Boasting about his administration's response to the coronavirus crisis — and arguing the outbreak would soon be under control — President Donald Trump claimed that recent American efforts to test widely for COVID-19 surpass those of other countries.
“We’ve done more tests in eight days than South Korea has done in eight weeks,” Trump said during a March 24 virtual town hall hosted by Fox News, reiterating a statement made just moments before by Dr. Deborah Birx, the head of the White House coronavirus response. The statement was repeated during the White House briefing that evening.
Trump doubled down the next day, tweeting that "over an eight day span, the United States now does more testing than what South Korea (which has been a very successful tester) does over an eight week span."
Why the comparison with South Korea? South Korea has been heralded globally for its swift response to the pandemic, which appears to have slowed its rate of new infections. Meanwhile, a national shortage of tests has hamstrung American efforts, resulting in many people at risk being forced to delay testing until they are seriously ill.
With that context, we were curious. Is the president's claim accurate? Has American testing been as robust as his statement indicates?
We contacted the White House and Centers for Disease Control and Prevention but never heard back. But the numbers suggest his picture is inaccurate and, more important, missing crucial context to understanding the battle against COVID-19.
The raw numbers
South Korea publishes a daily report of how many tests it has performed. As of Tuesday, 348,582 people had been tested, and testing began in early February. About 9,000 of those people were confirmed to have the virus. (The 345,582 figure includes tests that were run but hadn't yet yielded results.)
In the United States, it's harder to tell. The CDC doesn't put out updated, aggregated counts of tests performed in public and private labs — which is important to note. Since the start of March, a large chunk of American-done tests have been conducted in commercial — not government-run — labs.
Experts pointed us to a credible tally that suggests that, on the raw numbers, the president's stat is flawed.
The COVID Tracking Project, a dataset managed and updated by volunteer journalists and scientists, estimates that, as of Tuesday, American labs had performed a total of about 359,000 tests for COVID-19. That tally comes from state and local health departments around the country, including testing done in both public and commercial labs.
From March 15 through Tuesday, the United States conducted about 331,000 of those tests, per the tracker.
The raw comparison, then, suggests that the United States' eight-day tally falls short of South Korea's eight-week tally. Out of curiosity, we looked at the March 23 data for South Korea as well. At that point, it had run 338,036 tests. So even if Trump was off by a day, the American figure falls short.
And, experts reminded us, this raw-data comparison isn't that meaningful. If you want to compare data between the two countries, you need to look at the bigger picture.
More effective comparisons
Put simply, "raw numbers are not the best metric, given population size differences," said Jennifer Kates, a global health researcher at the nonprofit Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)
That's because the United States is simply a much larger country than South Korea — about 327 million people, compared with about 51.5 million.
To account for that, researchers serious about comparing the nations' responses would adjust to per capita rates of testing. That shows the extent to which the number of tests performed gauges how many people are at risk of infection.
"If a country has five people in it, of course they could only have five tests," said Dr. Robert Gallo, director of the Institute of Human Virology at the University of Maryland School of Medicine and a co-discoverer of HIV.
When you control for population, the American response compares poorly. Its tally of 359,000 tests per 327 million people works out to about 1,084 tests per million. South Korea has run closer to 6,768 tests per million.
Put another way, South Korea's testing rate for coronavirus is more than six times that of the American rate. To catch up, Kates noted, American labs would need to perform 2.24 million more tests — not an insurmountable task, but definitely a lift.
It's not just the number of tests performed, either. Researchers have stressed repeatedly that the timing of when the tests were run is also a big part of the equation. Both nations reported their first cases on the same day, Jan. 20.
In the entire month of February, American labs ran fewer than 1,000 coronavirus tests, per the volunteer COVID tracker. (Government health officials had begun sounding the alarm in January.)
By Feb. 29, South Korea had completed more than 55,000 tests, with almost 30,000 awaiting confirmation, for a total of more than 80,000 tests performed.
"For the assertion … the U.S. has done more #COVID19 testing in the last 8 days than South Korea cumulatively, that doesn’t mean anything," tweeted Dr. Eric Topol, a physician and researcher. "Nearly 0 tests were done for 2 months when they were desperately needed."
What's needed now
Many public health researchers say the U.S. is still not running enough diagnostics daily to meet demand — arguing that, though there has been significant improvement, labs need to be doing about 150,000 tests per day.
Right now, the COVID tracker suggests about 65,000 tests are being run per day. While that is a substantial increase from even a week ago, it's still well below the target number.
Beyond testing, there's the question of what happened after results were confirmed. Patients infected, epidemiologists argue, should be targeted, caught early and quickly separated from other people. That's key to stopping the spread of the virus — and something that still hasn't happened on a large scale.
"South Korea followed up tests vigorously to support isolation and quarantine — the steps needed to reduce spread," said Dr. Joshua Sharfstein, vice dean for Public Health Practice and Community Engagement at the Johns Hopkins Bloomberg School of Public Health in Baltimore. "The U.S. has a long ways to go to develop this critical capacity."
Trump claimed that the United States has "done more tests in eight days than South Korea has done in eight weeks."
The CDC has not put out comprehensive data on this. But independent work on the subject suggests the comparison is flawed. In eight days, the United States performed almost as many tests as South Korea did in eight weeks, but not necessarily more.
In addition, that statistic is relatively less important. The American rate of testing per capita is more than six times lower than South Korea's. It's certainly possible to catch up, but that hasn't happened yet.
The president's statement frames the data in a way that is misleading and doesn't accurately represent the status of the American response to COVID-19. We rate it False.
This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.