By The Washington Post · Danielle Paquette · NATIONAL, WORLD
Decisions made at those early, pivotal moments determined the course of the pandemic. China, after early denial-fueled stumbles, improved its response to the virus by deploying a flurry of rapid-fire tests. South Korea, hit hard in early days, mounted a comeback steered by knowledge gained from an avalanche of roadside swabs. In recent weeks, Italy has led the globe in testing, producing results that show the highest caseload and death toll in the world.
And Germany cleared regulatory hurdles to allow biotech firms to make tests available on a scale that the country's government could not.
But the United States and Japan stumbled, experts say, by initially shutting out the private sector while proceeding sluggishly with public sector efforts, leaving too few tests to track the extent of the virus' spread. Now, some experts say, the window for testing as a measure to curb transmission could be closing in many places where the virus is widespread.
"Because we didn't have testing early on, it fatally flawed our covid response," said Lawrence Gostin, director of the World Health Organization Collaborating Center on National and Global Health Law at Georgetown University.
The World Health Organization has said that the gold standard for fighting an outbreak starts with testing.
"Test, test, test," WHO head Tedros Adhanom Ghebreyesus has implored: Test broadly, pick up cases, isolate patients, trace their close contacts and put those people into 14 days of quarantine.
"You cannot fight a fire blindfolded," he said Monday.
Many countries do not publicly report covid-19 testing data, and the World Health Organization does not track testing by country. According to an Oxford University-based outfit that aggregates available governmental data, South Korea, Italy, the United Arab Emirates, Russia, Germany and one province in China are among those that have done the most testing.
The United States had tested about 50,000 as of Friday, according to the CDC.
U.S. lawmakers have pledged to massively amplify testing in the coming days, but epidemiologists say the virus has blazed through American soil, following a troubling community-transmission trajectory similar to Italy's.
"The very honest truth is we have missed the opportunity to really prevent the worst outcomes," said Gostin, who is studying the pandemic in Washington. "And now we are at the very last tool in our tool shed, which is: Everybody hunker down at home."
Some are asking whether the time for widespread testing has passed in places where the virus is spreading rapidly. On Friday, the head of Finland's health security agency questioned the WHO's advice to test as many people as possible.
"We can't fully remove the disease from the world anymore," Mika Salminen of the Finnish Institute of Health and Welfare said in an interview with Helsingin Sanomat newspaper. "If someone claims that, they don't understand pandemics."
Two months ago, as cases climbed in Wuhan, the WHO published instructions from German scientists with the recipe for any nation to create tests.
The global health body didn't talk to the Centers for Disease Control and Prevention about supplying kits to the United States, WHO spokesperson Tarik Jasarevic said. The United States, like other wealthy countries, normally develops its own diagnostic tests, then private companies approved by the Food and Drug Administration produce the kits.
But manufacturing problems with the CDC's initial diagnostic test led to a six-week delay. In a statement announcing coronavirus response legislation, President Trump on Wednesday pledged to ensure that "coronavirus testing is accessible to every American."
While malfunctions bungled the CDC's testing rollout, the WHO supplied hundreds of kits to countries around the globe. European nations largely got a head start on testing, opting to source materials from the WHO and a mix of companies.
Unlike South Korea and China, however, they hadn't battled other viral outbreaks in recent years. The Asian countries already had close relationships with emergency-ready businesses.
South Korea, which logged its first case around the time the United States did, helped curb its steep transmission by testing 10,000 people per day, experts say.
"They were much more amped up and ready because of SARS and MERS," said Ashish Jha, director of the Harvard Global Health Institute. "They were more aware and attuned to these issues."
The number of confirmed cases in South Korea has steadily declined since peaking in late February, a trend officials there attributed to widespread testing that allowed for quicker quarantines and other actions to contain the virus.
Germany, too, has significantly ramped up testing. The country has the capacity to carry out 160,000 tests per week, according to the Robert Koch Institute, a government agency. That's up from 35,000 tests between March 2 and March 8. Germany had more than 19,000 confirmed cases and at least 67 deaths by Friday afternoon, according to a tally by Johns Hopkins University.
France, Italy and Spain focused their testing efforts on travelers from coronavirus hotspots and the severely ill. But symptoms manifested after passengers left airports. Younger, seemingly healthy people brought the illness to older, more vulnerable groups.
Belgium, which opted to make its own kits, has cited shortages as the reason behind testing delays.
"It is becoming more and more important to prioritize testing and no longer do large-scale testing," the Belgian government posted on its coronavirus website.
India made the same call - though for different reasons.
Telling everyone to come in for a swab "creates more fear and more paranoia," said Balram Bhargava, director general of the Indian Council of Medical Research.
Japanese authorities, meanwhile, put the country's National Institute of Infectious Diseases in charge of its diagnostics launch. Critics soon blasted red-tape delays. The country licensed the private sector to help with the job a month later.
The coronavirus pandemic has afflicted more than 250,000 people across the globe. At least 11,100 people have died, according to official counts Friday.
A raging spread has yet to grip African nations, which have recorded fewer than 750 cases in more than 30 countries.
Only two labs on the continent - in Senegal and South Africa - could test for the illness in early February. That number has since expanded to 45 with the support of the African CDC, the WHO and regional health bodies, who have urged nations to brace for the worst.
Chinese billionaire Jack Ma, co-founder of the e-commerce giant Alibaba, has vowed to donate 20,000 testing kits to each of the continent's 54 countries in partnership with the Ethiopian prime minister.
"Africa can be one step ahead of the coronavirus," Ma tweeted this week.
In Dakar, the Senegalese capital, researchers have sourced kits from a German firm until the nation's top virologists can develop their own 10-minute kit. (Manufacturing on that is expected to start as early as June.)
The West African nation, like many in the region, has shut down schools, closed places of worship and plans to seal off its airspace Friday. The military is setting up hospital tents in the countryside.
Still, anyone who shows up at the hospital with symptoms can get swabbed, said Amadou Sall, director of the WHO-partnered Pasteur Institute - "right away."