'Vital and urgent': Inside New York City's difficult quest to obtain coronavirus testing kits

Kevin McCoy | USA TODAY

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New York City Deputy Mayor Raul Perea-Henze was worried about obtaining testing kits for the new coronavirus as the disease started ravaging the United States. His letters to the Centers for Disease Control and Prevention showed it.

He wrote the first on Feb. 2, just 12 days after the first confirmed U.S. case of COVID-19 had been detected in Washington state. By then, there were just eight confirmed cases of COVID-19 in the United States, yet no deaths.

Perea-Henze, who oversees New York City's health services, was among the experts who realized that total reflected the low number of patients who had been tested. There were countless other cases that hadn't been detected.

The Mexico-trained physician and former assistant secretary for the U.S. Department of Veterans Affairs practically pleaded for test kits from the CDC, the nation's leading public health institute.

The three letters Perea-Henze sent to the CDC in February and March — by turns thankful, anxious and pleading — show how the nation's largest city tried to get access to the coronavirus test in what proved to be a fruitless effort to contain the spread of COVID-19.

"We are requesting that the deployment of this test to (public health laboratories) be accelerated as much as possible," Perea-Henze wrote Feb. 2. If New York City's health lab had the test, the city would "have test results in hand within hours of specimen collection, faster than a specimen can even be shipped to CDC for testing."

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The snapshot of New York City's efforts — based on Perea-Henze's letters, public statements by officials in New York City, New York state and the federal government, and CDC announcements and records — shows one brief early success, followed by delays and other problems.

Perea-Henze's first letter noted the city already had made a similar request. Dr. Oxiris Barbot, the city's health commissioner, reached out to the CDC by phone around the time of the first confirmed case of COVID-19 in the U.S.

By the time the federal government gave New York City authorization to create its own tests on March 2, the U.S. had 53 confirmed cases of COVID-19 and six deaths.

The CDC's first COVID-19 test kits

The CDC often is the first developer of diagnostic tests for health emergencies. That's because the agency, headquartered in Atlanta, gets access to viral samples before others, Stephen Hahn, commissioner of the U.S. Food and Drug Administration, said during a recent White House briefing.

In many cases, the CDC's test for a virus or bacteria becomes the template for those used to diagnose the disease in patients in the U.S. and around the world.

The U.S. testing process for the novel coronavirus started with an early achievement. The CDC publicly posted its assay test for COVID-19 on Jan. 24, three days after the first confirmed case in the U.S.

The CDC shipped 90 COVID-19 test kits on Feb. 6 and 7, days after Perea-Henze's first letter. The kits, sent to public health labs in every state, the District of Columbia and the Department of Defense, enabled health care experts to run thousands of tests, according to a CDC timeline.

But on Feb. 8, some of those labs reported a problem: The test produced inconclusive results when they tried to validate the procedure before running it on patient samples, according to the CDC.

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Perea-Henze's second letter to the CDC, sent on Feb. 20, referred diplomatically to "the issues with the initial deployment" of tests. He thanked the CDC for its work to respond to the growing health emergency. But that wasn't his only reason for writing.

The city still needed reliable tests, lots of them, and authorization to process them locally without sending samples to the CDC.

The national network of public health labs like New York City's would be critical to fighting the disease, Perea-Henze wrote.

"It is vital and urgent that NYC has local testing capacity to enable swift detection of COVID-19 in order to respond quickly to protect the health of New Yorkers," he wrote.

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In order to conduct thousands of COVID-19 tests, New York City's public health lab and its counterparts around the country needed "quality test kits" and the chemicals needed to extract, purify and stabilize COVID-19 ribonucleic acid for testing, Perea-Henze wrote. They also required funding for lab scientists.

Two weeks had passed since the CDC had shipped the flawed tests. By then, there were 13 confirmed cases of COVID-19, plus three deaths. Health experts warned of thousands more.

"This has not gone as smoothly as we would have liked," Dr. Nancy Messonnier,director of the CDC's National Center for Immunization and Respiratory Diseases, said during a Feb. 28 briefing.

Dr. Thomas Frieden, who previously served as a CDC director and New York City's health commissioner, was less circumspect.

"Something went wrong here, and that has to be investigated," Frieden said in an interview with USA TODAY.

He recommended an independent examination of the flawed CDC tests by an outside organization, such as the National Academy of Medicine.

He said the review also should examine delays with COVID-19 testing by hospital and commercial laboratories. Despite the test kit mistake, he stressed that "the CDC is still a great institution."

The agency did not respond to a request for comment.

Coronavirus tests fixed, but delays persist

On Feb. 26, the CDC notified the Association of Public Health Laboratories that it would remanufacture its testing kits to ensure that they were "effective and reliable." The CDC also provided instructions on how labs could continue using the initial test.

The health agency started shipping new tests the next day.

By then, the U.S. had 16 confirmed cases of COVID-19. Five days later, health officials would disclose the COVID-19 infection of an attorney in the New York City suburb of New Rochelle, which would become one of the nation's largest coronavirus hotspots.

The delay in getting tests to public health labs wasn't the only problem.

The CDC initially approved testing only for travelers who had coronavirus symptoms — a fever, dry cough and shortness of breath — and had recently visited China, where the pandemic started, or had been near someone else who had.

On Feb. 26, New York City Mayor Bill de Blasio called on the CDC to expand who could qualify for testing.

"Right now, it is too narrowly focused on travelers coming out of China," he said. "We think that has to be expanded to any traveler coming from a country that's seen a major surge in cases."

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New York Gov. Andrew Cuomo and others also questioned the scarcity of tests. Although President Donald Trump said tests were available, many ill people and their families said they'd had problems getting tested.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, offered a de facto apology during a House oversight committee hearing on March 13. It came after Rep. Debbie Wasserman Schultz, D-Fla., asked whether "there is no one specifically in charge that we can count on to make sure the people who need to be tested" actually get tested.

"The system — the system does not — is not really geared to what we need right now, what you are asking for. That is a failing," Fauci said.

New York officials go public with their pleas

As the disease continued to spread, New York officials stepped up their efforts to obtain test kits.

As early as Feb. 7, Cuomo said New York State's Department of Health was "working to implement the coronavirus testing," but needed to "complete the proper verification protocols before testing can begin."

More than three weeks later, Cuomo announced Feb. 29 that the FDA had approved the state Department of Health laboratory for COVID-19 testing.

But New York City was still in a holding pattern.

On March 6, Perea-Henze wrote the CDC for the third time. The agency had sent the city's lab two test kits, which according to a city health official represented approximately 2,000 tests.

That total would "not meet the needs of New York City, America's most populated city, with 8.6 million New Yorkers," Perea-Henze wrote. "The slow federal action on this matter has impeded our ability to beat back this epidemic."

By the time of Perea-Henze's third letter, the number of confirmed U.S. COVID-19 cases had jumped to 217, plus 14 deaths.

On March 7, Cuomo declared a state of emergency in New York. Officials were cracking down on price-gouging for hand sanitizers and household cleaning fluids.

As of Saturday, the number of confirmed cases in the U.S. neared 20,000, with at least 275 deaths.

New York City alone accounted for more than 5,100 cases and 29 deaths, making it "the epicenter of this crisis" in the U.S., de Blasio announced Friday evening.

In New York and across the country, many government officials have shifted from trying to contain COVID-19 to emergency efforts to slow transmission by closing schools and asking employees in non-essential fields to work from home.

The restrictions came as some hospitals struggled with shortages of safety masks, breathing ventilators and other health supplies.

On Friday, Cuomo ordered workers for all but essential businesses to remain at home starting Sunday night. That mirrored an order a day earlier by California Gov. Gavin Newsom.

"This is not life as usual. Accept it. Realize it. And deal with it," Cuomo said. "We are all in quarantine."

Contributing: Letitia Stein