Short Wave - How An Early Plan To Spot The Virus Fell Weeks Behind

Episode Date: May 1, 2020

In several major cities, public health officials work every year to monitor the flu. It's called sentinel surveillance. And as early as mid-February, the government had a plan to use that system to find early cases of the coronavirus, by testing patients with flu-like symptoms. But NPR's Lauren Sommer reports the effort was slow to get started, costing weeks in the fight to control the spread of the virus. Read more from Lauren's reporting here. Email the show at [e-mail] pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

Hey there. Here at the show, we are trying to learn a little bit more about you and how podcasts fit into your life. If you can help us out, there is a short anonymous survey online that takes about 10 minutes. It's at npr.org slash podcast survey, all one word. We'd love to have your input. It really helps. NPR.org slash podcast survey. Thanks. You're listening to Shortwave from NPR. Maddie Safai here with NPR science correspondent Lauren Summer. Hey, Lauren. Hey, Maddie.

So today you've got a story that starts a long, long time ago. February 13th of this year. Yes, long ago. Morning everybody. Congress was still holding regular hearings. In the Senate, you know, it was a run-of-the-mill hearing on the 2021 budget. Health and Human Services Secretary Alex Azar told a committee about a plan that the government had for the coronavirus.

As of today, I can announce that the CDC has begun working with health departments in five cities to use its flu surveillance network to begin testing individuals with flu-like symptoms for the China coronavirus. Wow, wow, wow. Took people too long to stop calling it that, Lauren. Let's just, let's stick with coronavirus. Many questions about the virus remain, and this effort will help see whether there is broader spread than we have been able to detect so far.

Azar was right. There was a ton we didn't know about what was happening with the virus. I mean, still, really. But on this day, February 13th, there were only 12 confirmed cases in the U.S. Most of the cases that the world knew about were still in mainland China. So this plan to try to find cases if it was spreading here, it sounded good. You know, epidemiology 101. And the plan was for five cities.

Yeah, Chicago, Los Angeles, New York, San Francisco, and Seattle. All of them already work with the CDC to track the flu every year. So the idea was to piggyback on that system and run some of those flu samples from patients for coronavirus too. It's what's known as sentinel surveillance. That's trying to get a feel for what's out there. About a month later, on March 11th in another hearing, Dr. Anthony Fauci said this was an important part of containing the virus. We need to know how many people, to the best of ability, are infected, as we say, under the radar screen.

OK, some more context. On this day, March 11th, this was all just starting for a lot of Americans. This astounding and unprecedented story continues to evolve. Right. That was the day we learned that the NBA canceled its season. NBA is suspending the season. Tom Hanks had COVID-19.

What a story. So we have Tom Hanks with Rita Wilson. And I would say, most importantly, the World Health Organization declared a global pandemic. Right, and the government had been preparing for that pandemic to arrive, Fauci said. And they'd added Honolulu to the list of cities that were using their flu monitoring teams to find cases. And that's what the CDC is doing now in six sentinel cities. And they will expand that throughout the country.

Now, we should say, Fauci doesn't run the CDC, but he was testifying with the guy who does, Dr. Robert Redfield. And he also told this committee that flu surveillance in six cities was being used for COVID-Cube. surveillance. As we're now moving the COVID-19 into that system, we started with the six, we're going to expand jurisdictions. On the day he said that, only one city actually had any test results from those surveillance projects. So today on the show, the government's missed opportunity for surveillance of the coronavirus. What slowed scientists down and the lost time that could have been used to give some cities an earlier warning. You're listening to Shortwave, the Daily Science Podcast from NPR.

Okay, Lauren, so at least six cities were supposed to be using surveillance systems that were originally built for the flu to test for cases of the coronavirus. Weeks into that effort, only one had done that. So where's a good place to start? Let's start in Los Angeles. They ran into some issues. Back in February, they knew that tracking the outbreak through the number of positive cases that were popping up just wasn't a great idea, you know, because.

because testing was so limited. Right. In order to get tested at that time, you had to either have recently traveled to China or had close contact with somebody else who tested positive. So it was like a really high bar to get tested. Yeah. And that was because almost no state labs could run the CDC's coronavirus tests at the time. They had sent out faulty test kits. So, you know, even patients with the right symptoms really couldn't get a test, which makes it really hard to see what's happening in a community. But for this project, the surveillance cities, they were guaranteed testing by the CDC, and they could send their samples to the agency's headquarters in Atlanta.

So how did Los Angeles start looking for the coronavirus? So county health officials started talking to hospitals about testing these mildly symptomatic patients. You know, and they got pretty far with one of them. Dr. Prabu Gounder of the Los Angeles County Department of Public Health, he told me when the hospital's board discussed it, though, they declined to be part of it. We only had one confirmed COVID-19 case in L.A. County. And they were concerned that if the second case in L.A. County was linked to this hospital, that there would be a certain stigma that would potentially be bad for the hospital. Okay, so they were worried about the hospital's reputation?

Do I have that right? Yeah, he says the hospital was concerned that patients would be anxious and avoid the hospital if they found the coronavirus there. Now, county health officials declined to name this hospital. because they said they agreed to keep discussions confidential. Wow. Okay. So how did L.A. eventually get testing started? Well, another hospital reached out to county health officials, and that was L.A. County USC Medical Center. The chief medical officer there is Dr. Brad Spelberg, and he knew surveillance monitoring was important.

This is a leading edge indicator. If you don't look at it, you're missing the canary in the coal mine. you're waiting for the coal mine to collapse on you. Yeah, so Spelberg wanted to do this, but his hospital ran into one of the biggest issues in this story of the pandemic, testing. To speed things up, they were going to use tests from a private lab, but there was only a small number of them. That was against huge resistance.

The whole system was like you're wasting our tests. Don't do this. But his hospital pushed ahead and began testing at the county's medical center and some of its clinics on March 12th. When the results started coming back, it looked as if 5% of the patients they tested were positive for coronavirus. These were people that had been going to work, going to social events, wandering around in the community for the days and days they had the...

Right. This was well before we had broad social distancing policies. Yeah, we didn't have that almost anywhere in the country at the time. But once officials in L.A. County knew this, you know, they realized that people have been walking around with the virus, more of them that they knew. And this was a really key turning point in how that. they responded. Until then, it was about trying to contain the virus, use contact tracing, to track down every person who may have been exposed. You know, but when a virus is spreading undetected, epidemiologists will tell you, you know, that containment strategy just isn't enough. So in the days after those results, Mayor Eric Garcetti issued a stay-at-home order for Los Angeles.

Your actions matter, and they can and will save lives. Okay, so that's what happened in L.A. What happened in those five other cities? Most of them also struggled to get going. You know, for example, New York City didn't get results from its sentinel testing until March 31st. I couldn't get more information about why it took so long. You know, the city is obviously overwhelmed right now. Sure. But at that point, the surveillance was just too late to be useful.

I mean, there were already 40,000 cases at that time. Yeah, not exactly. An early warning at that point. And, you know, Seattle also had struggles. You know, Washington state officials had an idea of how they wanted to do the sentinel surveillance when they first started talking to the CDC. Scott Lindquist is the state epidemiologist. He wanted to use the Seattle flu study, which is a research project that was already testing people with respiratory symptoms. That was a surveillance system that was up and running.

My point was, why don't we use those samples? It's up and running. Let's do it. And that was denied. The problem, according to the CDC and FDA, was that it was a research project. and it didn't have the necessary approvals to run clinical tests for patients, and they hadn't gotten consent from the patients to do the coronavirus testing. So the FDA denied the request at that time. Okay.

I mean, that actually makes some sense to me. So was Seattle able to get anything together? Eventually, yes, about a month after that. The Seattle flu study did get all the necessary approvals, and they're doing surveillance testing now. But Lindquist thinks they clearly could have used it earlier. It could have let us know that it was here. before we had the community outbreaks and the transmission in the long-term care facilities.

But we missed that period. So, okay, this effort came up short, to say the least. These were weeks when we could have been looking for the virus, but the system itself didn't work. Those extra weeks had to have made a difference, right? Well, it's hard to say. We recognize the situation where we didn't have. That's Dr. Joseph Brzee, a deputy incident manager at the C. He said the delays happened because it was an entirely new virus.

It took extra planning for collecting samples, shipping them, ensuring health care workers had protective gear. But whether that time made any difference? It's a good question about whether there's a disability in what was happening. And I don't think so. Three weeks is an enormous amount of time to allow cases to accumulate without knowing about it. That's Jennifer Nuzzo, an epidemiologist at Johns Hopkins Bloomberg School of Public Health. If we had had sentinel surveillance stood up in, you know, a number of cities, cities where we would expect to see cases first, we possibly could have caught it earlier and possibly intervened before the case numbers exploded. And, you know, when you look at the data, it's not hard to see that the places with earlier state home orders seem to have done better.

Their curves are flatter and they avoided a lot of the hospitalizations and deaths, you know, according to models. It really wasn't easy for officials to issue those orders. you know, if you remember. There was a lot of debate about when to do it. But from talking to these cities, the ones that had this hard data from Sentinel surveillance, you know, that community spread was happening, they were able to act first. Right. So, okay, obviously this is a very useful public health tool. Does the CDC have any plans to do this in the future? Yes. A number of the cities and counties I spoke to are planning on starting sentinel testing again soon. Because, you know, As the outbreak starts waning, they're going to need to find the flare-ups and spot the new cases before it spreads even more. The Trump administration is also talking about using it in their plan for reopening the country. So we'll be doing sentinel surveillance throughout nursing homes, throughout inner city federal clinics,

throughout indigenous populations, to really be able to find early alerts of asymptomatic individuals in the community. Dr. Deborah Birx is talking about doing that testing for people, who don't show any symptoms, but who may still be infected and spreading the virus. The epidemiologist I spoke to said, you know, this is something the country has to get right this time. You know, not just waiting for COVID-19 cases to walk into an emergency room, but designing studies to go out and look in communities and actually get the early warnings that this kind of testing could have provided in the first place. All right, Lauren Sommer, thank you for sharing your reporting.

I appreciate you. Anytime. This episode was produced by Brent Bachman. edited by Viet Le and fact-checked by Emily Vaughn. I'm Maddie Safaya. Thanks for listening to Shortwave from NPR.