As officials in Illinois respond to the rising tide of coronavirus cases, including four new cases announced Monday, public health experts fear that some people who may have been exposed to the virus aren’t being tested.
Federal health officials announced last week that patients can now request a screening, though clinicians are advised to first look for symptoms — like fevers or respiratory illnesses — before administering a COVID-19 test. On top of that, Gov. J.B. Pritzker — while issuing a state disaster proclamation in the wake of the new cases — announced Monday that people with flu-like symptoms can now undergo “voluntary surveillance testing” at 15 hospitals across Illinois.
Despite those new measures, individuals who have come into contact with coronavirus patients but have exhibited little or no sign of infection are likely going unscreened.
“I’m sure they’re missing cases,” Dr. Robert Murphy, executive director of the Institute for Global Health at the Northwestern University Feinberg School of Medicine, said Monday.
Studies have shown that people likely can spread the disease without displaying symptoms. But experts said when to start testing people with limited or no symptoms remains murky, as preemptive screening could result in false negatives and wasted tests that remain in short supply.
State and local health departments across all 50 states currently have only 75,000 available coronavirus testing kits, which are distributed by the U.S. Centers for Disease Control and Prevention, officials said Monday morning. So far, the CDC has done tests for 1,700 people. As of Monday, more than 600 coronavirus tests have been conducted in Illinois.
“This thing with the number of tests is a complete fiasco,” said Murphy. “It’s a national disgrace, and it’s caused by the ineptitude of the Centers for Disease Control.”
At a White House press conference Monday night, Alex Azar, secretary of the Department of Health and Human Services, said hundreds of thousands of test kits shipped over the weekend to private hospitals and labs, which don’t have to report back on whether they’ve conducted a test. Azar noted that more tests are now ready to ship.
“I could not give you a number of how many Americans have received a test,” Azar said.
In Illinois, doctors reported an influx of panicked calls seeking tests. While Pritzker on Monday said the state’s three existing testing labs “meet our current need,” he anticipates the introduction of commercial testing this week would enable “widespread testing.” The cost of testing is currently covered by the IDPH and the CDC, and commercial kits prescribed by doctors will be waived by some of Illinois’ top private health insurers.
“Our expectation within the next couple weeks as more and more commercial entities come on board is that the majority of the available testing will actually be coming from the commercial sector,” Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, said in a conference call Monday morning.
When to test
Illinois’ seventh case of COVID-19 — reported Sunday in a Chicago man in his 60s — could be the first case of community-based transmission in the state, as the infection doesn't appear to be related to travel or contact with an infected person.
Dr. Howard Ehrman, the former assistant commissioner of the Chicago Department of Public Health, told the Chicago Sun-Times that “community spread” can’t truly be tamped down unless officials start testing asymptomatic people.
“They could pass the virus onto someone else who could get sick and possibly die,” said Ehrman, a University of Illinois at Chicago professor who also served as Will County’s chief medical officer during the West African Ebola virus epidemic of the 2010s.
“This is basic public health practice which they are not following,” he added.
Ehrman is particularly concerned about testing people who visited Vaughn Occupational High School in Portage Park, where the sixth sickened person in Illinois works. He believes everyone who was at the school between Feb. 24 and March 4 should be tested, even if they’re not showing signs of infection.
During Monday’s news conference with Pritzker, CDPH Chairman Dr. Allison Arwady said officials are interviewing people from the Vaughn community to determine whether anyone has developed symptoms. Arwady said COVID-19 isn’t airborne like the measles and is instead spread through “droplets” from coughing and sneezing that are transmitted at close range.
Contrary to Ehrman’s call, Arwady noted that screening people without signs of coronavirus “would not be helpful” and could result in a person testing negative and later getting sick.
“Those who do not have symptoms either do not have the virus or have it at such low levels that it would not register,” Arwady said. “This is why we monitor people for 14 days after their last exposure to a confirmed case. And if they develop symptoms at any point during that 14-day period, we test them at that point.”
Health officials across the globe are also grappling with how to manage patients who don’t show symptoms.
In February, a study in the Journal of the American Medical Association reported that an asymptomatic 20-year-old woman may have passed the coronavirus onto five family members the previous month when she traveled to Anyang from Wuhan, China — the epicenter of the outbreak.
When the woman’s family members tested positive for COVID-19, she was isolated and observed. Though her first test came back as a false negative, she was diagnosed with coronavirus days later.
“If the findings in this report of presumed transmission by an asymptomatic carrier are replicated, the prevention of COVID-19 infection would prove challenging,” according to the study.
In addition, two people who didn’t display symptoms after flying from Wuhan to Germany in February tested positive for the disease, according to the New York Times. And in Italy, the center of Europe’s outbreak, officials began aggressively testing for the virus and found sickened individuals who hadn’t displayed symptoms.
Contributing: Marin Scott