Americans are being told to prepare for a coronavirus outbreak — but US health agencies lack funding, and disease testing lags behind

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US passengers leave the Daikaku Pier Cruise Terminal in Yokohama port, next to the Diamond Princess cruise ship, on February 17, 2020.

Behrouz Mehri/AFP/Getty Images

US health officials issued a dire warning to American citizens on Tuesday: Prepare for a coronavirus outbreak.

"It's not so much of a question of if this will happen anymore, but rather more of a question of exactly when this will happen," Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, said in a press briefing. "We are asking the American public to prepare for the expectation that this might be bad."

On Wednesday, the Centers for Disease Control reported the first US case in which a patient got the virus from an unknown source — the person did not travel to China or knowingly interact with someone who got the illness, known as COVID-19.  

"The patient's exposure is unknown," the agency said in a statement. "It's possible this could be an instance of community spread of COVID-19, which would be the first time this has happened in the United States."

That announcement followed a dramatic spike in cases outside of China, especially in South Korea, Italy, and Iran. On Tuesday, the number of new cases reported outside of China exceeded the number of new cases reported in China for the first time.

The virus so far has killed nearly 2,800 people and infected more than 81,000 since December.

For now, the CDC doesn't recommend that Americans take any action other than continuing to practice good hygiene, like washing their hands frequently. But that could change, Messonnier said. If an outbreak were to become widespread in the US, schools may be forced to close, religious observances might be halted, and employees could be asked to work from home. 

"I and many others were much more nervous this Tuesday then we were last Tuesday," William Schaffner, an infectious disease specialist at the Vanderbilt University School of Medicine, told Business Insider. "I think we need to implement much more widespread testing."

But the rate of coronavirus testing in the US has lagged behind that of other nations. As of Wednesday, the US has only tested 445 people for the virus, compared to around 35,000 people who have been tested in South Korea. Switzerland, whose population is 38 times smaller than that of the US, said it's capable of conducting around 1,000 tests per day

"I know the infectious-disease community and the public health community desire to do much more testing than is currently feasible," Schaffner said. "There's been a delay in making testing more readily available, more quickly available across the country — and we're all waiting for this."

The CDC was short on funds before the outbreak

The CDC has developed a laboratory test for the new coronavirus, but only three of the nation's more than 100 public-health labs have verified it for use, the Association of Public Health Laboratories said last week.

The tests have also been faulty, causing more than half of state labs to receive inconclusive results. The labs are now waiting for replacement tests. In the meantime, they have to send samples to the CDC in Atlanta to confirm a case.

"At first, CDC was the only place where testing could be performed," Richard Martinello, an associate professor of infectious disease at the Yale School of Medicine, told Business Insider. "For a country of our size, when you only have a single site doing that, it limits the resources available for testing."

Commuters wear masks in Singapore on February 18, 2020.

REUTERS/Edgar Su

A single coronavirus test can cost around $250 to run, Politico reported. But in 2018, the Trump administration slashed the CDC's global disease-fighting budget. As a result, the agency was forced to scale back on efforts to prevent disease outbreaks.

Whereas the CDC had previously helped nearly 50 countries prepare for future epidemics, in 2018 it limited its involvement to just 10 "priority countries." The Trump administration's proposed budget for 2021 includes another 16% cut to the CDC budget. 

Health experts want more testing right away  

Schaffner said he visited the CDC on Monday and told his colleagues there to widen the scope of testing in the US.

"We don't need doctors to test everybody who's got a cough — that's inappropriate — but we need a broader testing program than we currently have available. We need to get with it," he said.

Coronavirus test kits in Krasnodar, Russia, on February 4, 2020.

AP Photo

Schaffner said some of his colleagues are in favor of testing people without a fever who might have a high likelihood of being infected. It might also be time, he added, to start testing people who have recently returned from hotspots outside China.  

"Suppose they've come back from Italy, particularly northern Italy — I would open the door to that testing," he said.

Schaffner also said the US Food and Drug Administration should speed up the process of approving a commercial test. For now, the FDA has issued an emergency use authorization for the CDC test. 

Meanwhile, the Chinese genome-sequencing firm BGI Group has already distributed tens of thousands of commercial test kits throughout China. 

"Other countries are testing much more broadly than we are," Schaffner said. "We are trotting along while they're racing along."

The problem with over-testing

Martinello agreed that it is time to start testing people who return from countries with major outbreaks, like South Korea, Italy, and Iran. But like Schaffner, he cautioned against testing every person with flu-like symptoms.

"Whenever we see something occur where there is a concern for an infectious disease — whether it's anthrax in 2001 or the pandemic flu in 2009 — we see a lot of interest from people in the community to get tested," Martinello said.

Travelers arrive at LAX airport wear face masks for protection against the coronavirus on February 2, 2020.

David McNew/Getty Images

His emergency department at Yale, he said, has seen patients with flu symptoms who are unnecessarily concerned that they may be infected with the coronavirus. 

"We have to dissuade them that, unless they have a travel history that would be concerning or other contacts with individuals that would be concerning, there's not even a reason to think about testing them," he said. 

However, if the virus were to spread more throughout the US, hospitals would do more widespread testing. Martinello said his department is trying to prepare for that scenario as best it can. 

At a hearing on Wednesday, Health and Human Services Secretary Alex Azar said the US needed 300 million N95 masks — which filter out most airborne particles from the surrounding air — to protect healthcare workers during an outbreak. At present, it only has 30 million, he said.

Travel bans aren't likely to keep the virus out of the US

The US has confirmed 60 coronavirus cases so far, including 42 passengers aboard the Diamond Princess cruise ship docked in Japan and three people who were evacuated from Wuhan to the US.

The CDC recently cautioned that any travelers returning from China, South Korea, Italy, Japan, or Iran who develop a fever, cough, or shortness of breath should seek medical help and self-isolate. US citizens have also been advised to avoid all nonessential travel to China. 

A health official talks to US passengers who chose to leave the Diamond Princess cruise ship in front of the bio-containment unit on their evacuation flight on February 17, 2020.

Courtesy of Philip and Gay Courter/via REUTERS

But travel bans themselves are unlikely to keep the virus from spreading, Martinello said.

"This virus has already circulated so widely that, at best, travel bans may slow things down a little," he said. "Without real draconian measures, it's essentially impossible to prevent further spread of this."

Schaffner said the only way to get ahead of a potential outbreak is to have a contingency plan: Companies should decide whether they're going to pay employees for remote work — and for how long. Sports teams should consider the possibility that their games might be canceled, and movie theaters and malls should prepare to be temporarily shuttered. 

"There are people undoubtedly in this country — mayors, governors, hospital directors — who are still looking at this phenomenon and saying, 'You know, this is really bad, but it's way over there. It's not here,'" Schaffner said. "I think they have to get over that. They all have to pull their pandemic plans off the shelf, dust them off, and start rehearsing."

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