[tejohnso]

> At this point, the hospital called the CDC requesting permission to perform the COVID-19 testing. The CDC denied the request on the ground that I did not have the most life-threatening symptoms

Two questions:

1. Why would the hospital require permission to run a test?

2. Why would the CDC not want to test suspicious cases before severe symptoms present? From what I've read, the virus is contageous whether severe symptoms are present or not.

[seraphsf]

The core problem is that the CDC (and country) has had the capacity to test only a few hundred samples per day. Meaning, they don’t have the ability to test everyone with flu-like symptoms.

Nobody thinks it’s right to NOT test every potential case. It just wasn’t possible.

Good news: Just today, they released new rules that should increase testing capacity by 400x.

[garmaine]

The CDC doesn't run the tests. The hospitals and independent labs do. There has been some issues with the test kits distributed by the CDC, but since the virus genome has been sequenced you don't actually need a test kit (it's just a faster process if you have one).

However the CDC has enacted emergency powers to make it illegal for hospitals to use their own testing equipment, which they have in-house, to test their own patients unless they first get CDC approval. And the CDC has ridiculously stringent requirements for approving these tests.

As a result, the only confirmed case of community-spread COVID-19 in the US is in Northern California, because the UC Davis hospital basically said "go fuck yourself" to the CDC and tested anyway.

This is not because COVID-19 is not spreading throughout the community--it is!--but rather because the CDC's stringent testing requirements prevent testing of any case that cannot be rationalized away as having been caught elsewhere. If you don't test for the virus, then you don't confirm the presence of the virus, so there is no virus, amirite?

[voidmain]

Some clarification based on what I've been able to put together (caveat: I'm not an expert in this area)

The CDC developed a testing protocol (crudely, a set of 3 conserved RNA sequences of the virus to chemically "grep" for). The protocol is here [1] and I think anyone with suitable equipment (an RT-PCR machine and an oligonucleotide synthesizer to make the primers and probes?) could run tests using just the information on that web page, though they would probably also want known positive samples of the virus to validate against. And there are lots of labs with suitable equipment. But as that page says, it is not legal to do this clinically.

The CDC also sent out test kits [2]. These are just vials of primer/probe pairs synthesized from the short sequences on the above page, and a fake positive control to validate with. These were authorized by the FDA, and so are legal to use. But apparently somehow they screwed up the production of primer #3 (or maybe the sequence itself is wrong), and so almost all the labs were not able to validate the test. After several weeks the CDC has still not fixed this problem, but labs are now allowed to run tests using just primer 1 and 2, so testing capacity is rapidly increasing (though of course who knows how sensitive or specific the tests are).

The federal organization preventing labs from running tests is the FDA [3], not the CDC. It is also the FDA who would have to approve the commercially produced test kits.

[1] https://www.cdc.gov/coronavirus/2019-ncov/lab/rt-pcr-panel-p... [2] https://www.fda.gov/media/134922/download [3] https://www.fda.gov/emergency-preparedness-and-response/mcm-...

[garmaine]

What you say is correct, but is conflating a separate issue.

You are correct that FDA approval is required for a clinical test, and for that a CDC test kit must be used (even though the biochemistry involved is trivial and a grad student with access to the right tools could put together their own kit...)

An entirely separate issue is that the CDC has used its emergency powers to restrict usage of these kits--you cannot use the kit to test a patient unless the CDC gives the OK for doing so. Even though for a long time many of these kits were not being used to available capacity...

[voidmain]

My understanding was that prior to Friday, CDC Atlanta's comically limited RT-PCR capacity was backlogged even under the "see-no-evil" testing criteria, and that approximately no other labs were able to do tests (since validation of the CDC issued tests failed). If there was also unused lab capacity that is good to know, do you have a source?

[rrss]

> the only confirmed case of community-spread COVID-19

There are now 4 confirmed cases of community-spread COVID-19. 2 in california, 1 in oregon, 1 in washington.

https://abcnews.go.com/US/high-school-student-washington-lat...

[vkou]

There's now a nursing home in Washington with a staffer, and a resident[1][2] confirmed to have COVID-19, and ~50 people in that nursing home showing symptoms. But, since only those 2 people have been tested, the national stats look amazing! Only 4, no, scratch that, 6 transmissions!

[1] https://nymag.com/intelligencer/amp/2020/02/two-new-us-coron...

[2] Neither of them have been to China.

[hutzlibu]

"Good news: Just today, they released new rules that should increase testing capacity by 400x"

How can new rules increase testing capacity? All you can do, is adjust the rules to the existing capacities ...

[TheSoftwareGuy]

The capacity basically existed, but couldn’t be used until it had gone through fda certification for the virus. The new rules allow labs to perform testing after sending the required information to the fda but before the fda has had time to review that information

[aliceryhl]

Presumably they have obtained more resources and have updated the rules to reflect that.

[dgacmu]

Because it's a CDC test in limited supply, and they're doing their best to try to balance the available supply with detecting as many cases as possible. The challenge is that the spread is changing rapidly enough that the guidelines will inevitably be a day or two behind periodically.

[takeda]

They are also banning hospitals from doing their own tests. All hospitals have equipment to test for virus presence. In fact we learned about first case of local virus spread, because a hospital ignored CDC and tested the suspected patient anyway.

[donarb]

Because all test samples are sent to the CDC headquarters in Atlanta for testing. They only have a certain number of people available to analyze the test results. And the number of test kits is limited so the CDC is trying to triage cases until the supply opens up.