As COVID-19 cases in the United States passed 700,000 today, researchers published early findings that suggest, as expected, the disease is more widespread than case numbers reflect.

And in international developments, outbreak totals climbed in parts of Asia, including Japan, Indonesia, and Singapore, as well as in Russia. US cases reached 726,645 cases, with nearly 39,000 deaths, according to the Johns Hopkins online dashboard. The global total stands at 2,310,572 cases from 185 countries, with 158,691 deaths.

States press feds for testing fixes

Testing issues continue to hobble state’s plans to ease off stay-at-home orders, and yesterday at a White House briefing, President Trump said the administration will be sending 5.5 million swabs to the states, though he signaled the governors have the capacity to provide them, CNN reported. And in an interview with PBS, Vice President Pence said the administration is focusing on expanding unused capacity at labs.

Meanwhile, the American Association for Clinical Chemistry in a statement yesterday said supply chain issues, such as personal protective equipment, swabs, and reagents are obstacles to scaled-up testing and that the White House is in the best position to coordinate resources, the Washington Post reported.

Yesterday, 130 Republican House members had a conference call with Health and Human Services Secretary Alex Azar and other officials, and aired questions about testing and supply shortages, but federal officials reiterated that it's up to state and local officials to obtain supplies from manufacturers, according to the Post report.

Meanwhile, Democrat lawmakers who had a conference call with Pence yesterday also focused their concerns on testing issues, but some voice frustration with unclear answers and the continued assumption that states are responsible for unraveling the testing problems, according to the CNN report.

In another testing related development, contamination at a Centers for Disease Control and Prevention (CDC) lab delayed the distribution of COVID-19 tests to states, the Washington Post reported today. Citing scientists with knowledge of the situation and federal regulators, the report said cross contamination probably stemmed from assembling chemical mixtures in a lab space that handled synthetic coronavirus material, a practice that didn't follow CDC procedures.

It took the CDC a month to remove the problem step from its test kits, adding to delays in the rollout of the test. In the middle of February, the CDC had said there was a problem with one of the reagents, that the test wasn't performing consistently at state labs, and that problem reagent would be manufactured.

In another federal government development, the US Department of Agriculture (USDA) announced a $19 billion COVID-19 food assistance program to support farmers, ranchers, and consumers. It targets $16 billion in direct relief to farmers and ranchers and $3 billion to buy fresh produce, dairy, and meat to provide food boxes to food banks and other nonprofit groups.

Studies yield undetected case clues

Three new studies—two involving seroprevalence and one analyzing a home-based polymerase chain reaction (PCR) test—revealed early clues about how widespread the disease is in some US communities.

A study of seroprevalence in Santa Clara County, Calif., by a team based at Stanford University found that based on three scenarios for test performance, the population prevalence ranged from 2.49% to 4.16%, suggesting that 48,000 to 81,000 people in the county were infected by early April. They published their findings in the preprint server medRxiv.

The authors enrolled participants through Facebook ads, and the sample size included 2,718 adults and 612 children who were tested at one of three drive-through testing locations. At the time of the study, Santa Clara County had about 1,094 cases, the largest in northern California. The test kit, made by Premier Biotech, based in Minneapolis, was tested in Stanford labs before it was used to test study participants.

Researchers not involved in the study who weighed in on Twitter noted a "consent bias" in the study, meaning participants may have volunteered, because they had been sick with COVID-19. Natalie Dean, PhD, with the University of Florida Department of Biostatistics, on Twitter also raised concerns about unstable population weighting, wide uncertainty bounds after adjusting for clustering, and test specificity.

In Chelsea, Massachusetts, a seroprevalence study of 200 city residents conducted this week by a team from Massachusetts General Hospital found that 64 (32%) had antibodies to the virus, the Boston Globe reported. The participants were generally healthy, though half said they had at least one symptom of the illness in the past 4 weeks. The city is one of the state's hot spots and earlier this week had recorded at 712 cases, at least 39 of them fatal.

Meanwhile, a home-based swab testing study launched on Mar 23 by the Seattle and King County health department and the Seattle Flu Study group found that of 4,092 samples, 44 (1.6%) were positive for COVID-19. In a blog post, researchers said the proportion of positive tests was lower than testing through the medical system, but may still represent thousands of unrecognized community infections. Prevalence declined over the testing period, but the drop wasn't statistically significant.

The team urged caution in analyzing the findings because of the sample size and said it's too early to draw general conclusions from the data.

Russia cases surge; Italy mulls isolation centers

At the international level, Russia for a sixth day in a row reported a record high number of COVID-19 cases, the Moscow Times reported. The country reported 4,785 cases, raising its total to 36,793. So far, at least 313 people have died from their infections. The country's hot spot is Moscow, which is on lockdown at least until May 1. A city health official said Moscow is still 2 to 3 weeks away from its peak and warned that difficult days are ahead.

In Italy, where illnesses and deaths are still high but slowing, experts said at a briefing yesterday that the lockdown had reached a lid on its benefits and that the main source of infection is now families, the Canada-based Globe and Mail reported. They said the only way to drive illness levels down further is to isolate people who test positive in treatment centers away from their relatives.

Japan, Singapore cases spike; Indonesia expands distancing

In Asia, Japan's outbreak continues to accelerate, especially in Tokyo, and cases have now passed 10,000, Reuters reported. The country's prime minister recently extended the state of the emergency to the whole country, and health officials warn that disease spread to rural areas could overwhelm health systems.

Singapore reported a record-high daily total of 942 cases today. The country's health ministry said of the latest cases 893 involve foreign workers living in dormitories, 27 are foreign workers residing outside of the dorms, and 22 are community cases.

Elsewhere, Indonesia, which is experiencing a spike in infections, health officials extended social distancing measures to people on the main island of Java and in West Sumatra, areas that have seen significant increases, Bloomberg News reported. The country has expanded its measures outside of Jakarta, its main hot spot.

Indonesia, the world's fourth most populated country, reported 325 cases today, down from 407 yesterday, raising its total to 6,248. And China today reported 27 new cases, 10 of them local cases form Heilongjiang (7), Guangdong (2), and Sichuan (1) provinces, according to the National Health Commission. It also reported 54 more asymptomatic cases, 3 of them imported.