SF health officials grapple with COVID-19 testing shortage

Limited supplies, lack of information hampers effort to control spread of disease

The head of San Francisco’s Department of Public Health expressed frustration this week over a lack of tests to diagnose people for coronavirus and announced he is working on a plan to improve testing and coordination among public and private entities.

The short supply of tests has remained a concern for local officials since the virus was first detected in San Francisco, as those with mild symptoms or those who are asymptomatic can spread the disease.

To get a better handle on the testing, Dr. Grant Colfax told the Health Commission Tuesday evening that he has asked the City Controller’s Office and personnel from University of California-San Francisco to work with the department to develop a testing plan that will allow the department to track what tests are available, who they are available to, and how many are done.

Colfax said that “we’re working to get full visibility in who is testing and who they’re testing across the city right now.”

The plan will also help strategize on how to increase the number of available tests and areas where private funding could help.

The prevalence of coronavirus in San Francisco remains unknown since tests are prioritized for those in high-risk categories like seniors, those with underlying health conditions and health care workers.

As of Wednesday morning, The City has confirmed 51 cases of COVID-19, the disease caused by the coronavirus.

The City’s Health Officer Tomás Aragón, who ordered all of San Francisco to shelter-in-place at midnight Tuesday, also stressed the importance of testing at Tuesday’s Board of Supervisors meeting.

He said creating a more robust health surveillance network to test those with mild or no symptoms is necessary to slow the spread.

“This virus, the way it moves, is explosive,” Aragon told the board.

“We have an iceberg,” he said. “At the very top of the iceberg are the people that die. Then we have the people who are in the ICU and then you have this iceberg that you cannot see. And we’re not able to see any part of this iceberg because of our testing debacle that happened in the country.”

Aragon said that the part of the “iceberg that we cannot see is doubling every six days.”

The City has seen improvements in testing, such as increased COVID-19 test capacity in private labs. The private labs report positive cases to the department, but not the total number of tests, something Aragon hopes to change to better monitor the virus.

But there is also a shortage of test-related supplies like swabs and reagents, chemicals used to test samples.

“The testing capacity is a key issue for us,” Colfax said. “It is a key issue across the country right now.”

The federal Centers for Disease Control and Prevention provides the test kits for public health labs across the nation, but the Department of Public Health’s own public lab test capacity “is relatively small,” Colfax said.

“We are getting tests delivered to us by the CDC in a very challenging fashion because we’re simply not able to be assured that either we have enough tests at the current rate to last us say, two months, or that we have enough tests so that we can actually expand our capacity to run 24 hours a day,” Colfax said.

He also addressed challenges with private labs.

“That again is a process that is dynamic and challenging,” Colfax said. “The information we have changes on a regular basis where Quest Lab turnaround is three to four days and we are working to ensure that we get people tested who need to be tested and Quest is frequently, and the other private testing companies, are telling us that they don’t have capacity to accept any more tests and so on and so forth.”

Colfax also said that the UCSF has developed its own tests but is hampered by “global limitations on reagents.”

“On Friday I was informed that UCSF was going to be able to perform hundreds of tests a day, not just for DPH but through the UCSF system, but then today I am told they can’t get started because they don’t have sufficient reagents,” Colfax said. “So they have the tool but they can’t scale up the tool.”

“There are multiple different streams of testing and each lane I would say has its own inherent challenges,” he added.

Challenges include “such a national shortage of supplies.”

“I have to say we are short of things like swabs,” Colfax said.

Aragon said that an important strategy to combat the virus is containment.

“Getting people into housing for isolation and quarantine is absolutely critical, super time intensive and it has been limited by testing,” he said.

As a result of the lack of testing he said that people with no symptoms or mild symptoms are unaware that they are spreading the disease.

“When you have 100 percent of the population susceptible, that asymptomatic infection is like dropping a match,” Aragon said. “It may be only a few matches, but it’s dropping a match on gasoline because everybody is susceptible.”

Aragon said that South Korea and Singapore have shown how aggressive testing and tracking down contacts with known cases can help control the spread.

But he said “our public health infrastructure is so small.”

“We don’t have enough to do syphilis contact investigation,” Aragon said. “We are down to the bare bones of public health infrastructure.”

Aragon put it simply: “Testing is really going to help us.”

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