WASHINGTON — A couple of week after the primary report of a Covid-19 case at a meatpacking plant in southwest Kansas in early April, the state’s governor, Laura Kelly, issued a pointed warning to President Trump: With out take a look at kits to separate the effectively from the sick, a fast-moving outbreak might idle amenities that produce roughly one quarter of the nation’s meat provide.
Inside three days, 80 blue-and-white containers of take a look at kits and testing machines arrived, and two Black Hawk helicopters from the Kansas Nationwide Guard whisked them to the troubled area. Because the take a look at outcomes got here in final week, the prices of the delay turned clear: 250 staff in six vegetation had been already contaminated.
In Albany, Ga., a scorching spot for the illness, a hospital lastly found out a strategy to run its personal coronavirus exams, slightly than counting on restricted state capability or outsourcing the work to slow-moving non-public labs. Nevertheless it nonetheless struggles to run as many exams as it could like due to a scarcity of parts.
In Ohio, a analysis establishment in Columbus is partnering with a plastics firm to churn out nasal swabs on 3-D printers to be used within the state. However when Mysheika W. Roberts, the town’s well being commissioner, provided take a look at kits to native well being facilities, she discovered they lacked the protecting gear they wanted to place them to make use of.
As governors resolve about opening their economies, they proceed to be hampered by a scarcity of testing capability, leaving them with out the knowledge that public well being consultants say is required to trace outbreaks and include them. And whereas the US has made strides over the previous month in increasing testing, its capability is nowhere close to the extent Mr. Trump suggests it’s.
There are quite a few causes. It has proved onerous to extend manufacturing of reagents — delicate chemical components that detect whether or not the coronavirus is current — partly due to federal rules meant to make sure security and partly as a result of producers, who often produce them in small batches, have been reluctant to put money into new capability with out assurance that the surge in demand shall be sustained.
Some bodily parts of take a look at kits, like nasal swabs, are largely imported and onerous to return by amid world shortages. Well being care staff nonetheless lack the protecting gear they should administer exams on a wide-scale foundation. Labs have been sluggish so as to add folks and gear to course of the swelling numbers of exams.
On prime of all that, the administration has resisted a full-scale nationwide mobilization, as an alternative intervening to allocate scarce gear on an advert hoc foundation and leaving manufacturing bottlenecks and shortages largely to market forces. Governors, public well being officers and hospital executives say they’re nonetheless working in a type of Wild West financial system that has left them scrambling — and competing with each other — to obtain the gear and different supplies they want.
“You might be utilizing a free-market mannequin in a public well being emergency,” Governor Kelly, a Democrat, mentioned an interview, “and I’m undecided these two go collectively notably effectively.”
The US carried out about 1.2 million exams from April 16 to April 22, up from about 200,000 exams between March 16 and March 22, in response to information from The Covid Tracking Project.
But as states begin to reopen, the nation is far from being able to conduct the kind of widespread surveillance testing that health experts say would be optimal. Many states are still struggling to conduct much more urgent testing of patients with symptoms, or those in high-risk groups. Few have the money or the personnel to also check on the presence of the virus in the general population or to reach out to people who have been in contact with those confirmed to be ill.
“We are not in a situation where we can say we are exactly where we want to be with regard to testing,” Dr. Anthony S. Fauci, the nation’s leading infectious disease expert, said this week in an interview with Time.
Congress is pushing the administration to give states more guidance. The $484 billion relief package passed last week included $25 billion to expand testing and required the administration to come up with a strategic testing plan to support the states.
In the meantime, a flurry of research groups, professors and other experts have stepped in with proposals. On the low end, the liberal Center for American Progress estimates that eight-tenths of one percent of the national population must be tested each week to contain the virus. On the high end, a group from Harvard has put the figure at as much as 21 percent.
In Ohio, Gov. Mike DeWine announced on Friday a deal with Massachusetts-based Thermo Fisher Scientific that will begin providing the state with 7,200 tests a day by Wednesday and scale up by the end of May to 22,000 a day. That trajectory is enough, he said in an interview, to make him feel comfortable about taking the first steps toward reopening businesses on Monday.
That type of entrepreneurial response by some states is all well and good, said Thomas R. Frieden, a former director of the Centers for Disease Control and Prevention, but it does not help other states that are still struggling.
“It’s great to have innovation from academia and the private sector to come up with new ways to do things as efficiently as possible,” he said, “but on the other hand we do need national coordination.”
Mr. Trump continues to insist that the current approach is adequate.
“America’s testing capability and capacity is fully sufficient to begin opening up the country, totally,” he said at one point this month. At another, he said that “we are doing more testing I think than probably any of the governors even want.”
After getting 2,000 tests kits to southwest Kansas and assessing the scale of the outbreak there, Ms. Kelly decided it was not necessary to close the meatpacking plants.
But she said the tortuous path to freeing up even minimal supplies for testing remains the biggest reason she is reluctant to lift the stay-at-home order she imposed on March 28.
“We are nowhere near where we need to be with testing supplies,” she said on Thursday. “I’m looking down a lot of rabbit holes trying to figure out how we are going to get those test kits here. It’s imperative if we are going to be able to lift that stay at home order.”
Kansas has one of the lowest Covid-19 testing rates in the nation. Dr. Lee A. Norman, the state’s top health official, estimated that Kansas needed tens of thousands more testing kits.
The state is so short of plastic test swabs that he has appealed to dentists to manufacture them in their offices by modifying 3-D printers used to make dental models.
Since March 20, Kansas has sent the Federal Emergency Management Agency nine requests for medical supplies, including for 235,000 testing swabs, 60,000 kits to transport samples and 178,200 kits to analyze them. As of Wednesday, the agency had sent “nothing,” said Jonathan York, the state’s coordinating officer. Federal officials told him that other states were in more desperate shape.
In mid-April, the federal government delivered 273,000 surgical masks, the kind needed to protect medical workers who administer tests. But Dr. Norman said the masks, which had been privately donated, “were so substandard they wouldn’t even make a good coffee filter.”
Late on Friday, the Centers for Disease Control and Prevention, which has helped the state obtain some supplies, told officials it intended to ship at least 25,000 of the 80,000 test kits it had requested.
State officials have had no luck trying to buy supplies themselves. Dr. Norman said Kansas had standing requests with private suppliers for $43 million in equipment, a “staggering” sum equivalent to nearly a third of his department’s annual public health budget.
“But the pipelines have pretty much dried up,” he said.
Kansas is still dealing with the hangover of seven years of draconian budget cuts under former Gov. Sam Brownback, a Republican. Ms. Kelly said the state health department “had been pretty much decimated” by the time she became governor in 2018, with the laboratory that now processes many Covid-19 tests resembling “something out of the past.”
The state plans to rely heavily on volunteers to create a corps of 400 workers to monitor the contacts of people who test positive.
Although the state is far from meeting the broad guidelines for testing capacity the White House has recommended for reopening, Ms. Kelly is under growing pressure to allow her stay-at home order to expire as scheduled on May 3. The Republican-controlled state legislature has moved to curb her emergency powers, and protesters gathered on Thursday on the statehouse grounds.
“What is an acceptable level of risk?” Dr. Norman asked. “We cannot get it down to zero, so how can we guarantee that people won’t get sick?”
Whatever the course of action, he said, “there will be death.”
Georgia: ‘It’s Not Gone.’
As Phoebe Putney Memorial Hospital in Albany, Ga., began filling up last month with gasping patients, Scott Steiner, the hospital system’s president, immediately encountered the ways in which a lack of testing capacity left the region vulnerable.
He wanted to test as many patients and staff members as he could, but the state’s laboratory had set criteria so strict that few people qualified. When he turned to LabCorp, a private company, results took as many as 10 days to come back. With no way to know if patients were positive, doctors and nurses burned through precious protective equipment until the results came in.
So Mr. Steiner decided the hospital had no choice but to develop the capacity to test on its own. He and his staff considered buying a testing machine from Abbott Laboratories, a company that had been praised by Mr. Trump, but worried about competing with the federal government over scarce supplies.
Finally, they decided to buy $400,000 worth of equipment from Cepheid, a California-based diagnostic company.
Now, the hospital tests every patient who is admitted, even those coming in for unrelated procedures, as well as outpatients who have symptoms. The number of cases has fallen, as has the percentage of patients testing positive, from about 40 percent in March to 25 percent in April.
But doctors can’t run as many tests as they would like. Mr. Steiner said he requested enough materials from Cepheid for 1,500 tests a week, but the company has only sent enough to do between 400 and 900.
“We didn’t get any last week,” he said. “We heard that there were other government agencies that took the supply.”
So far he has been unable to get tests for antibodies, which help to show how many people have already contracted the virus, and the county health department’s efforts to conduct contact tracing are at a very early stage.
Mr. Steiner has seen both the devastation of the virus and also the increasing risks of the shutdown for patients who have had to delay surgeries, including breast cancer patients awaiting mastectomies. The hospital, which gets most of its income from elective surgeries, could resume those procedures in a few weeks.
But nearly 100 Covid-positive patients remain in the hospital. And on a single day this week, eight more patients were admitted.
“It’s not gone,” Mr. Steiner said.
Ohio: ‘Are We Testing Enough People?’
Although Mr. DeWine, a Republican, has been one of the most aggressive governors in addressing the crisis, testing has been a concern from the start.
On April 1, the state’s health director, Amy Acton, ordered hospitals to stop sending coronavirus tests to private laboratories because a huge backlog had created delays of up to 10 days in processing. (This week, Mr. DeWine lifted the order, saying the labs had caught up.)
But by March 31, Ohio State University’s Wexner Medical Center and Battelle, a nonprofit research institute, had developed their own test that produced results within five hours. Ohio State now processes slightly more than 1,000 tests a day, with a capacity of 4,500 per day, said Harold L. Paz, the Wexner Medical Center’s chief executive.
Facing a shortage of nasal swabs, the medical center teamed up with a plastics maker to produce swabs on 3-D printers; it has received 15,000 swabs, with another 100,000 expected soon.
Yet the health commissioner in Columbus, Dr. Roberts, was struggling to keep up with the demand. While she supervises a staff of 450 people with a budget of $45 million, she said she and her team probably spent 20 percent of their time searching for necessary test kits and supplies.
A little over a week ago, the state shipped her 1,000 test kits. She will distribute them judiciously, she said, focusing on nursing homes and other hot spots or high-risk groups.
“I worry, are we testing enough people?” she said. “And how do we get the tests to the right people and make sure that we don’t have something brewing that we failed to pay enough attention to and it becomes a huge fire.”
Ohio’s testing capacity has been limited by a shortage of reagents, the compounds needed to process the tests. Mr. DeWine complained privately to Vice President Mike Pence that the Food and Drug Administration was moving too slowly to approve a new reagent made by Thermo Fisher Scientific. Last Sunday, Mr. DeWine repeated his plea for faster action on NBC’s “Meet the Press.”
The pressure campaign worked; on Tuesday, Mr. DeWine announced the F.D.A. had granted approval, clearing the way for his announcement on Friday about expanded testing.
Mr. DeWine said Ohio would now have enough capacity to do intensive testing in hot spots and to test the contacts of those infected, helping to guide him through “gut-wrenching decisions” about the balance between getting the economy going again and keeping people from spreading the virus.
“Frankly,” he said, “I feel a lot better than a few days ago when I didn’t have this.”
Sheryl Stolberg and Sharon LaFraniere reported from Washington, and Farah Stockman from Cambridge, Mass. Kitty Bennett contributed research.