital network in Louisiana, sent patients with covid-19 home for hospice care and pressured families to discontinue treatment. Many patients did not receive regular follow-up care, and some families were not given protective equipment.

“In the dozens of cases ProPublica examined, every patient who died after the hospital sent them home was Black,” Waldman and Kaplan write. “ … Nationally, coronavirus patients ages 85 and older died at home only 4% of the time. In New Orleans, it was 17%.” 

Though there is a growing movement for patients to receive hospice, including home hospice, in end-of-life scenarios, many hospitals have opted against home hospice for coronavirus patients for fear it could spread to others in the household and because its symptoms are often difficult to control. 

Coronavirus latest

  • Medicaid rolls are swelling amid job losses during the coronavirus pandemic, and state budgets are feeling the strain, The Post’s Amy Goldstein reports.
  • Jeannette Young, the chief health officer in the Australian state of Queensland, recently spoke out about receiving death threats, which she said have taken an “enormous toll.” It’s the latest case in a worldwide trend, as health officials around the world face threats over their response to the coronavirus, The Post’s Rick Noack and Ruby Mellen report.
  • As wildfires tear through Oregon, prisoners have been hastily moved to an overcrowded state prison, where advocates worry that the coronavirus may spread rapidly, the New York Times reports.
  • The AstraZeneca coronavirus vaccine trials have resumed in Brazil after health regulators confirmed their counterparts in the U.K. had approved a restart. So far, 4,600 of the 5,000 planed volunteers have been vaccinated without serious health issues, Reuters reports.

Elsewhere in health care

A nonpartisan group advocating for lower drug prices is running ads in key states before the election.

Patients for Affordable Drugs is running TV and digital ads asking voters to support candidates who will “stand up” to the pharmaceutical industry and work to lower drug prices. The seven-figure ad campaign will run in 15 key states and will also feature a website including the stories of patients facing skyrocketing drug prices.

The campaigns first digital ads features Candice Brown, a patient who depends on a $6,700 per month drug to manage ulcerative colitis:

Ambulance rides leave patients saddled with surprise medical bills but have received little legislative attention.

“Studies show the majority of ambulance rides leave patients saddled with hundreds of dollars in out-of-network medical bills,” Kaiser Health News’s Laura Ungar reports. “Yet ground ambulances have mostly been left out of federal legislation targeting ‘surprise’ medical bills, which happen when out-of-network providers charge more than insurers are willing to pay, leaving patients with the balance.”

Temporary changes during the coronavirus pandemic have protected some patients. Ambulances that receive Cares Act funding are not allowed to charge coronavirus patients the leftover balance after insurance kicks in. During the pandemic, Medicare can also cover ambulance rides to places other than hospitals, including doctors’ offices or urgent care clinics.

But researchers and advocates are calling for more protections past the end of the pandemic. 

The costs of ambulances can be steep.

“A Health Affairs study, published in April, found 71% of all ambulance rides in 2013-17 for members of one large, national insurance plan involved potential surprise bills. The median out-of-network surprise ground ambulance bill was $450, for a combined impact of $129 million a year,” Ungar writes.

A bill that was introduced in the House of Representatives in February to create an advisory committee to study ground ambulance costs has failed to advance since the pandemic begin. 

Sugar rush