What We Know About Coronavirus Tests, Treatment and Vaccines

How the U.S. is faring in the public-health race to safely reopen schools, businesses and daily life

Leading medical experts say the U.S. needs levels of testing that are roughly four times what exist now.

Photo: Maddie Meyer/Getty Images

香蕉视频苹果下载The U.S. has performed millions of coronavirus tests, but returning the nation to its normal life will require far more.

Some of America’s most prominent public-health doctors say the country must conduct in the range of four million tests a week to capture most cases and prevent the disease from spreading as the public returns to work and schools. That is more than twice the amount the U.S. is doing weekly at this point.

On top of that, the doctors say, the nation needs about 100,000 people to undertake “contact tracing”—getting in touch with those who have had contact with infected people and may now be infected themselves.

Yet, some states that lack a robust testing program are going to allow certain businesses to reopen soon. Georgia will become a test case for whether infections rise as states relax measures to constrain the outbreak, as the state has permitted some businesses to reopen 香蕉视频苹果下载as of April 24, before its testing program is as comprehensive as some public health doctors recommend.

We are updating this guide regularly with what we learn about testing and treatments across the U.S.

How much testing would it take for the country to safely lift restrictions?

• Prominent public-health doctors say far more testing is needed—and an insufficient supply of swabs, testing chemicals and temporary sites to conduct tests are among the seemingly simple elements that have become limiting factors. “It’s insane that we have the country shut down because of swabs,” said Ashish Jha, a physician and director of the Harvard Global Health Institute.

• He and other leading medical experts say the U.S. needs levels of testing that are nearly three times what exists now. Also called for, they said, is a greatly enhanced ability to do contact tracing. For every positive case, tracing finds about 10 contacts, who then are tested. Those who test positive would have their own contacts traced.

• That widespread testing would need to show declining cases for at least 14 days, and ideally “very, very low numbers,” to know that it is safe to ease up current social-distancing rules, said Dr. Jha and others.

• Rather than declining, new cases and deaths are increasing across the country, raising further questions about moves to ease restrictions.

• Another benchmark for safely ending shelter-at-home rules, laid out by the World Health Organization, is that the number of positive cases should account for no more than 10% of total tests. Dr. Jha recommends a target even lower than 10%. In the U.S. at the moment, positive cases account for about 19% of tests.

• Well into the future and even after the pandemic subsides, the U.S. should have a long-term ability to perform at least 750,000 tests weekly, former Food and Drug Administration commissioners Mark McClellan and Scott Gottlieb wrote with colleagues on April 7. And each U.S. region, they wrote, should continue to have beefed up ability to watch for and respond to outbreaks.

Beyond robust testing, what is needed to reopen businesses and end shelter-at-home rules?

香蕉视频苹果下载• For people to go back to an office or other workplace, everyone in that office should be tested and found negative, some public-health doctors say. Because people take trains and buses to work, transit systems should test at least a sample of riders, doctors say. And maybe before people get on an airplane, they should show evidence of a negative test with a kind of “passport” to certify they are healthy.

Can anyone who wants a test get one?

• The process varies by state. The Centers for Disease Control and Prevention says doctors and health departments may decide whether a patient should be tested, and it recommends that people who want a test call their doctor.

• Local and state governments have varying standards about who can be tested. Some say a person must be showing symptoms and have a note from a doctor. Many people are finding it hard to find a testing site. Websites such as and, have lists of some testing sites around the country. A possible boon to more testing: LabCorp.香蕉视频苹果下载 on April 21 won FDA clearance for a nasal swab test that can be done at home and mailed in. But it may be weeks before the general public can use it.

• The biggest U.S. drugstore chains have begun offering free testing to people who meet federal guidelines for screening. CVS Health Corp., Walgreens Boots Alliance Inc., and Rite香蕉视频苹果下载 Aid Corp. combined have about three dozen drive-through testing locations in which people self-administer tests from their cars, with help from a pharmacist or medical practitioner. Rite Aid has the most locations, while CVS and Walgreens use tests that produce results in minutes. Each chain has said it is working to expand into more locations.

Where in the country are tests being done?

• Ninety-five public-health labs around the U.S. are performing Covid-19 diagnostic tests, according to the CDC. The labs are in all 50 states, plus the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands.

• Academic hospitals across the country have developed their own distinct methods. These often can be excellent options.

• Some companies are seeking to get their own test kits for their workers. Amazon.com Inc. has started building capacity to test all employees, including those who display no symptoms.

How do tests work?

• Current tests for live infections use nasal swabs to collect samples. RNA is extracted, isolated and processed through a device called a thermocycler that amplifies the amount of genetic material to identify it.

What about antibody tests—how much can they help?

香蕉视频苹果下载• At Partners HealthCare, which includes Massachusetts General Hospital, Chief Academic Officer Ravi Thadhani said staffers were working on blood tests for hospital employees and their families. The idea would be to identify workers who have been infected and have developed sufficient antibodies against the coronavirus to be protected.

• Dr. Thadhani said more than 250 antibody tests are on the U.S. market, and “we have no idea” how accurate they are. It is vital that such tests be precise, and that they show a person has developed antibodies against the current virus and not some earlier coronavirus.

• Even with accurate antibody tests, Dr. Thadhani said, researchers would need to show that a person’s antibody levels are high enough to confer immunity against getting the disease.

香蕉视频苹果下载• While antibody testing could be useful in medical settings, Dr. Jha, of Harvard Global Health Institute, said that unless it turns out roughly 40% or more of the U.S. population has already been infected and built up immunity—something most doctors don’t believe has occurred—“antibody testing is not a central feature of letting businesses get back to work.”

How do testing results match up with the number of actual infections in the U.S.?

• As of Friday morning there were 1,070,032 confirmed cases and 63,019 deaths in the U.S., according to data available from Johns Hopkins University.

• The , a volunteer effort to collect data from public-health authorities and other sources, reported more than 6.2 million completed tests in the U.S. as of Friday.

As testing becomes one of the most hotly debated topics during the coronavirus crisis, WSJ’s Gerald F. Seib explores what role pharmacists will play in diagnosing patients. Photo: Adam Glanzman/Bloomberg

• The number of cases confirmed by testing is substantially lower than the number of infections, public-health officials say. Along with a shortage of tests for those who want one, many people who are infected might not be sick enough to realize it.

香蕉视频苹果下载• The number of tests that can be done is also limited by a lack of mundane supplies, such as swabs and reagents, as well as a shortage of trained people and protective gear at many testing sites, say the nation’s nearly 400 academic medical centers. “We hear a constant cry to remedy the various shortages that leave individuals untested,” said David Skorton, president of the Association of American Medical Colleges, in an April 13 letter to the Trump administration’s coronavirus task force.

How long does it take to get test results?

• As with many medical tests, the wait for results 香蕉视频苹果下载can be as long as two or three weeks, depending on where testing is done. Some processing, however, is as short as several hours or even minutes.

What snags has the U.S. hit in expanding testing?

• CDC officials botched an initial test kit developed in an agency lab and wound up retracting many tests. They resisted calls from state officials and medical providers to broaden testing, and health officials failed to coordinate with outside companies to ensure that needed test-kit supplies, such as nasal swabs and chemical reagents, would be available, according to suppliers and health officials.

• Early on, the CDC restricted testing to people with symptoms who had recently traveled to China, where the virus first emerged, or who had been exposed to a known case. That narrow effort was “a failing,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

香蕉视频苹果下载• The FDA relaxed testing regulations on Feb. 29. Under its current policy, testing companies and academic hospital labs with ability to perform complex tests can do so with only retroactive review by the FDA of data verifying accuracy.

Are tests accurate?

• Health experts say they now believe nearly one in three patients who are infected are nevertheless getting a negative test result. They caution that only limited data are available, and their estimates are based on their own experience in the absence of hard science.

• That picture is troubling, many doctors say, as it casts doubt on the reliability of a wave of new tests developed by manufacturers, lab companies and the CDC. Most of these are operating with minimal regulatory oversight and with few robust studies amid the call for wider testing.

香蕉视频苹果下载• The FDA said it has placed a priority on getting new tests to the public and that it is unable now to disclose the rate of test inaccuracies. Two members of Congress, Reps. Lloyd Doggett (D., Texas) and Rosa DeLauro (D., Conn.) wrote April 9 to FDA Commissioner Stephen Hahn asking for labs’ data on the precision of new tests.

What treatments are in the works?

• Possible treatments for Covid-19, the respiratory disease caused by the coronavirus, are all experimental or have only emergency-use approval, as opposed to full approval from the FDA.

• The drug with the most evidence behind it now is called remdesivir, a drug from Gilead Sciences Inc. The National Institutes of Health says in a randomized, controlled trial of 1,063 patients, the drug lowered the median time to recovery to 11 days compared with 15 days on placebo, according to preliminary results. The company’s website has more information about .

• Another possible treatment is “convalescent plasma,” which uses the colorless fluid in blood taken from recovered Covid-19 patients that contains antibodies to the virus. This approach worked in some respiratory viruses before, though the plasma from one patient can treat only one or two others. The approach was FDA-endorsed on an “emergency use” basis, meaning it can be used during the pandemic but not necessarily beyond. You can learn more about how to seek treatment and to donate plasma 香蕉视频苹果下载from the National Covid-19 , a collaboration of doctors and scientists in 17 states.

• On the horizon are possible novel treatments. Drugmakers including Vir Biotechnology Inc., AbCellera Biologics Inc. and Regeneron Pharmaceuticals Inc. are pursuing therapies. More than 120 drug and vaccine research programs aimed at the coronavirus are under way. Ten agents are being studied in some 200 clinical trials, and hundreds more trials are planned, many spearheaded by universities and government research agencies.

香蕉视频苹果下载• The NIH said it was forming a public-private partnership with drug companies, the FDA and the European Medicines Authority, to prioritize which drugs and vaccines are most promising for further research. The NIH also announced a $1.5 billion effort to find faster and more accurate diagnostic tests for the virus, with the goal that such tests would be available by late summer 2020.

What about hydroxychloroquine and chloroquine and other drugs touted by some politicians?

• These two are years-old drugs approved for malaria, with limited evidence of their effectiveness against Covid-19 from small studies in France and China. The FDA is overseeing clinical trials. The agency also says the drugs are being distributed from the Strategic National Stockpile for doctors to prescribe when appropriate and a clinical trial isn’t available. Because the drugs are also needed for other conditions, including lupus, some states are limiting prescriptions or demanding proof of a Covid-19 diagnosis.

• Various studies of the drugs are taking place, including an effort by Intermountain Healthcare and the University of Utah in Salt Lake City. They and are seeking to enroll 2,300 patients. Also, an NIH-backed study of hydroxychloroquine in 500 patients with coronavirus has begun at Vanderbilt University Medical Center and other hospitals.

• A recent development in France, while short of a randomized study, illustrates why many medical experts caution against the wide use of drugs unproven for coronavirus treatment. Government monitoring authorities there reported 54 cases of patients with Covid-19 who developed serious heart problems while taking hydroxychloroquine. Seven had cardiac arrest and four died.

香蕉视频苹果下载• The FDA warned patients and doctors that the use of hydroxychloroquine and chloroquine can be associated with dangerous heart-rhythm problems, such as ventricular tachycardia. The agency said that randomized, controlled studies of the drugs continue, but the development illustrates why such carefully designed trials are important in the first place.

• Another unproven drug is being touted, with limited evidence, by Japan’s Prime Minister Shinzo Abe, who calls favipiravir a silver bullet and has discussed it with President Trump.

How far away is a vaccine?

• There is considerable hope that a vaccine could be developed as soon as next year, or perhaps even this fall. One potential vaccine has come from work at Moderna Inc., and the National Institute of Allergy and Infectious Diseases has already started human testing among 45 adults in the Seattle area.

• Other companies, including Johnson & Johnson, Sanofi SA and Inovio Pharmaceuticals Inc., are also seeking to develop Covid-19 vaccines. J&J said recently that it could start human trials as soon as this fall.

Have you been tested? Tell us about it.

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Write to Thomas M. Burton at tom.burton@wsj.com

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