“That escalated quickly!” is a common trope used in popular culture to describe when a situation gets out of hand before you’ve even had a chance to think about it. We don’t often use this trope in medicine, but I can think of nothing better to describe what has been going on in the U.S. with the coronavirus outbreak.

I am a physician scientist who practices infectious disease medicine and runs a research laboratory that specializes in viruses. I spend much of my time directing a clinical microbiology laboratory for a large academic medical center. If you’ve ever had a doctor tell you that they are going to test you for a virus, it’s teams like mine that develop and run that test. 

When I first heard about the coronavirus outbreak in China, I had no idea I would soon be on the front lines of dealing with this outbreak.

Why testing is at the heart of the problem

For the most part, public health officials don’t know who in the U.S. has it because there isn’t a method to test most of the population for it. If you don’t know who has a disease, it’s impossible to predict its spread, how many people will get it, or how many people may die from it. Testing in the U.S. must be expanded, which a number of companies are working on, to reveal the scope of the problem.

How the US lagged behind

Earlier this year, the Centers for Disease Control and Prevention developed a rapid test for SARS-CoV-2. This test is designed to amplify and detect the genetic material in the virus – its RNA (ribonucleic acid) – from your body. It targets certain conserved RNA sequences in the virus that are different from those found in other coronaviruses. The problem is that for a population of 331 million, a single testing center wasn’t nearly enough. The CDC enabled state public health labs to use their test, but this still hasn’t been enough to meet population needs.