Coronavirus Update 4-6

“Next Week Will Be Our Pearl Harbor and 9/11 Moments.”
— Surgeon General Adams

“We are really coming up onto a time that’s going to be horrendous. We’re getting to that point where it’s going to really be … some very bad numbers.” — President Trump

“It Would Be False Statement to Say We Have Coronavirus Under Control.” — Dr. Fauci

“This is the moment to not be going to the grocery store, not going to the pharmacy, but doing everything you can to keep your family and your friends safe.” — Dr. Birx

Connect with us and receive the Coronavirus Update in your inbox every morning– send us an email at info.dailycovid19post@gmail.com.

Note: As there is a lot of inaccurate information circulating, we only include information that we can confirm from a credible source or that is based on data that we can verify. To the extent that we derive information from an online source, we provide a link to the source, which typically provides more detail that is included in our update. If you have any questions about any information included in an update, or if you have a different view, please let us know and we will supplement or correct as needed.

A. Recent Developments and Headlines

Note: All changes noted in this Update are since the 4/05 Update

Sources: New York Times Coronavirus Updates, New York Post Coronavirus Updates, Zero Hedge Coronavirus Updates, Drudge, Breitbart, Wall Street Journal, Coronavirus White House Task Force Briefing, NY Governor Daily Briefing, and Worldometers

The coronavirus is affecting 208 countries and territories (+3)
Worldwide Confirmed Cases = 1,275,146 (+6%)
Worldwide New Cases = 72,045 (-12,854) (-15.1%)
Worldwide Active Cases = 939,751 (+5.4%)
Worldwide New Active Cases = 48,146 (-13,634) (-22.1%)
US Active Cases = 309,254 (+7.2%)
US New Active Cases = 20,896 (-9,626) (-31%)
NY Active Cases = 108,381 (+8%)
NY New Active Cases = 7,998 (-1,013) (-11.2%)
US deaths = 9,620 (+1,161) (+13.7%)
NY deaths = 4,156 (+242) (+6.2%)
White House: Coronavirus Numbers Appear to Be Stabilizing; Keep Social Distancing
White House: Americans should avoid grocery shopping as coronavirus hits apex
US reports highest single-day coronavirus death toll since outbreak
Surgeon General: ‘This is going to be the hardest and the saddest week’ of most Americans’ lives
President Trump Foresees ‘Horrendous’ Coronavirus Deaths in Coming Days
Bill Gates calls coronavirus pandemic a ‘nightmare scenario,’ but predicts lower death toll than Trump
NY hospitalizations, ICUs and deaths drop
NY Gov. Cuomo: New York may be hitting coronavirus apex
NY remains the epicenter in US, with death count surging past 3,500, including more than 2,600 in NYC by Saturday night
Trump says USNS Comfort could be used to treat COVID-19 patients if needed
White House: Americans should avoid grocery shopping as coronavirus hits apex
Washington State is returning more than 400 ventilators to the national stockpile
Queen Mary ocean liner may be used as hospital ship for California patients as coronavirus cases surge
Virus hot spots in South poised for disproportionate suffering
Coronavirus death rate for New Orleans is double that of New York City on a per capital basis
Louisiana warns it will run out of ventilators in five days
The Trump administration plans to pay hospitals for treating uninsured coronavirus patients, rather than expand insurance coverage
Americans are underestimating how long coronavirus disruptions will last, health experts say
Yonkers Raceway may have been source of NJ coronavirus outbreak
Poll: Most Americans will stay home this month even if lockdown lifted
U.S. is undercounting the number of people who have died in the pandemic, experts say
Using the “Chinese” experience as indicative of what other countries can achieve, Deutsche Bank estimates that US will begin easing restrictions between May 1 and May 22
Bill Gates is funding new factories for 7 potential coronavirus vaccines, even though it will waste billions of dollars
Half A Million Chinese People Entered America At The Height Of The COVID-19 Outbreak
Europe Sees More Signs of Hope as Italy’s Virus Curve Fall
Italy’s virus deaths plunge to lowest since March 19
France also reports a drop in deaths
UK reports biggest jump in new cases
UK Warns of Tougher Social Distancing Measures
UK may ban all outdoor exercise
British Prime Minister Boris Johnson hospitalized for coronavirus
Tokyo reports yet another jump in new COVID-19 cases
Japan To Declare State Of Emergency On April 7
Low-risk’ activities to resume in Iran on April 11, Rouhani says
Coronavirus May Cause African States to Collapse
Ecuador stores coronavirus victims in giant fridges as morgues fill up
Turkey Tightens Controls in Public Places over Coronavirus Threat
‘Better die of this disease than starve’: Angolans defy virus lockdown
Scotland’s top medical official resigns after ignoring own coronavirus advice
NYC Pharmacies Run Out Of Tylenol, Hand Sanitizer, Common Drugs
Some New Yorkers riding crowded subway commutes during coronavirus pandemic
Nearly 3,000 firefighters and EMTs out sick in NYC, but over 100 have returned to work
Looting Wave Strikes New York City Amid Coronavirus Lockdown
Hasidic funerals flout social distancing rules amid coronavirus
Despite Soaring Body-Count Across the Nation, Americans Continue to ‘Resist’ Lockdown Orders
Nursing homes in Canada instructed by health officials to ‘keep seniors comfortable’ if they contract COVID-19 but not to take them to the hospital due to their high mortality rate
100+ Vanderbilt Students Suffer Chinese Virus Symptoms After Campus Parties
Pope Celebrates Palm Sunday Without Public in St. Peter’s
Biden says Democratic convention may need to be virtual
Bronx Zoo tiger tests positive for coronavirus
Fortitude Ranch, Doomsday Shelter, Draws New Interest
Police App Encourages People To Report Neighbors Who Violate Stay-At-Home Orders

B. Numbers and Trends

[Note: All numbers in this update are worldwide unless otherwise indicated. The numbers in this update only include cases that have been (i) confirmed through testing, and (ii) reported. The actual number of cases may be materially higher than confirmed cases, which means that the number of actual deaths from COVID-19 and recoveries may both be materially higher than reported. As testing in US ramps up, confirmed cases may rise rapidly as actual but unidentified cases are confirmed.]

Source: Worldometers

1. Confirmed Total Cases and New Cases

Worldwide: 1,275,146 Total Cases (+6%)
- New Cases = 72,045 (-12,854) (-15.1%)
  - Trend: 2^nd day of Declining Number of New Cases
Europe: 639,116 Total Cases (+4.9%)
- New Cases = 29,768 (-7,413) (-20%)
  - Trend: 2^nd day of Declining Number of New Cases
United States: 336,851 Total Cases (+8%)
- New Cases = 25,214 (-8,802) (-25.9%)
  - Trend: 2^nd day of Declining Number of New Cases
US States:
- 31 States > 1,000 cases (+1)
- 20 States > 2,500 cases (+1)
- 13 States > 5,000 cases (+0)
- 9 States > 10,000 cases (+0): NY, NJ, MI, CA, LA, MA, FL, PA & IL
- Top 5 States: (i) NY: 123,018 (+8,243); (ii) NJ: 37,505 (+3,381); (iii) Michigan: 15,718 (+1,493); (iv) California: 15,201 (+1,272); and (v) Louisiana: 13,010 (+514)
- For more information on US States, see https://ncov2019.live/data
New York State:
- NY Total Cases = 123,018 (+7.9%)
- NY New Cases = 8,243 (-3,056) (-27%)
  - Trend: 2^nd day of Declining Number of New Cases
New York City:
- Total Cases = 67,551 (+6.3%)
- NYC New Cases = 4,245 (-1,901) (-30.9%)
  - Trend: 2^nd day of Declining Number of New Cases

2. Confirmed Active Cases

Worldwide: 939,751 Active Cases (+5.4%)
- New Active Cases = 48,146 (-13,634) (-22.1%)
  - Trend: 2^nd day of Declining Number of New Active Cases
- Top 5 Countries: (i) US: 309,254 (+20,896); (ii) Italy: 91,246 (+5,858); (iii) Spain: 80,925 (+3,437); (iv) Germany: 69,839 (+4,530), & (v) France: 68,578 (+6,928)
US Active Cases = 309,254 (+7.2%)
US New Active Cases = 20,896 (-9,626) (-31%)
NY Active Cases = 108,381 (+8%)
NY New Active Cases = 7,998 (-1,013) (-11.2%)

3. Serious or Critical Cases

Worldwide serious or critical cases = 45,899 (+1,804)
US series or critical cases = 8,702 (+496)
NY serious or critical = 4,127
US serious or critical cases = 2.8% of Active Cases (+0%), compared with worldwide percentage of 5%
NY serious or critical cases = 3.8% of Active Cases

[Note: Serious and critical cases give insight into the need for ICU beds and ventilators]

4. Deaths

Worldwide deaths = 69,503 (+4,760) (+7.3%)
- Top 5 Countries: (i) Italy: 15,887 (+525); (ii) Spain: 12,641 (+694); (iii) US: 9,620 (+1,161); (iv) France: 8,708 (+1,148); & (v) UK: 4,934 (+621)
- Deaths per 1M population: (i) Italy: 263; (ii) Spain: 270; (iii) US: 29; (iv) France: 124; & (v) UK: 73
- Worldwide Closed Case Fatality Rate = 21% (+0%) [Note: Fatality Rate for Closed Cases is significantly higher than estimated range of public health officials (1% to 3.4%) because public officials are estimating the number of actual cases that have recovered but not been reported]
US deaths = 9,620 (+1,161) (+13.7%)
NY deaths = 4,156 (+242) (+6.2%) [65% decline in number of deaths]
NYC deaths = 2,624

5. Recoveries

Worldwide recoveries = 265,892 (+7.7%)
US recoveries = 17,977 (+21.3%)
NY recoveries = 10,478

C. Projections and Our (Possible) Future

1. IHME (Murray) Model

An updated version of the IMHE model was scheduled for release on April 4, but it has not yet been released. A new post says that the IMHE model is being revised but does not provide estimate of when the updated model will be released. We will provide a summary of the updated model as soon possible after its release. In the meantime, you can see the current IHME model projections at https://covid19.healthdata.org/projections.

D. Potential New Treatments

1. Can an Old Vaccine Stop the New Coronavirus?

A vaccine that was developed a hundred years ago to fight the tuberculosis scourge in Europe is now being tested against the coronavirus by scientists eager to find a quick way to protect health care workers, among others. The vaccine is cheap and safe, and seems to bolster the body’s immune system.
The Bacillus Calmette-Guerin vaccine is still widely used in the developing world, where scientists have found that it does more than prevent TB. The vaccine prevents infant deaths from a variety of causes, and sharply reduces the incidence of respiratory infections.
The vaccine seems to “train” the immune system to recognize and respond to a variety of infections, including viruses, bacteria and parasites, experts say. There is little evidence yet that the vaccine will blunt infection with the coronavirus, but a series of clinical trials may answer the question in just months.
“Nobody is saying this is a panacea,” said Nigel Curtis, an infectious diseases researcher at the University of Melbourne and Murdoch Children’s Research Institute, who planned the trial. “What we want to do is reduce the time an infected health care worker is unwell, so they recover and can come back to work faster.”
“We have really strong data from clinical trials with humans — not mice — that this vaccine protects you from viral and parasitic infections,” said Dr. Faustman. “I’d like to start today.”
The vaccine was first used in humans in 1921 and is primarily used in the developing world and in countries where TB is still prevalent, where it is given to over 100 million babies a year.
Like other vaccines, B.C.G. has a specific target: TB. But evidence accumulating over the past decade suggests the vaccine also has so-called off-target effects, reducing viral illnesses, respiratory infections and sepsis, and appears to bolster the body’s immune system.
Epidemiological studies — including a 25-year study of over 150,000 children in 33 countries — have reported a 40 percent lower risk of acute lower respiratory tract infections in children who received a B.C.G. vaccine.
A study in the elderly found that consecutive B.C.G. vaccinations reduced the incidence of acute upper respiratory tract infections.
“This vaccine has saved as many lives as the polio vaccine — it’s an amazing story,” said Dr. Curtis, who designed and launched the B.C.G. trial in Melbourne in less than a month, hoping to stay one step ahead of the coronavirus’s spread in Australia.
Dr. Faustman said it should not be used in hospitalized patients with active disease, because it may not work fast enough and could interact poorly with other treatments.
Not everyone is convinced B.C.G. holds much promise. Dr. Domenico Accili, an endocrinologist at Columbia University, said he thought efforts to use the vaccine against the coronavirus sound “a bit like magical thinking.”While acknowledging that B.C.G. is “a non-specific booster of the immune system,” he said, “we should be able to deploy a more tailored approach.”
A recent study found that countries that did not implement or had abandoned universal B.C.G. vaccination have more coronavirus infections per capita and higher death rates.
“You can make a new vaccine,” Dr. Faustman said. “We’re really smart, and we can do that. But it’s two years off, and two years is going to be two years too late.”
“If we’ve got something generic globally at hand that we can use to make the human host stronger, this is a win-win for the public right away.”

Source: Can an Old Vaccine Stop the New Coronavirus?

2. FDA chief raises possibility that plasma from recovered COVID-19 patients might protect the healthy

A vaccine for coronavirus is still many months away, but on Sunday, the commissioner of the FDA pointed to another potential preventive treatment that he said could serve as a “bridge.”
The commissioner, Dr. Stephen M. Hahn, said that researchers are looking into whether a manufactured version of plasma from people who have already been infected with the virus could be administered preventively.
Researchers are already studying whether using plasma from those who have recovered — so-called convalescent plasma, which contains antibodies needed to ward off the virus — could be used to treat people who are suffering from the disease. It is being used on an experimental basis by doctors around the country.
Dr. Hahn said that if convalescent plasma proved safe and effective, it could be pooled from many patients and manufactured into an injection called hyperimmune globulin, which could be given to people to prevent getting infected.
“We have to study it and we’re doing this quickly, but also as a prophylactic. And that acts as a bridge to get us to a vaccine.”
On Friday, the F.D.A. approved a clinical trial that will allow Johns Hopkins researchers to test whether convalescent plasma would be effective in treating people who are at high risk of being exposed to the virus, such as health care workers and other front-line responders.

3. Thousands of NY COVID-19 patients are being treated with Hydroxychloroquine

As many as 4,000 seriously ill coronavirus patients in New York are being treated with hydroxychloroquine in combination with the antibiotic Zithromax, or azithromycin.
The University of Albany’s School of Public Health is observing the drug’s impact on the patients, and its preliminary study could come back in weeks instead of the usual months.
There are also clinical trials being conducted to see whether the drug can help block transmission. NYU Langone Medical School is conducting a random trial with a $9.5 million grant from the Bill & Melinda Gates Foundation.
“If hydroxychloroquine provides protection, then it could be an essential tool for fighting this pandemic. If it doesn’t, then people should avoid unnecessary risks from taking the drug.” Its potential side effects include everything from fatal heart arrhythmia to vision loss, ear-ringing, vomiting, mood changes, skin rashes and hair loss.
Health officials are saying they don’t anticipate hydroxychloroquine will be a “miracle drug” against the coronavirus — but the studies are worth the gamble.
If everything goes as planned, the eight-week trial could provide answers by summer on whether a preventive dose of the drug is safe and effective. If so, the strategy could give health officials a much needed boost in slowing person-to-person transmission.

Source: Thousands of NY COVID patients are being treated with anti-malarial drug

E. New Scientific Findings and Other Advancements

1. Severe Covid-19 illness in young down to genes or ‘viral load’

It remains one of the biggest puzzles of the Covid-19 pandemic. The disease generally causes serious problems only in older people or those with underlying health problems. But occasionally Covid-19 strikes down young, apparently fit individuals, including medical staff exposed to patients with the virus.
In some cases, previously undiagnosed conditions are later revealed but in others no such explanations are available, leaving scientists struggling to find reasons for the behavior of the coronavirus.
Several theories have been proposed. Some researchers believe the amount of virus that infects an individual may have crucial outcomes. Get a huge dose and your outcome may be worse. Others argue that genetic susceptibility may be involved: in other words, that there are individuals whose genetic makeup leaves them more vulnerable to the virus as it spreads through their bodies.
This latter idea is favored by virologist Michael Skinner at Imperial College London. “It is very possible that some of us could have a particular genetic makeup that makes it more likely that we will respond badly to an infection with this coronavirus.”
Others, however, suggest that the amount of virus that a person is infected with could be a crucial factor in determining their outcome.
“A person with a high viral load has more virus particles than one with a low load,” said virologist Alison Sinclair at Sussex University. “We do not yet know what impact viral load has on the symptoms of a person infected with Covid-19. Whether there is a link between a high viral load and worse outcomes is going to be important to find out.”

Source: Why do some young people die of coronavirus?

2. Could summer heat help beat Covid-19?

Scientists believe warm weather could bring new insights into the virus by showing whether it reacts to the onset of spring. Could sunshine affect the behavior of the coronavirus and its spread? It is a key question, and epidemiologists will be watching for changes very closely.
A key study of the common coronaviruses – HCoV-NL63, HCoV-OC43 and HCoV-229E – was published last week by scientists at University College London. By analyzing samples collected several years ago they found high rates of coronavirus infections in February, while in summer they were very low. Other studies have also shown coronaviruses are seasonal in behavior in temperate climates.
The study’s lead author, Rob Aldridge, sounded a note of caution, however. “We could see continued but lower levels of coronavirus transmission in summer but this may reverse in the winter if there is still a large susceptible population at that point,” he said.
This point is stressed by other scientists, who warn that the Covid-19 virus is a completely new infectious agent and so there has been no chance for populations to build up any immunity. As a result, it is likely to continue to spread at current rates despite the onset of summer.
“I am sure seasonal variations in the virus’s behavior will play a role in its spread,” said virologist Michael Skinner at Imperial College London. “But compared with the effect we are having with social distancing, it will be a very minor influence. It may produce some marginal effects but these will not be a substitute for self-isolation.”
The arrival of spring does not only affect the behavior of a virus, however. It also produces changes in the human immune system, other researchers point out. “Our immune system displays a daily rhythm, but what is less known is how this varies from season to season,” said immunologist Natalie Riddell at Surrey University.
To find out, Riddell and other researchers at Surrey and Columbia Universities have been studying immune changes in humans at different seasons and different times of day. Biological samples were taken from volunteers at the winter and summer solstices and the spring and autumn equinoxes. Initial findings suggest a subset of white blood cells that play a key role in the immune system appear to be elevated at certain times of day, indicating that the system responds differently at varying times. For example, B cells that produce antibodies were found to be elevated at night.
However, the impact of seasons on cell rhythms is still under investigation, added the study’s leader, Micaela Martinez of Columbia University. Results would be of considerable importance, she added. “Knowing the vulnerabilities of our body to diseases and viruses across the year could inform the timing of vaccination campaigns that will help us eradicate infections.”

Source: How you could get your covid-19 test results faster

3. AI runs smack up against a big data problem in COVID-19 diagnosis

Researchers around the world have quickly pulled together combinations of neural networks that show real promise in diagnosing COVID-19 from chest X-rays and CT scans. But a lack of data is hampering the ability of many efforts to move forward. Some kind of global data sharing may be the answer.
Teams of artificial intelligence researchers are trying to bring decades of technology to bear on the problem of diagnosing and treating the disease, but the data they need to develop their software programs is scattered around the globe, making it practically inaccessible.
The painful lack of data is evident in one particular use case for AI, the development of diagnostic tests for COVID-19 based on X-rays or on “computed tomography” scans of the lungs.
While definitive tests for the disease are genetic tests, called “RT-PCR,” those tests have been in notoriously short supply in many parts of the world including the U.S. An alternative is an X-ray or CT scan. X-rays in particular are widely available throughout the world, and the results come back much quicker than RT-PCR. There’s a common belief that CT scans are more “sensitive” than RT-PCR, a potential advantage of using them.
Analyzing X-rays and CTs takes time, so numerous scholars around the world have put together so-called deep learning neural networks that can compute whether there are anomalies in the scans. The idea is to ease the burden of radiologists suddenly inundated with COVID-19 patients. Triaging the scans as a kind of first pass can yield a preliminary analysis, and that can place priority cases at the head of a radiologist’s workflow.
Articles have circulated describing amazing successes, particularly in China, of a number of AI diagnosis projects, including Chinese software maker Infervision, Chinese insurance firm Ping An’s healthcare division, Chinese search giant Alibaba, and Chinese tech startups Deepwise Technology and Iflytek. Media stories make it sound as if AI is a miracle technology that can be turned on and start churning out diagnoses.
The reality is less exhilarating. Despite some success, numerous efforts face challenges, with the biggest issue being the access to data. Especially with a novel disease such as COVID-19, which is distinct from other pulmonary infections, the presence of distinguishing features isn’t always conclusive. The analysis needs to be tweaked for the novel condition.

The Way Forward

The great rush of effort by AI scientists, and their sudden immersion into a real-world setting with critical demands, cannot help but have a profound effect on the field of AI. Right now, scientists need help with access to data on a much larger scale. To the extent they can get it, it appears AI can have a real impact. How that struggle changes the discipline of AI will be an interesting phenomenon that will unfold in the years to come.

Source: AI runs smack up against a big data problem in COVID-19 diagnosis

F. Ventilators and Testing: Key Weapons in the Fight Against Coronavirus

1. ‘It’s given me hope:’ Auburn engineers use CPAP to make emergency ventilator to fill COVID-19 demand

A team of engineers at Auburn University have developed an attachment to easily convert CPAP machines into ventilators in response to the COVID-19 pandemic.
Michael Zabala, an engineering professor at Auburn, and his colleagues spent the last two weeks in his home garage developing the RE-INVENT attachment after learning about the United States ventilator shortage.
The device can be used with a CPAP, continuous positive airway pressure machine used to treat sleep apnea, to assemble ventilators to treat patients with COVID-19.
The RE-INVENT device can be assembled in four hours with $700 in component parts in addition to a standard CPAP machine. The emergency ventilator system is made up of the CPAP machine, the RE-INVENT valve assembly and tubing used in ventilators.
Auburn is currently working with the U.S. Food and Drug Administration to find a way to manufacture and distribute the RE-INVENT device to increase the availability of ventilators.

Source: ‘It’s given me hope:’ Auburn engineers use CPAP to make emergency ventilator to fill COVID-19 demand

2. UK Hospitals Trial Modern-day ‘Iron Lung’ to Beat Ventilator Shortage

British hospitals will trial a low-cost modern-day “iron lung” dubbed the Exovent, which may help beat the enormous ventilator shortage the country faces.
The so-called Negative Pressure Ventilator (NPV) would fit over the torso of the patient and support their breathing without require them to undergo an induced coma or intubation, as with a standard Intermittent Positive Pressure Ventilators (IPPV).
The Exovent does not require the same sort of components as an IPPV ventilator, either, meaning they could be manufactured — at a rate of 5,000 a week, its designers believe — without putting any strain on the supply chain being used to produce more IPPVs.
Six of the machines are set to be trialled at a number of NHS hospitals, including the Royal Papworth Hospital in Cambridge — described as the country’s “leading heart and lung hospital” by the Independent.
“This is one of a number of projects we are involved in following the government’s call to industry for support in the battle against Covid-19 and we are incredibly proud that our engineering talent is being put to such important use.”
“Clearly there is still long way to go but I am very excited about the potential of the Exovent product. It has so many positive attributes in terms of cost, ease of production and application, and at the same time doesn’t use any of the same parts that are being used in the production of the much needed positive pressure ventilators,” he added.
The design team’s lead clinician said they worked “flat out” to flesh out the concept in just ten days, on the assumption that a new negative pressure-based device could “allow us to produce literally thousands of ventilators very quickly and cheaply to cope with the tsunami of people with pneumonia that may be upon us because of the Covid-19 virus.”
“[I]t immediately became apparent that this will allow us to produce less-invasive devices than the conventional units in current use, possibly better for patients’ hearts, at a fraction of the price, using off-the-shelf parts.”
Other promising-sounding developments after the British government’s call for industry to join a National Effort for ventilator have proved underwhelming, however, at least up to now.
All told, Britain’s arsenal of 8,000 ventilators — fewer per capita than its Western European contemporaries — has been increased by a mere 30 as of this weekend.

Source: UK Hospitals Trial Modern-day ‘Iron Lung’ to Beat Ventilator Shortage

3. How to Get Results from Testing Faster

Testing remains among the most pressing problems with America’s response to the pandemic. On March 31, the country announced that it has collectively tested a million people—weeks behind the schedule repeatedly promised by the Trump administration.
That is more than a mere statistic: testing people is the key to understanding how widely the novel coronavirus has spread and gauging its severity. Health-care workers need access to quick testing so that they can continue to safely take care of the rest of us. In the near future, we will also need testing to figure out how many among us may be immune and can get out of our houses and restart the economy.
But as more and more Americans have been swabbed to test for covid-19, the lag between sample collection and the delivery of results has become increasingly unpredictable and is taking too long.
An informal survey of physicians two distinct patterns. The outpatient testing through the commercial labs is setting longer and longer while turnaround time for inpatient testing for hospitalized patients has been coming down.”

There are currently four main types of labs performing coronavirus testing:

the federally run CDC, which initially handled all US testing (and was widely seen as a bottleneck early on in the outbreak)
public health labs run by states
in-house hospital labs that are part of a broader health system
commercial labs, such as ARUP, BioReference Laboratories, LabCorp, Mayo Clinic Laboratories, Quest Diagnostics, and Sonic Healthcare, which now account for the bulk of testing volume throughout the country
While there currently isn’t any aggregate data on the number of in-house hospital tests done in the US to date, it’s likely a small percentage of the total.

What’s going on with delays at commercial labs?

There are three major reasons for the delays.
The first is a shortage of supplies. When a commercial lab conducts a covid-19 test, the lab first supplies materials like nose or throat swabs to the testing locations. But according to the American Clinical Laboratory Association (ACLA), an industry group whose members include the big commercial testing companies, the supply of testing kits is still a problem, as is access to reagents, protective gear, and swabs. A shortage of any one item grinds the entire testing process to a halt. “No laboratory, in our understanding, has the predictable access to supplies necessary for the continued expansion of testing,” says ACLA president Julie Khani.
The second problem is lack of funding. Despite promises from the federal government that people tested for covid-19 won’t be charged, there remains very little clarity on who will foot the bill for testing resources, Khani says, which makes it hard for labs to keep ramping up their capacity.
The third factor is poor prioritization of testing samples. Commercial labs have tried to deal with skyrocketing demand for tests by prioritizing the most urgent cases—but they rely on clinics and hospitals to sort patients’ tests according to CDC guidelines. If testing queues aren’t well managed, it slows down overall operations. In a letter sent to the CDC on April 2, the ACLA urged the agency to educate physicians and hospitals about testing prioritization.

In-house facilities have fast turnaround times but much smaller volume

California has been one of the hardest hit states in terms of testing delays. As of April 2, it had over 59,000 tests pending results, of about 95,000 conducted in total. (Two days later, however, it had reduced that backlog to 13,000.)
In-house testing offers several advantages over commercial labs, the most obvious being that test specimens don’t have to be packaged and sent back and forth between different facilities and systems. Processing, prioritizing, and tracking the tests all happens within one system, which cuts down on red tape and improves efficiency. They also have more flexibility in their testing workflows than large automated labs (Stanford has four different ways it can process a test, for example), which helps them react to fluctuations in supply.
Perhaps most important, in-house labs currently process only a fraction of the tests commercial labs handle. “It’s not surprising that if you’re trying to test for basically the whole country that isn’t affiliated with a medical system, your turnaround times may be slower,” says Ben Pinsky, the medical director of Stanford’s Clinical Virology Laboratory, which can now process up to 2,000 tests per day with an average turnaround time of under 24 hours. As of April 1, the lab had carried out about 10,000 of the 30,000 or so tests that had been completed in California.
Large manufacturing companies, like Roche, are starting to improve things further. They have recently begun selling testing devices that regional hospitals can use to test for covid-19 without having to send samples to an outside lab. With more hospitals and other facilities able to process tests on site, commercial labs might get some relief and begin to bring down wait times.

What’s coming

For Bae, it’s changes on the ground that matter—and so far, he says he hasn’t seen many. “We hear these things like ‘This quick test is coming,’ or ‘All these things are being FDA-approved and fast-tracked,’” he says. But “with the exception of commercial testing being available, I really have not seen any of those things come true.”
Commercial labs have the potential to scale up even further than they have already, but they need clear pathways to funding from Congress, as well as redundancies that will guard against hiccups in the supply chain. And as more commercial labs start testing, taking their capacity into account when routing and prioritizing tests could also help reduce the backlog.
If the US can make the necessary changes to the network of laboratories involved in coronavirus testing, it might make these next six months a little less painful. To introduce true mass testing of the population, we need rapid, cheaper tests, like one offered by Abbott Labs that purports to deliver a result in five minutes. At-home testing would help even more. These advances might provide the volume of tests necessary to conduct contact tracing and identify hot spots of infection as they crop up, as well as allowing people who have no symptoms to confirm they’re free of disease. All this is essential to get people back to work. Whether that means leaning on big commercial labs or health systems, or getting a new crop of testing gear up and running in hospitals around the country, every effort is a meaningful contribution. “We’re all in this together,” says Khani.