I tried to explain many, many times that NA extraction is THE bottleneck. It is laborious and now this! The test kits that have primers and probes can be produced in mass quantities relatively quickly using readily available reagents. The extraction reagents are likely proprietary (Qiagen et al) so can’t be easily copied or reverse-engineered (patent infringement aside) and looks like they are becoming scarse. Great. Where are the fully automated tests like Genexpert?
Just over 80,000 people in all of China have gotten Coronavirus.
Wuhan, the epicenter, is a city of 11,000,000.
So, even if all those cases were in Wuhan, which is far from the reality, it would still be less than 1% having gotten it.
And as others have questioned many, many times - other countries seem to have figured out how to design, produce and deploy thousands of tests, so why can’t we? If the US is incapable of this then it’s time to swallow pride and talk to the countries who have working tests about seeing how we get some of the working tests.
We don’t know what problems those countries are experiencing. Are they batching the tests? Have they used up the extraction reagents (same suppliers sell them worldwide) depleting the stocks before us? Are they using suboptimal protocols? We don’t know.
So let’s ask.
Seriously, we should be asking. The lack of test situation in the US is beyond embarrassing and shows an incompetence at multiple levels. The answer isn’t to keep explaining why this is really, really hard. The answer is to call around and find out what’s working then replicate or buy it.
@MYOS1634 yes. See 25th amendment. It’s been used before when presidents are (for example) undergoing surgery.
BB: since you seem to be extremely knowledgeable about organic chem, does what we’re testing for (3 targets on the N gene) make a difference? Quality, speed, accuracy? Any thoughts?
So far, South Korea has 7,300 confirmed cases out of 196k tested. (50 have died).
https://www.cnn.com/2020/03/09/asia/south-korea-coronavirus-intl-hnk/index.html
Thanks. I thought that amendment was just in case the president dies or resigns. 
However there’s nothing about asking him to self quarantine so as to not infect the VP so let us hope we don’t have a problem there.
A depressing article in the Boston Globe tonight about the Biogen conference. The testing could not have been handled worse. I fear for us after reading this article.
https://www.bostonglobe.com/2020/03/11/nation/how-biogen-leadership-conference-boston-spread-coronavirus/?s_campaign=breakingnews:newsletter
I wish this wasn’t paywalled. 
You know what the big joke is? You can come in on a flight from a hotspot country and no questions, no fever check, no instructions on self-quarantine, nada, zip, zilch.
Thanks for the link.
There was a time when one just developed these reagents in lab using shared, established protocols, and ensuring that one obtained reproducible results with standards to assess sensitivity and negative controls to ensure there was no contamination. RNA extraction isn’t complicated.
Nonetheless, RNA extraction kits from Qiagen, Roche, Promega, and others were a boon to researchers because the companies would do the quality control, enhanced by consistent production procedures under conditions that minimized contamination (not always successfully though). And labs began to depend on them. Maybe CDC should have anticipated this. Certainly a failure of imagination. Perhaps not quite as bad as their botched assay development and roll out.
The article is quite clear that worldwide demand has depleted Qiagen stocks. I’m amazed that I’m reading this here and haven’t gotten an email through work. Did Redfield alert other agencies before testifying? There are hundreds if not thousands of labs in the US that usually have unopened, unexpired Qiagen RNA extraction kits (for use with patient samples) - for HCV work, for HIV work, etc. I bet the in lab capacity is well over 100k. Maybe CDC can highlight where these shortages are so we can share with colleagues. Yeah, and before posting, after seeing this (very useful) article share, I sent a few emails to folks in the government that might know if anything is being done/organized. Next contacting folks in Seattle to see what they need.
Panama reports first coronavirus death - 1st and a total of 8 cases reported in the past day.
The patient that died was a 64-year-old male who had also suffered from diabetic complications and bacterial pneumonia.
UK’s junior health minister has contracted coronavirus
From CNN
Nadine Dorries, the UK’s junior health minister, has tested positive for coronavirus, UK Department of Health told CNN on Tuesday.
Dorries, who is an MP and health minister for patient safety and suicide prevention, is now in self-isolation and “the usual contract tracing has begun,” a spokesperson for the health ministry told CNN.
Democratic congressman will self-quarantine after contact with coronavirus patient
Rep. Don Beyer will self-quarantine after having dinner with someone who later tested positive for COVID-19.
The Virginia Democrat said he was contacted by the Virginia Department of Health.
He said in the 10 days since the interaction neither he nor his wife, who was also at the dinner, have had any symptoms.
Beyer has been on Capitol Hill this week and in meetings with members.
“My office will close for public business and I will not attend votes or hearings until Monday, when medical advisers say I should be clear to return,” Beyer said in a statement. (CNN)
Wasn’t Qiagen just acquired THIS WEEK by Thermo Fisher Scientific (A US based company)? Was the shortage hidden for some reason? It’s baffling to me that this could happen.
Pence says task force discussed recommending additional travel advisories
From CNN
Vice President Mike Pence said Tuesday that the White House coronavirus task force thoroughly discussed the potential for recommending additional travel advisories.
“I will tell you, we had a very thorough discussion today of the prospect of recommending to the President additional travel advisories,” Pence said in the White House press briefing room. “We’re going to be bringing those recommendations forward in the time and manner that we as the White House coronavirus task force determine are appropriate. It’s literally a day to day consideration,” Pence added.
South Dakota reports one coronavirus death
From CNN
South Dakota Gov. Kristi Noem announced that five people in the state have coronavirus and one of the infected people has died.
The person who died today was a man in his 60s, who had underlying medical conditions that complicated the situation, according Kim Malsam-Rysdon, South Dakota Secretary of Health.
The other four cases are not in the hospital at this time, but are at home recovering, Malsam-Rysdon said. According to Malsam-Rysdon, these cases include two men in their 40s, one man in his 50s, and one woman in her 30s.
TURKEY - 1st confirmed case - patient came through Europe.
Top US health official: Americans “can’t be doing the kinds of things we were doing a few months ago”
From CNN
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, provided an update — and a warning — on the novel coronavirus at the White House Tuesday.
As of this morning, he said, there are 712 confirmed cases in the US with 27 deaths.
“By this evening, that’s going to be up. The question is, what are we going to do about that?” he said.
Fauci said there are a number of things that can be done to “interfere with the natural flow” of an outbreak such that it infects less people, leading to less deaths.
“We would like the country to realize that as a nation, we can’t be doing the kinds of things we were doing a few months ago. It doesn’t matter if you’re in a state that has no cases or one case,” Fauci said, referring Americans to the website coronavirus.gov for precautionary methods for the workplace, home, and commercial establishments.
“If and when the infections will come — and they will come, sorry to say, sad to say — when you’re dealing with an infectious disease… we want to be where the infection is going to be, as well as where it is,” Fauci said.
Everyone should be taking those precautions, he said, “whether you live in the zone that has community spread or not.”
“Everybody should say, ‘all hands on deck,’” he said.
Americans who live in places with community spread, according Fauci, should ratchet up those mitigations. That includes the states of Washington, California, New York, and Florida.
The US has now identified 975 coronavirus patients
Source: CNN
There are at least 975 cases of novel coronavirus cases in the United States as of Tuesday evening, according to the state and local health agencies, governments and the US Centers for Disease Control and Prevention (CDC). Thirty-one people have died.
According to the CDC, there are 49 cases from citizens who were repatriated from abroad – three from Wuhan, the pandemic’s epicenter, and 46 from the Diamond Princess cruise ship in Japan.
Twenty-one cases have also been identified in connection with another cruise ship, the Grand Princess, which arrived in port in Oakland, California on Monday.
According to CNN Health’s tally of US cases that are detected and tested in the United States through US public health systems, there are 905 cases in 37 states and the District of Columbia, bringing the total number of coronavirus cases to 975. 30 people have died from the virus.
This includes presumptive positive cases that tested positive in a public health lab and are pending confirmation from the CDC, and confirmed cases that have received positive results from the CDC.
Here’s the state-by-state breakdown, as of Monday night Eastern Time:
Arizona: 6 cases
California: 116 cases, 3 deaths
Colorado: 17 cases
Connecticut: 2 cases
District of Columbia: 4 cases
Florida: 15 cases, 2 deaths
Georgia: 17 cases
Hawaii: 2 cases
Illinois: 19 cases
Indiana: 6 cases
Iowa: 13 cases
Kansas: 2 cases
Kentucky: 8 cases
Louisiana: 3 case
Maryland: 9 cases
Massachusetts: 92 cases
Minnesota: 3 cases
Missouri: 1 case
Nebraska: 3 cases
Nevada: 4 cases
New Hampshire: 5 cases
New Jersey: 15 cases, 1 death
New York: 173 cases
North Carolina: 7 cases
Ohio: 3 cases
Oklahoma: 2 cases
Oregon: 15 cases
Pennsylvania: 11 cases
Rhode Island: 5 cases
South Carolina: 9 cases
South Dakota: 5 cases, 1 death
Tennessee: 7 cases
Texas: 19 cases
Utah: 2 cases
Vermont: 1 case
Virginia: 8 cases
Washington state: 273 cases, 24 deaths
Wisconsin: 3 cases
@BunsenBurner
And anyone else who might know.
What is the difference between a rapid test and a regular lab test? I know for flu it just detects most general flu viruses and then it’s sent in for additional screening. Same, I think?, for strep.
What would it take to get a rapid test for this?
A new patient was taken back when I wouldn’t shake his hand today. I told him we have a coronavirus policy to not shake hands. He asked,“So that’s for real”… Yes Johnny, it’s not fake news… Lol. ?
Uh oh. Michigan just announced its first two cases (Wayne county and Oakland County). The governor is preparing to go on-air now.