It’s been over a year since the first case of COVID-19 was confirmed in the United States. The virus spread rapidly, infected more than 1 million people in just three months after the first confirmed case [1]. Very few countries were spared from this pandemic. Ironically, the United States was ranked first on epidemic preparedness based on the GHS index but bears the most human toll from Coronavirus with over 600,000 deaths as of today [1,7]. Since the first awareness of the outbreak in Wuhan China, the U.S. lagged in public health response. As other countries took more aggressive measures on containing the spread during the initial phase of the pandemic, the U.S. underestimated the deadly impact of the virus and took a “wait-and-observe” approach. The delayed response exacerbated the situation, giving the virus ample time to circulate the country. If the U.S. had accurate diagnostic testing available on a mass-scale early on during the pandemic, the spread can be contained more efficiently and many lives can be saved.
One of the reasons that make Coronavirus hard to control is its incubation period. The incubation period ranges from 2-14 days [2], which is long enough that the infection rate wouldn’t spike until it’s too late. In addition, it is estimated that 30% of the infected population are asymptomatic [3], making the disease even less notifiable. Given this unique nature of SARS-CoV-2, epidemiologic surveillance cannot solely depend on reports of symptomatic cases. A mass scale of diagnostic testing needs to be available to carry out the epidemiologic investigation within the U.S. In a public health crisis like the COVID-19 pandemic, epidemiologic surveillance is extremely important especially during the early stages, when the virus has not yet penetrated the country. Prompt reporting of newly confirmed cases allows public health officials to get ahead of the coronavirus by identifying hotspots and taking control measures before it turns into a full-blown outbreak.
South Korea and the U.S. had their first confirmed case on the same day, January 21, 2020. Compared to the U.S., South Korea was much more successful at controlling the spread, which largely contributed to their rapid early response. After 4 confirmed cases, South Korea started to inform private companies to develop testing kits on January 27th. The first test was approved one week later and started to roll out immediately [4]. With a high testing capacity, South Korea was able to quickly identify the ones who were infected and take follow-up actions such as contact tracing and mandatory quarantine to minimize the spread. The early response to the initial cases and prompt development of testing kits effectively prevented the wider spread of transmission.
When South Korea was testing more than 10,000 people each day in February, the US had just started to develop its testing kits. After recalling the initial flawed batches, more reliable testing kits were distributed in late February [5]. At that point, the virus had already been spreading unimpededly for over a month since the first confirmed case. Moreover, the supply didn’t meet the demand. With a limited amount of kits, people had to meet certain criteria to be tested. When the testing capacity finally ramped up, the widespread transmission had already occurred; contact tracing became extremely difficult and containment was no longer an option. Symptomatic patients had already overburdened the hospitals while asymptomatic carriers continued to spread the virus unintentionally. According to research from National Center for Disaster Preparedness, if the U.S. response had mirrored that of South Korea’s, the U.S. might have avoided 215,000 deaths. Without timely development of diagnostic testing, the U.S. failed to recognize the actual extent of the infection, and miss the best window to confine the disease [6].
Shortly after the wide deployment of diagnostic testing, states started to implement many useful policies including lockdown orders, quarantine, mask mandates, social distancing, and hand hygiene. The impact of these mitigation strategies can be easily appreciated by the flattening of the curve. However, it is important to realize that these interventions came after the rolled out of testing kits. As testing revealed more positive cases, the public started to realize the aggressiveness of SARS-CoV-2. With a collective effort, Americans followed these non-pharmaceutical interventions and we finally saw a slow down in transmission. Had we had the capability to conduct more testing during the initial phase of the pandemic, we could have implemented these non-pharmaceutical interventions sooner. A study examined the effects of intervention timing during COVID-19 and concluded that a longer response time leads to a stronger rebound of infection and death. If these same interventions had been implemented 1-2 weeks earlier, “a substantial number of cases and death could have been averted”[8].
At the beginning of the pandemic, very little was known about this novel virus. When there is no treatment available to respond to the pandemic, public health measures become the most essential tool to keep people safe. Unlike therapeutic medicine, the public health approach focuses on prevention rather than treatments. Preferably, recognition and containment of an epidemic would occur before the death rate starts to rise. This requires the government to act fast during the initial period. One of the most important measures that should have been taken was wide diagnostic testing to unmask the actual number of infected. From there, a more targeted intervention such as contact tracing and quarantine can be implemented to monitor the infected while keeping the uninfected people healthy. Sadly, the U.S. fell behind to respond during the crucial phase. The U.S. only accounts for 4% of the world’s total population but constitutes 15% of the total death toll relative to COVID-19 [1]. After a wide adoption and stricter enforcement on non-pharmaceutical interventions, we finally curtail the infection rate. However, these measures are not designed for damage control; they should take place early on during the pandemic to have maximum impact. If the U.S. had engaged in testing efforts from the very beginning, it would consequentially lead to better disease identification and containment.
Reference:
1. “United States COVID: 34,677,662 Cases and 622,225 Deaths – Worldometer.” Worldmeters, 2021, www.worldometers.info/coronavirus/country/us.
2. “Healthcare Workers.” Centers for Disease Control and Prevention, 11 Feb. 2020, www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html.
3. “Pandemic Planning Scenarios” Centers for Disease Control and Prevention, 11 Feb. 2020, www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html.
4. Berger, Matt. “How South Korea Successfully Battled COVID-19 While the U.S. Didn’t.” Healthline, 30 Mar. 2020, www.healthline.com/health-news/what-south-korea-has-done-correctly-in-battling-covid-19#Late-January:-Tests-come-online.
5. Myers, Philip Wallach, And Justus. “The Federal Government’s Coronavirus Actions and Failures.” Brookings, 1 Apr. 2020, www.brookings.edu/research/the-federal-governments-coronavirus-actions-and-failures-timeline-and-themes.
6. Redlener, Irwin. “130,000-210,000 Avoidable COVID-19 Deaths and Counting – in the U.S..” ncdp.columbia.edu, October 2021. https://ncdp.columbia.edu/custom-content/uploads/2020/10/Avoidable-COVID-19-Deaths-US-NCDP.pdf
7. “The Global Health Security Index Is Not Predictive of Coronavirus Pandemic Responses among Organization for Economic Cooperation and Development Countries.” PubMed Central (PMC), 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7540886.
8. Pei, Sen. “Differential Effects of Intervention Timing on COVID-19 Spread in the United States.” PubMed, 20 May 2020, pubmed.ncbi.nlm.nih.gov/32511526.
