--:-- Sean Rameswaram: Welcome to Today Explained. I'm Sean Rameswaram.
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--:-- Sean Rameswaram: It's getting real out here in Corona country. California, which has already declared a state of emergency, is currently dealing with yet another cruise ship outbreak. The University of Washington in Seattle announced today that it would be canceling in-person classes for the foreseeable future. And President Trump just announced $8.3 billion in emergency aid to deal with COVID-19. Safe to say, this thing is waxing, not waning, in the United States. But what about that tickle in the back of your throat? That mild fever? That dry cough? Is that allergies? Is that the flu? Or, you know.
--:-- Sean Rameswaram: On today's show, we wanted to help explain how you know if you have this thing or how you'd go about finding out. Caroline Chen has been reporting on COVID-19 testing for ProPublica, and she's going to present how this whole situation could go. Extra stress on could, because it could go a lot of different ways depending on your doctor, your test, your state, all that.
--:-- Caroline Chen: So let's say you woke up and you're not feeling so hot and you're thinking, oh no, do I have the coronavirus? So the first thing I would say is, what symptoms do you have? And I think a lot of people don't know actually what the presenting symptoms are of the coronavirus because a lot of people have just been hearing it's flu-like. So actually a good thing to know is that the first two presenting symptoms are fever and a dry cough, not the runny nose or, you know, a wet, mucousy cough.
--:-- Caroline Chen: So let's say that you do have the two presenting symptoms, which is a fever and dry cough. The next thing to do would be ideally to call. By which I mean, ring your doctor, or if you have a primary care physician, or if you don't have a primary care physician already to call, say, a local clinic, or to call your local hospital.
--:-- Caroline Chen: And the reason why is, particularly if you are in an area, say, a place like Seattle right now, which has had a lot of cases, they're pretty overwhelmed right now. And this helps to do some triage. And your doctor's probably going to ask you questions like, What's your travel history been? Or if you're in the Seattle area, Tell me something. What does your day-to-day look like? Are you around a lot of people? Are you riding public transit?
--:-- Caroline Chen: And this calling just helps you talk to a medical professional who will help you sort out, you know, are you a likely candidate for the coronavirus? And it helps to not overwhelm emergency rooms. And part of the reason for this is because it's also flu season right now. Just statistically speaking, it is still more likely that you have the flu than the coronavirus.
--:-- Caroline Chen: So if everybody who thought they had the coronavirus just went straight for the emergency room, our hospitals would be in trouble. So at this point, you've called your doctor and you're going to follow whatever your doctor tells you to do. And your experience could vary really dramatically depending on where in the country you are, which state you're in.
--:-- Caroline Chen: But I would say broadly, you're probably going to get, you know, one of a number of responses. If your doctor thinks it's very, very unlikely that you have the coronavirus, it's possible they'll say, I think you should stay at home, you should monitor your symptoms, and keep me posted. Call me if anything changes.
--:-- Caroline Chen: They could say It sounds like you are sick, but I really don't think you have the coronavirus, so here's what you need to do. Come to the office, we'll assess you for whatever else we think you might have, but we're not going to test you for coronavirus right now. Or they could say Based on what you're telling me, especially since you're in the Seattle area where we've seen other people with symptoms like yours, we'll test you just to be safe.
--:-- Caroline Chen: They probably then tell you to come in And I not really sure exactly what the procedure is say in the greater Seattle area but it likely that there are specific hospitals that they are directing likely candidates to for testing and they would give you directions to go to a specific location that is taking what they call PUIs, which is a person under investigation, and that's when they would test you for the coronavirus.
--:-- Caroline Chen: So at this point, it's a swab like if you were being tested for the flu. They'll take a swab and send that specimen to a lab. And depending on where you are in the country, there are some states where their labs are already set up and able to take tests. And there are other states where they're still working on getting their public labs or local academic medical centers, you know, hospitals to have capabilities to do testing locally.
--:-- Caroline Chen: And so if they don't, they have to send the specimens to the CDC. And that's going to determine how fast you get an answer. So I'm currently at a conference in New Orleans, and I spoke to an official at the public health department here. And they said that they currently haven't been running a lot of tests. So in their local lab, they can get an answer in under six hours.
--:-- Caroline Chen: But currently, if they get what they call a presumptive positive, so they get a positive answer, answer, they then send the patient sample to the CDC as well for confirmation. And that can take days. If doctors suspect that you are positive, even if they're waiting for the test results to come back, they will most likely, I can't imagine why they would not, they would isolate you at a hospital because they don't want you to transmit the disease to someone else.
--:-- Caroline Chen: And I would not be surprised if they would also start asking you about who else you live with and ask them to do what's called self-isolation and start tracking yourself for symptoms like cough and fever until they hear back on your test results. And then of course, if you're positive, then the people who you are close to are going to be closely watched in case they come up with symptoms. And that's known as contact tracing because they want to know who you've been around in case they then also become positive cases.
--:-- Caroline Chen: If you've been paying attention to the news this week, you know that people have been having wildly different experiences and having real trouble even getting to the point where you can get tested. And doctors and nurses are frustrated, too, saying they can't even get their patients tested.
--:-- Caroline Chen: I'm going to read a statement from one of our quarantine nurses who works at a Northern California Kaiser facility. She said, as a nurse, I'm very concerned that not enough is being done to stop the spread of the coronavirus. I know because I am currently sick in quarantine after caring for a patient who tested positive. I am awaiting permission from the federal government to allow for my testing, even after my physician and county health professional ordered the test.
--:-- Caroline Chen: I'm here to tell you right now, at one of the busiest hospitals in the country, I don't have it at my fingertips. I still have to call the Department of Health. I still have to make my case, plead to test people. This is not good.
--:-- Caroline Chen: Why has it been so difficult for people? Man, there is a big story behind why the U.S. is at the place it is in testing right now. And I'm an investigative reporter. I don't really cover breaking news. So when my boss told me, hey, I'd like you to get into coronavirus two weeks ago. And to give some background, I have some experience covering the Ebola outbreak a few years ago. And also I've covered Zika as well.
--:-- Caroline Chen: And so one of the things that I was just curious about was that countries like South Korea seem to be doing large volumes of testing. And I live in New York City, and I had seen Mayor de Blasio tweet that they were testing a patient. I just thought, hey, what happened to that patient? Was it patient positive or negative? And I had to go look and find and see if there was an answer.
--:-- Caroline Chen: It wasn't like, you know, a few hours later there was a response. And I just knew from the experience I've had before that that means that they're sending samples to the CDC because it's taking days to get answers. And I thought, how is it that we're not able to test at the local level? And so that sort of sent me down this reporting rabbit hole of trying to understand how it is that South Korea is able to test in the tens of thousands, but the U.S. as of last week still wasn't.
--:-- Sean Rameswaram: OK, we're going to take a quick break. Could you tell us all about what you found out after it? That sounds great.
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--:-- Caroline Chen: So, Caroline, before the break, you said that this kind of question of why testing in New York in particular was taking so long sent you on this reporting journey. Tell me what you found out when you tried to answer the question of why things were taking so long.
--:-- Caroline Chen: So what I found out was that the CDC had made this critical decision at some point to design its own testing kit, which is different from the test that was endorsed by the WHO, which is used by many, many countries around the world right now to test for the coronavirus.
--:-- Caroline Chen: So the way the CDC decided to design its tests was so that it wouldn't just test for the current coronavirus, which is one in a family of coronaviruses. It would also test for other coronaviruses. In the documents, it says that it's intended for the universal detection of SARS-like coronaviruses.
--:-- Caroline Chen: And I can see why someone somewhere might have thought this was a good idea, which is, you know, every few years a coronavirus sort of pops up from the wild and transfers from animals into humans. So why not design a fancy test that can be used in future years to catch, you know, all these other coronaviruses? Why not?
--:-- Caroline Chen: When the CDC then shipped out its test kits to the public health labs around the country, it shipped it to 100 public health labs in early February. It turned out that this test kit was a little bit faulty. And so what we found was because of this decision, we wasted many weeks of time in the U.S. where we could have had a test up and running and have testing started.
--:-- Caroline Chen: And even to this day, at this point in time, as of Thursday morning, only 67 of the 100 labs have validated their tests and got them working, even now that it is sort of this more narrow, specific test that's only testing for COVID-19, because it takes a little while to set up the kit.
--:-- Caroline Chen: And the way I've been explaining this to people is it's kind of like a blue apron kit that the CDC sends. It takes a little bit of assembly and a little bit of setup, and it takes a little bit of expertise. It's not like a power bar where it's like ready to go right out of the wrapper.
--:-- Caroline Chen: So now that they've figured it out, are there lingering issues, or has this all been resolved and the tests are flowing?
--:-- Caroline Chen: So now the tests are flowing. However, we then come to sort of the next snag, which is there are only 100 public health labs. And even if you have stacks and stacks and stacks of kits that are produced, you have a manpower issue. And so the Association of Public Health Labs has told me that each lab on average can run 100 samples a day.
--:-- Caroline Chen: So you take 100 labs, you multiply that by 100 samples a day, and then you need to divide this by two because you run two samples per person so you can double check your result. So that comes out to 5,000 patients a day. That is not enough for all of America, according to the experts that I talk to.
--:-- Caroline Chen: So this is why you've been hearing about all these hospitals and academic medical centers that have also been trying to come on board. We continue to work with the University of Washington Virology Lab and expect them to be ramping up their tests in the upcoming days.
--:-- Caroline Chen: And so on Saturday last week, the FDA, which originally was saying you have to go through this really long and cumbersome process as an academic medical center to be able to test. They said, never mind that. We're letting you start testing so long as you internally validate the test.
--:-- Caroline Chen: Because they also realized that it's not going to be enough testing capacity if we only rely on the public health labs. You need large volumes of kits, and you need manpower and capacity, and you sort of need both of those.
--:-- Caroline Chen: And so now I think we're in like full-on ramp-up mode. We have the public health labs. We have the academic medical centers. And Quest and LabCorp, which are these huge testing giants, commercial companies, are also getting into the fray. And they say that they should be able to come on board next week.
--:-- Caroline Chen: So I fully expect that testing capacity will really be sort of escalating by next week and the week after and it just keep going up and up But we really sort of got off to a very slow start
--:-- Sean Rameswaram: Caroline, we're talking Thursday evening here, and the CDC at this point has confirmed 99 total cases. With the delays we've had in getting testing kits out to people and people having real difficulty even getting tested beyond that, trying to get through to their doctors, trying to get through to their hospitals, I wonder how accurate do you think is that count from what you know? Are you asking me do you think there are 99 people in the U.S. who are infected?
--:-- Caroline Chen: Uh, kinda. I do not think that there are 99 people in the U.S. who are infected, and that's it. I think that that is definitely an undercount at this point in time. For a number of different reasons. Partly it is because it's slowness to testing, but also because COVID-19 is a relatively mild illness for many people.
--:-- Caroline Chen: So what we've seen is that the sickest people seek out treatment and testing first. And there are going to be a lot of people who may be infected who may never go see their doctor because it doesn't really present as a very severe illness. So it's hard at this point to get a really good idea of the total number even globally of infected cases.
--:-- Caroline Chen: Like right now, this is all a ballpark estimate and the more data we have, a better sense we'll have of the actual fatality rate. So what I'm trying to tell people is what we do know is that it is more deadly than the regular seasonal flu, and it is less deadly than something like SARS.
--:-- Caroline Chen: Caroline, you grew up in Hong Kong during the SARS outbreak, and you mentioned earlier that you covered the Ebola outbreak, too. How does the way this is being handled in the United States at this point compare to those outbreaks?
--:-- Caroline Chen: So I was 13 when I was living in Hong Kong during SARS. So my perspective as a teenager was that I was kind of bummed to not be able to go to school because I missed my friends. And I mainly paid attention to the daily death toll because my parents told me that I wasn't allowed to go back to school until the daily death toll fell under two per day.
--:-- Caroline Chen: Your parents just made up this rule? That was the rule they made up? That was the rule my parents came up with. But, you know, obviously that's the very teenager perspective. But I did come to really gain a huge respect for the medical workers during that time.
--:-- Caroline Chen: There were medical staff, doctors and nurses in Hong Kong who worked around the clock and really, truly just sacrificed themselves to the point that they succumbed. And I remember that and am still moved by that to this day.
--:-- Caroline Chen: And we have seen that happen in Wuhan, China, with the coronavirus outbreak. And to me, that drives me as a reporter now to think about what kind of support medical workers are going to get in the U.S. And it's a question I'm asking now as I am reporting.
--:-- Caroline Chen: And we're hearing so far, you know, very different experiences from nurses and doctors at different hospitals. But we want to hear more because that's a big concern of mine. You know, how prepared hospital staff are, especially after a difficult flu season.
--:-- Caroline Chen: I'm still trying to get a better sense of decision making at the governmental level and understanding preparedness. You know, the big question that is just driving my reporting generally is just, is the U.S. prepared, you know, at all different levels? And trying to see where we aren't prepared and if we aren't prepared, you know, who is accountable? Because it is a matter of understanding our health care system and how it intersects with government.
--:-- Sean Rameswaram: Caroline Chen is a reporter at ProPublica. You can help her and her colleagues report on COVID-19 right now. They want to hear from frontline workers, medical staff and experts dealing with COVID-19 across the country. If you know one, or you are one, you can share stories at propublica.org slash coronavirus.
--:-- Sean Rameswaram: I'm Sean Rameswaram for Today Explained. The rest of the Today Explained team includes Halima Shah, Amina al-Sadi, Jillian Weinberger, Bridget McCarthy, and Noam Hassenfeld, who does music too. The mysterious Breakmaster Cylinder does music three. Cecilia Lay checks facts every day. Afim Shapiro played the role of the doctor today.
--:-- Sean Rameswaram: Special thanks to Jeff Geld this week. And extra special thanks to Desmond's mom, Liz Nelson, who also happens to be the editorial director of Vox Podcasts. Today Explained is part of the Vox Media Podcast Network.
--:-- Sean Rameswaram: And we are having our first ever live show in these United States on April 29th. It's going to be a bit of a homecoming here in Washington, D.C. at the 6th and I. You can buy your tickets now by visiting 6thandI.org. That's S-I-X-T-H-A-N-D-I dot O-R-G.
--:-- Sean Rameswaram: And we'll be bringing the heat once more on April 29th. Come and say hello. We'll do elbows instead of handshakes. What do you say?
