With testing still limited, coronavirus remains a ‘moving target’

By Kara Manke | March 17 2020

A worker from a Servpro disaster recovery team wearing a protective suit and respirator peers out a window as he waits to exit the Life Care Center in Kirkland, Wash. for a break cleaning the facility. The nursing home is the center of the coronavirus outbreak in Washington state. (AP photo by Ted S. Warren)

When Berkeley News first spoke to medical doctor and infectious disease specialist John Swartzberg in early February, the United States was home to only a handful of cases of the new coronavirus infection COVID-19, and many were optimistic that travel restrictions and quarantines on affected individuals could quickly contain the virus.

A little more than a month later, the number of confirmed COVID-19 cases in the United States now tops 3,400, and with testing still limited in many regions, the actual number of people carrying the virus could be much higher. Efforts to prevent transmission of the highly contagious disease have upended lives across the nation, with schools shutting down, bars and restaurants closing, large events cancelled and many required to work from home or losing their jobs altogether. And, at midnight on Tuesday, March 17, residents of six Bay Area counties were ordered to shelter in place, limiting any non-essential travel outside the home.

In a new interview, Swartzberg underscores the fact that  in part due to poor leadership by the executive branch of our government, the Centers for Disease Control (CDC) and the Food and Drug Administration (FDA), which failed to deliver adequate testing on time  we still don’t have enough data on the virus to really know how widespread the disease will ultimately become, or how long these drastic social distancing measures will last. But, he says, preventing transmission through hygiene and limited social contact remain crucial to avoid overloading our hospital system.

 Faculty Headshot for John Swartzberg

John Swartzberg is clinical professor emeritus of infectious diseases and vaccinology in the the UC Berkeley-UCSF Joint Medical Program.

Berkeley News: What is currently known about the disease progression of the virus? What symptoms should people watch out for?


If you’ve got symptoms consistent with either influenza, or COVID-19, or another respiratory pathogen, that’s a reason to call your doctor’s office and ask his or her advice about what you should do. They may want to do a rapid influenza test, because there’s a drug to treat influenza. If the influenza test is negative, that may prompt the test for COVID-19.

How do we make sense of the reports about the mortality rate of COVID-19, which seem to range from 1% to 3.4% and even as high as 6% in Lombardy, Italy?


On the other hand, if you look at how you calculate the fatality rate, you’re looking at the number of people who died at a particular time over the number of people diagnosed with the disease at that same time. But the number of people who died doesn’t include people who are sick, who in the next week or two might die. If that’s the case, then the case fatality rate may actually be higher that what we measured.

Better testing will give us a better handle on it, but for now, it’s a moving target. All of that said, here in the United States, the Johns Hopkins site, for example, suggests that the case fatality rate is about 3.4%

Angela Merkel said that up to 70% of Germans will eventually contract COVID-19. In a panel last Tuesday, UCSF doctors said the same thing: We can expect 50% to 70% of Americans to get COVID-19 this year and up to 1.6 million to die from it. Are these worst-case scenarios or the likely scenario?


Why has been so hard to get the number of tests that we need? Is it particularly hard test to develop?

The technology to do this testing has been around for 35 years. It’s very easy to do, and all laboratories can do it. It’s done many times a day here on our campus. So, it’s not the technology that was the limiting feature. The blame goes squarely on the CDC and the FDA, and certainly to the executive branch of our government.

I’ve not been privy to any of the discussions at the CDC and the FDA. That said, just like the public has been getting very mixed messages from the current administration, the FDA and the CDC have also received mixed messages that have created a great deal of confusion, in terms of how to conduct things.

Very quickly, the Chinese researchers identified the entire viral genome and made it available worldwide. The Germans developed a test based upon the data from China, they gave it to the WHO, the WHO disseminated it to all the countries and the United States said, “No, we’re going to develop our own.” Why? I have no idea. I think it’s an element of bureaucracy, and it’s an element of hubris.


I see a lot of people stressing the importance of “flattening the curve,” or slowing disease transmission, through social distancing and hygiene measures. Could you explain a little about what this means and why it is important?


我们必须设法限制我们的卫生资源的利用率,使他们将在那里为大家谁生病。你是怎样做的?而不必在情况下,大穗,然后下降的,我们尝试,正如你说的,扁平化的曲线。我们尽量减少病毒的传播,因此,即使受感染相同数量的人最终结束了,而不是在时间的六个或八个星期内发生的一切,它在3至6时 - 月,甚至12个月的时间。如果我们能够扁平化这条曲线,这将意味着,我们应该有足够的病床,我们应该有足够的人呼吸机。但如果我们不压扁这条曲线,我们会在同一个地方,意大利是现在,使得谁在呼吸机去谁死的选择。

Many policymakers and public health experts are urging social distancing through working remotely, canceling large events, and now, in the Bay Area, issuing a shelter-in-place order that limits all non-essential travel outside the home. Do you know how long these social distancing measures are likely to last?


Based on your experience and scientific understanding, what do you think the next few months are going to look like? What should we expect, as individuals and as a larger society?


This article originally appeared on the Berkeley News Website.