Coronavirus Testing Slumps in the U.S.

Screening for the coronavirus at the University of Idaho in Moscow, Idaho, last week. The volume of testing in the United States has fallen by 30 percent since January.
Credit…Rajah Bose for The New York Times

Widespread testing is crucial in controlling the spread of the coronavirus and squashing new outbreaks, experts say. But the amount of testing being done in the United States has fallen by 30 percent in recent weeks.

From a high of nearly 14 million tests a week in early January, the pace fell to fewer than 10 million — a level not seen since October —  in the week ended Feb. 24, according to the Covid Tracking Project.

Some areas report even sharper declines: Michigan is testing about half as many people now as it was in November, and Delaware’s state-run sites are testing about one-third as many. Los Angeles County’s sites, which were running flat out last month, tested just 35 percent of their capacity last week.

Experts cited a number of factors that could be contributing to the slump:

  • Fewer exposures. Since daily tallies of new coronavirus infections have fallen sharply, fewer people may be having contacts that would prompt them to seek a test.

  • Less travel. The holiday rush is over, reducing the need for people to get tested before or after trips.

  • Bad weather. The severe storms and Arctic temperatures that battered much of the country, from Texas to the Northeast, caused many testing sites to close temporarily.

  • The vaccine rollout. Some states have shifted their limited public health resources, and their public messaging, toward vaccination efforts at the expense of testing.

  • Pandemic fatigue. Some experts worry the decline may be yet another symptom of public exhaustion and frustration with pandemic precautions and safety measures.

All those forces may be at play, said Dr. Jennifer Nuzzo of the Johns Hopkins Bloomberg School of Public Health: “My sense is that it’s probably that there are fewer options for testing, fewer communications about it, people may be perceiving that it’s less necessary — maybe they just don’t see the point any more.”

The slump in testing, at a time when a clear picture of the pandemic is still badly needed, worries some epidemiologists. “There’s nothing about the current situation that has made testing any less necessary,” Dr. Nuzzo said.

Among other things, less testing makes it harder to follow the virus’s mutations and to get ahead of variants that may be more contagious or deadly, said Dr. Rick Pescatore, the chief physician at the Delaware Division of Public Health. “We can’t identify variants until we first identify positives.”

But the decline in testing may not be a cause for alarm — and may even be a good sign — if it reflects wider progress in tamping down the pandemic, said Dr. Clemens Hong, who runs Los Angeles County’s testing program.

“The biggest reason for the drop in testing demand, I think, is the decrease in infections and spread,” Dr. Hong said. “Covid-19 is not spreading as quickly right now, which means there’s fewer people with symptoms, and also fewer people having contact with people with Covid-19. That’s just the reality.”

Across the country, new case reports have dropped sharply since mid-January. At its peak on Jan. 8, the U.S. reported a seven-day average of over 259,000 new cases. Now, the seven-day average is less than 70,000, as of Saturday.

Hospitalizations and deaths have followed suit, and vaccine distribution is rapidly increasing: 15 percent of the U.S. population has now received at least one dose.

Nonetheless, Dr. Hong said, testing remains vital to getting ahead of outbreaks.

“Even with all these declines and the rollout of the vaccines, it’s just not enough,” he said. “We don’t have enough immunity in the community to prevent another surge. We may never see a surge like we saw in December and January again, but we’ll see little pockets and little surges that will try to come to life, and we just need to put them out.”

Tracking the Coronavirus ›

United States › United StatesOn Feb. 28 14-day change
New cases 50,925 –26%
New deaths 1,129 –21%

World › WorldOn Feb. 28 14-day change
New cases 333,883 Flat
New deaths 5,832 –23%

Luis Valdivia from Veracruz, Mexico, picking vegetables on a farm in Hemet, Calif., in February.
Credit…Ariana Drehsler for The New York Times

The desert valley tucked behind the San Jacinto Mountains in California is best known for the Coachella music festival and a series of lush resort towns where well-heeled snowbirds go to golf, sunbathe and party.

But just beyond the turquoise swimming pools of Palm Springs, more than 10,000 farmworkers harvest some of the country’s largest crops of date palms, vegetables and fruits.

Mainly undocumented immigrants, they have borne the brunt of the pandemic in California: In some areas, up to 40 percent of the workers tested for the virus had positive results. The Rev. Francisco Gómez at Our Lady of Soledad church in Coachella said his parish had been averaging 10 burials a week. “You’re talking about an apocalyptic situation,” he said.

Ending the virus’s rampage through farm country has been one of the United States’ biggest challenges. Undocumented immigrants are wary of registering for government programs or flocking to public vaccination sites, and the idea of offering the shots to immigrants who are in the country illegally ahead of other Americans has spurred debate, particularly among some Republican members of Congress.

But a landmark effort is underway across the Coachella Valley to bring the vaccines directly into the fields. Thousands of farm workers are being pulled into pop-up vaccination clinics hosted by growers and run by the Health Department.

The county is the first in the nation to prioritize farm workers for vaccination, regardless of their age and health conditions, on a large scale. But epidemiologists say such programs will need to expand significantly to have any chance of ending one of the biggest threats to the stability of the country’s food supply.

Hundreds of outbreaks have crippled the work force on farms and in food processing centers across the country. Researchers from Purdue University in Indiana estimate that about 500,000 agricultural workers have tested positive and at least 9,000 have died.

The challenges to getting farmworkers vaccinated go well beyond worries about their immigration status. The odds of being able to sign up for a vaccine online are low in a population that often lacks broadband access and faces language barriers. Many cannot easily reach vaccination sites in urban areas because they do not have reliable transportation or the ability to leave work in the middle of the day.


Prime Minister Narendra Modi of India was injected in New Delhi on Monday. Mr. Modi was given the Covaxin shot, which was developed by Bharat Biotech, an Indian pharmaceutical company.
Credit…India’s Press Information Bureau, via Reuters

NEW DELHI — Prime Minister Narendra Modi of India was vaccinated against the coronavirus on Monday as the country began the next phase of its inoculation drive, one of the largest in the world.

India has approved two coronavirus vaccines for emergency use: the Oxford-AstraZeneca vaccine, which is produced by the Serum Institute of India, the world’s largest vaccine producer; and Covaxin, which was developed by Bharat Biotech, an Indian pharmaceutical company.

Mr. Modi received the first of two doses of Covaxin, in line with his pitch for a “self-reliant India,” which he reiterated in his monthly radio address over the weekend. “The first condition for self-reliance is to have pride in the things of one’s own country,” he said.

Mr. Modi’s appeal to “make India Covid-19 free” comes at a time when vaccine hesitancy in the country is high, with 58 percent of respondents in one survey expressing doubts. India has managed to inoculate only about 14 million of its 1.3 billion people since the inoculation drive began this year.

As of Monday, vaccine eligibility in India has been expanded to include anyone 60 and older, as well as people 45 and older with chronic conditions such as heart disease, diabetes and hypertension.

Last month, India appeared to be experiencing something of a breather in its outbreak. The country has registered more than 11.1 million total cases, the second-highest tally in the world, after that of the United States, according to a New York Times database. But cases are now increasing again.

On Sunday, the chief minister of the state of Maharashtra, which includes the country’s financial capital, Mumbai, imposed a lockdown in some areas after cases there surged to over 8,000 in a single day.

In other global developments:

  • Auckland, the most populous city in New Zealand, on Sunday went into its second lockdown in less than a month after a single case of the coronavirus was recorded in the community. The weeklong lockdown was prompted by the discovery of an infection linked to an earlier cluster of cases involving the virus variant first detected in Britain. That cluster led officials to put Auckland on lockdown for three days in mid-February.

  • As most of Italy struggles to fight back coronavirus infections, the authorities on the island of Sardinia on Monday all but lifted restrictions. For the first time in months, locals will be able to eat in restaurants at night and stay outside past 10 p.m. Masks and social distancing will still be mandatory. Christian Solinas, the region’s president, said it was “a great result reached thanks to the sacrifices of all Sardinians.”

Passengers arriving at Heathrow Airport, which serves London, were escorted by security personnel last month.
Credit…Dan Kitwood/Getty Images

LONDON — The British government was hunting on Monday for someone whose Covid-19 test sample came back positive for a concerning variant of the coronavirus first detected in Brazil, one of the first known instances of that variant in Britain.

But the person’s identity and whereabouts were a mystery: The person neglected to fill out an information card that accompanied a test kit, sending British officials on a frantic quest to use postal service data to track them down.

Nadhim Zahawi, the government minister overseeing Britain’s vaccination campaign, resorted to asking anyone who was tested for the coronavirus on Feb. 12 or 13 in Britain but who did not receive a result to call a government hotline.

The appeal was an attempt to use all avenues to “make sure we locate them as quickly as possible,” Mr. Zahawi said on Monday on a BBC morning show.

The unidentified person was one of six British cases of the variant first seen in Brazil, known as P.1, that were announced on Sunday night. Two of the cases, in England, emerged in a household with someone who had recently traveled to Brazil. Three unrelated cases turned up in Scotland in people who had also recently returned from Brazil.

English and Scottish officials said they were tracing those people’s contacts, including fellow airline passengers. But for the moment, contact tracing was impossible for the sixth case.

In Brazil, the P.1 variant is believed to be responsible for cases of people who were previously sick with earlier versions of the virus becoming reinfected. It has several concerning mutations in common with the variant first detected in South Africa. That variant is known to have some degree of resistance to the immunity that people develop after recovering from an infection or being inoculated, though the variant first seen in Brazil is not believed to be quite as problematic.

It is possible that the P.1 variant is also more contagious, but that remains unclear, British government scientists have said. The variant has been reported in 25 countries, including the United States.

For Britain, most of the concerns so far have revolved around the variant first detected in southeast England, known as B.1.1.7, that is believed to be more contagious and deadlier, but not necessarily resistant to vaccines.

Asked on a radio program on Monday morning about how concerned people should be, Danny Altmann, a professor of immunology at Imperial College London, said: “Somewhat worried, but not total panic, perhaps.”

Health care workers in the Covid-19 Unit at United Memorial Medical Center in Houston.
Credit…Mark Felix/Agence France-Presse — Getty Images

Every coronavirus variant of concern to researchers around the world has been circulating in Houston at a low level for at least six to eight weeks, a new study has found. Houston is the first U.S. city to find all of the variants, including those recently reported in California and New York and the ones found in Brazil, Britain and South Africa.

The discovery mainly highlights how little is actually known about the variants — their true whereabouts, prevalence and impact — as no other American city has the data in place to make such a survey possible.

Since last March, a team of researchers led by Dr. James Musser, chair of the department of pathology and genomic medicine at Houston Methodist Hospital, have been sequencing the viral genomes drawn from patients — 20,000 genomes so far.

Dr. Musser said the team had also analyzed detailed information on the infected patients. By linking the data sets, scientists can begin to ask vital questions: How do these variants affect the ability of the virus to spread, if at all? Do they make the symptoms any more or less severe? Are they any more or less resistant to vaccines, pre-existing immunity or treatment with monoclonal antibodies?

Before the pandemic took off in Houston, the team had set up a plan to match any variant it found with the clinical course of patients infected with it.

“If you don’t have the sequencing matched up with patient data, they are far, far less interesting, if not uninterpretable,” Dr. Musser said.

To Dr. Musser’s knowledge, Houston is the only city with the patient and sequencing data to address those questions. Iceland is undertaking a similar effort, he said, and he expects Israel to do so, also.

So far, researchers have tried to infer the effect of variants by looking at their prevalence in different populations and by doing laboratory studies. Those can provide important clues, Dr. Musser said, but to make the best use of those data, they must be linked to patient data.

Some critics, including Dr. Eric Topol, the founder and director of the Scripps Research Translational Institute, have said that the attention given to the succession of new variants — “scariants,” he has called them — has done little more than frighten the public.

Dr. Musser agreed, referring to such reports as “mutant porn.” Highlighting the existence of variants without indicating whether they make any functional difference to real-world patients was no more enlightening than collecting stamps or identifying the birds flying overhead, he said: “‘There’s a bird. There’s another bird.’”

He added: “I think the crucial thing in all of this is that it is extraordinarily difficult for both the medical and lay public to really sort through all this noise about variants. At the end of the day, does any of this mean a hill of beans to anyone?”

“The big issue is to try to get things toned down.”

The Sinovac vaccine arriving in Manila on Sunday. The Philippines aims to vaccinate 70 million people this year.
Credit…Ezra Acayan/Getty Images

MANILA — The Philippines, which has had one of the worst coronavirus outbreaks in Southeast Asia, began its inoculation campaign on Monday even as the government struggled to reassure a population wary of foreign-made vaccines.

President Rodrigo Duterte on Sunday urged the public to get vaccinated as he greeted a Chinese military aircraft carrying 600,000 doses of the vaccine developed by Sinovac, a private Chinese company. The Philippines, a nation of more than 100 million, is among the last Southeast Asian countries to receive any coronavirus shots but aims to vaccinate 70 million people this year.

“To my fellow Filipinos, please set your fears aside,” Mr. Duterte said. “These vaccines are backed by science and deliberated on by our experts.”

But the president, 75, did not say whether he would receive the Chinese vaccine, saying he was waiting for advice from his doctor. Philippine regulators, who issued emergency-use authorization for the Sinovac shots last week, recommended that it not be administered to health workers or people 60 and older, citing uncertainty over its efficacy rate among those groups.

In an effort to improve confidence, a group of cabinet officials, health care workers and others were publicly vaccinated at six hospitals in metropolitan Manila on Monday, the Department of Health said on Twitter.

The Philippines has secured 25 million doses of the Sinovac vaccine to be delivered by the end of the year. Regulators have also approved the Pfizer-BioNTech and Oxford-AstraZeneca vaccines, but the first Pfizer doses are not expected to arrive until later this year, and more than 500,000 of the AstraZeneca shots expected to arrive on Monday have been delayed, officials said.

Mr. Duterte has accused wealthy Western nations of blocking countries like the Philippines from securing the doses they need.

Also on Monday, the Philippine government said that Sinopharm, a Chinese state-owned company, had applied for emergency-use authorization for its coronavirus vaccine.

But recent surveys have shown that almost half of Filipinos are unwilling to receive any coronavirus vaccine, mostly because of safety concerns. At a protest on Friday, employees of Philippine General Hospital in Manila expressed doubts about the Sinovac vaccine, which has been shown in studies to have an efficacy rate of just over 50 percent among health workers, compared with over 90 percent for the Pfizer vaccine.

On Monday, they demanded that the Sinovac vaccine undergo another appraisal by a government panel after being granted a last-minute emergency approval.

Vaccine hesitancy in the Philippines also stems from an earlier vaccine scare. In 2017, a dengue immunization program was suspended after shots developed by the French drugmaker Sanofi were found in rare cases to provoke a severe form of the disease. By the time the program was halted, more than 830,000 children had been inoculated, and the vaccine has been linked to dozens of deaths.

Health workers and officials say the Dengvaxia scandal often comes up in conversations with those reluctant to receive a coronavirus vaccine. Dr. Joshua San Pedro, co-chairman of the Coalition for People’s Right to Health, said there was “lingering distrust and trauma” from the episode.

“We must dialogue with the people, especially those who remain alienated by a health system seemingly only for the privileged,” he said.

Gwen Palafox Yamamoto, mayor of the northern town of Bani in Pangasinan Province, said many worried that the new vaccines had not been sufficiently tested.

“We have been explaining the benefits of the vaccine and how this can help bring back normalcy to their lives,” she said. “They dismiss Covid-19 as just a simple fever, and would rather take their chances than die from an unproven vaccine.”

It does not help that many are wary about vaccines developed by China, which has a complicated relationship with the Philippines that includes a territorial dispute in the South China Sea.

“They just do not want a ‘made in China’ tag,” Ms. Yamamoto said.

“I was the only one in the time I was there who walked out of there,” Haydar Sal said of his time in the I.C.U.
Credit…Andrew Testa for The New York Times

Britain often tried to ignore the coronavirus as it advanced from Asia to northern Italy to the United States, leapfrogging political and geographic boundaries, carried by airline passengers and cruise ship vacationers just as the government entered the final phase of the departure from the European Union.

But today, the battle against the virus is still being waged on myriad fronts.

It is fought from emergency rooms to burial grounds, from the parlors of modest homes to the chanceries of state, from the soaring vault of a cathedral-cum-vaccination center to small-town mortuaries designed to cope with quotidian calculations of mortality, not the crushing onslaught of a pandemic.

The British government casts its fight in superlatives: the fastest authorization of vaccines, the speediest rollout of inoculations. But there is another, more macabre marker: a higher per capita death toll than any other large country in the world.

It took the emergence of a much more transmissible variant of the virus in the southeastern county of Kent in December to galvanize the country and its government. Last month, Sharon Peacock, the head of Britain’s genetic surveillance program, said the variant had “swept the country,” adding, “it’s going to sweep the world in all probability.”

For years, British physicians say, they have sought funds for the National Health Service to expand intensive care facilities, only to be “laughed out” of committee rooms, as one of them put it. And so, their charges cling to life in crammed theaters, many in induced comas.

Dr. Susan Jain, a specialist in anesthesia and intensive therapy, works in an intensive care unit in London that had to expand from 10 patients to 30, nearly all of them on ventilators. “We are very packed in our particular unit,” she said. “It isn’t quite as bad as MASH, but that’s what comes to mind.”


Credit…Andrew Testa for The New York Times

It is not a place Mohammed Malik, 53, a retired I.T. project manager who was discharged in February, recommends visiting. “The I.C.U. is the last place you want to end up,” he said. “There’s nothing after the I.C.U. other than death.”

While he was there, one of his five daughters, Miriam, who was pregnant, was found to be infected, too. Her baby was delivered by cesarean section; his daughter was in a coma for 10 days. “It was the darkest of all the darkest moments,” he said.

They survived. But even now, he said, he experiences strange anomalies, like the absence of a detectable pulse on his right side. He had nothing but praise for his doctors.

As elsewhere in Europe, the virus seemed to retreat in late summer. Travel restrictions were eased. In England, the government even offered cash incentives for people to eat out in crowded restaurants. Then the caseload curve veered sharply upward again.

“I never thought it would be so severe,” Dr. Jain said.

In this wave, she noted, the patients seemed to be younger, possibly because of the new variants, though the government’s data was inconclusive. But the “root is probably in the way it has been handled centrally,” she added, referring to officials’ having shied away from harsher measures earlier.

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