According to data compiled by John Hopkins University, the United States currently has 761 confirmed cases of COVID-19, with Washington (167), California (143), and New York (148) reporting the highest numbers.

This national case load is conspicuously low compared to other global hotspots like Italy (9,172) and South Korea (7,513), along with lesser outbreaks in Germany (1,281), France (1,412), and Spain (1,646).

Why are the official US numbers so low? Simple: there aren’t enough tests being carried out. So if there is in fact a “bomb” lying in wait for hospitals and healthcare workers, it’s one that is currently counting down outside of the notice of most federal and state authorities.

Background

By some estimates, only 4,987 tests have been carried out by federal and state public health authorities in the United States thus far. By contrast, Canada had carried out some 3,000 tests by early March (the USA, which has a population over ten times higher, had carried out just 500 at the time). Israel has carried out 2,000 tests through March 8, and the United Kingdom has conducted 20,000 tests over the same period. South Korea – home to one of the largest outbreaks in the world – is believed to have a capacity for 10,000 tests a day (it has already tested 180,000 people).

How is it that the United States is lagging so far behind?

Some has to do with apparent deficiencies in contingency/crisis planning. A country like Canada, which benefits from lessons learned during the SARS outbreak (though not always), was routing early COVID-19 testing through provincial labs in order to get a quicker result. Doctors were also granted clinical discretion to test patients who didn’t fit the presumed profile; for example, testing a recent traveler from Iran before the outbreak there had become publicized.

The health system in Ontario, Canada’s most populous province, had access to three government labs and a provincial lab that itself could handle 1,000 samples a day from the earliest stages of the outbreak. Washington state on the other hand, which has roughly half the population of Ontario, up until very recently only had a capacity to test about 100 patients a day.