As states with confirmed cases of the coronavirus grew Wednesday to 14, public health experts in Michigan said the state's current capacity to test fewer than 140 individuals and quarantine 20 patients is inadequate to deal with a potential outbreak.

The Michigan Department of Health and Human Services is looking to a private vendor — and potentially to state hospitals and universities — to increase its testing capabilities since the federal Food and Drug Administration issued guidance Friday that allows companies and public institutions to develop and validate COVID-19 tests.

"It’s not nearly enough capacity, and I think that’s probably been the greatest weakness in our response from the United States — the small number of test kits that have been available to do diagnostics," said Kent County Health Department Director Adam London.

"I really think that there are many, many infected people that are not hospitalized and maybe have mild symptoms, or no symptoms, and we don’t know about them — we can’t know about them because there’s not enough test kits to test them," said London, referring to areas across the nation.

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"That’s why we’re seeing cases popping up sporadically throughout the country right now that have no apparent link to either travel or to a sick person themselves."

Michigan has tested eight patients for the coronavirus, and the results have been negative — including a case from Allegan County finished Wednesday.

But the state is short on locations to quarantine people should an outbreak occur, London said. And hospitals would be stressed to accommodate an influx of people with a serious upper respiratory illness at the height of flu season, he said.

"Nationally, we should probably have a better strategy for testing, for quarantine isolation and for ramping up of health care in the midst of a crisis," London said. "We’ve lost touch with the reality that over the course of history it’s been disease that, more than anything else, has been the leading cause of mortality in the nation."

The state received one testing kit on Feb. 8 from the federal Centers for Disease Control and Prevention. Each kit contains enough supplies to test up to 140 individuals. States can order additional kits, but the CDC has been limiting orders to no more than one kit at a time, said state health department spokeswoman Lynn Sutfin.

Michigan ordered an additional kit. But as outrage mounted nationally this week over the lack of testing kits, the CDC informed Michigan officials at 1 p.m. Wednesday that two kits will be sent. The additional kits will increase Michigan's testing capacity to 420 people, though it was unclear Wednesday when the kits will arrive.

"I think that everyone in public health, whether it’s federal, state or local level, is trying to learn as much as they can about the virus and ramp up their preparedness as quickly as possible," Michigan Chief Medical Executive Dr. Joneigh Khaldun told The Detroit News on Wednesday.

"Just historically, going back decades, public health has not been funded in the way that it should be, to be able to appropriately respond to these types of threats.

"... I think this response here is an example of what happens when you don’t invest public health appropriately."

Infectious disease doctors at the Detroit Medical Center are “on high alert,” said Dr. Teena Chopra, the DMC's corporate medical director for infection prevention and hospital epidemiology, and a professor of infectious diseases at Wayne State University.

Chopra said she treated two patients in Detroit with possible coronavirus infections since Tuesday but decided they didn’t need to be tested for COVID-19.

“We performed the required tests — flu and such — on them, but even flu was negative,” Chopra said. “We called the local health department, and (they) advised us against performing the coronavirus test because the patients didn’t have fevers.

“We have a very stringent process that we put together for screening patients, and we are keeping our criteria in accordance with CDC. We narrowed these patients down after careful monitoring, we followed all of the protocol using the appropriate precautions for our health care workers.”

Chopra added: “Things are moving as I speak. Things are changing a lot — even CDC definitions are changing, so accordingly we will also change our algorithms.”

Expanding testing capacity

The U.S. House of Representatives approved Wednesday $8.3 billion to fund a coordinated nationwide response to the coronavirus. The measure now goes to the U.S. Senate.

More than $3 billion would be for research and development of vaccines, treatments and diagnostic tools, such as COVID-19 testing kits.

The bipartisan coronavirus funding package includes $14.5 million for Michigan for public health response efforts, according to the offices of Michigan Democratic U.S. Sens. Debbie Stabenow and Gary Peters. Michigan municipalities could apply for a slice of $350 million targeted at “hotspots” funding in the event of an outbreak, the senators said.

"This bipartisan bill will include much-needed funding for medical equipment, vaccine development, staffing and more," Stabenow said in a statement.

Michigan Senate Majority Leader Mike Shirkey, R-Clarklake, didn’t rule out a state appropriation related to the coronavirus in Michigan when asked Wednesday.

“I like where we’re at on that issue right now, both in our state and in our nation,” said Shirkey, adding the virus was “dangerous” but good hygiene is “the secret.”

In Washington state, cases of the virus grew to 28 since the first infection was confirmed last week in a King County nursing home. New cases were reported Wednesday in California and New York, and a first case was reported in North Carolina. Eleven deaths were reported by Wednesday evening — 10 in Washington and one in California.

The World Health Organization reported Wednesday a death rate of 3.4% for people infected with COVID-19, more than three times higher than the death rate for flu, which kills about 1% of people infected.

As community-acquired cases have emerged among people with no known source of exposure, the CDC expanded testing Saturday to anyone with severe upper respiratory symptoms with no known cause. Previously states were allowed to test only those people who had recently traveled to China or been in direct contact with an infected person.

“They’ve given the states more flexibility, but we don’t have enough test kits," said London, the Kent County health official. "The CDC and the state health department are the only ones who have test kits.”

The state also has ordered a COVID-19 testing kit from Coralville, Iowa-based Integrated DNA Technologies, though the company's kit has not been validated under Food and Drug Administration protocols. Sutfin couldn't say how many individuals could be tested with the kit or when it will be delivered to the state laboratory in Lansing.

State officials are trying to determine if the private firm's kit "will produce accurate results," Sutfin said. If it does, the state will seek federal approval for its use, she said.

"This will expand testing ability in the state lab as well as provide an option for private labs and hospitals to obtain kits that they will be able to use for testing," Sutfin said.

Michigan health officials also have been in talks with potential hospitals and universities that might be able to produce or process tests under the relaxed FDA guidelines.

"The laboratory stands ready to provide technical assistance to clinical and research partners," Sutfin said.

"This would allow Michigan hospitals and universities the ability to develop and validate their own tests and it will quite possibly happen here in our state. Institutions could have tests ready for use in weeks once they have the materials/testing elements. If there are issues in getting the materials/testing elements, then it could take longer."

Quarantine strategy

County health departments across Michigan have monitored 379 people since Jan. 31 who were asked to self-quarantine for 14 days due to recent travel to mainland China. There were 63 still in isolation as of Tuesday. The rest were released from quarantine after 14 days without symptoms.

In Washington state, King County moved hastily in the past week to identify locations to quarantine people who cannot be isolated in their own homes. In a Monday press conference, officials there said the county had purchased a motel, repurposed housing recently created for the homeless and ordered the quick construction of prefabricated housing units in anticipation of a need for quarantine facilities.

In Michigan, state Department of Military Affairs Gen. Paul Rogers said Friday the National Guard's Fort Custer Training Center in Battle Creek has been designated to receive up to 20 people for quarantine should an outbreak occur.

But it is largely the responsibility of each individual county to identify locations for quarantine in their communities.

Kent County's London said he doesn't expect Michigan to need vast amounts of quarantine space, and finding even a small number of units can be challenging.

"Here in West Michigan, for example, we don’t have a lot of hotels that are vacant," he said. "We have a housing shortage and a housing affordability crisis.

"... So right now, we’re really counting on an isolation or quarantine at the home."

kbouffard@detroitnews.com

Twitter: @kbouffard

Staff Writer Craig Mauger contributed.