The cry du jour from the usual anti-Trump folks is testing, testing, testing!  Where are my COVID-19 (aka Wuhan) virus test kits, some governors shout?  As of the start of Ramadan (April 23, 2020), about 5 million tests have been administered in the U.S.  The current rate of testing with proven underutilized equipment by states, counties and cities is about 1,000,000 per week.  At President Trump’s daily COVID-19 virus task force briefing Thursday, the president noted that all 183 other countries’ combined testing was less than what the U.S. has done. (By the way, I can’t remember the frequency that the Obama administration held public briefings about the H1N1 pandemic.  Much of the time I was out of the country.  Were they held from Martha’s Vineyard or golf courses in Hawaii or Palm Springs?)

Between April 2009 and April 2010, CDC held 60 related media events – 39 press briefings and 22 telebriefings – reaching more than 35,000 participants. From 2009 H1N1 Pandemic Timeline per CDC.

So how was the testing done for H1N1 under Obama’s watch?  According to CDC, Centers for Disease Control and Prevention, in their June 16, 2010 report,  The 2009 H1N1 Pandemic: Summary Highlights, April 2009 - April 2010:  “On May 1, 2009, CDC test kits began shipping to domestic and international public health laboratories. (Each test kit contained reagents to test 1,000 clinical specimens). From May 1 through September 1, 2009, more than 1,000 kits were shipped to 120 domestic and 250 international laboratories in 140 countries. Once labs had the test kits and verified that their testing was running properly, they were able to identify new cases more quickly than before and no longer needed to send samples to CDC for lab confirmation”.  As an aside, the WHO declared the H1N1 virus an imminent pandemic on April 29, 2009, however, WHO waited until June 11, 2009 to declare it a world pandemic.

In other words, in the first 4.5 months of the H1N1 pandemic in the U.S. in 2009, CDC produced and shipped about one million “tests”.  However, at least 25% of those tests were shipped to other countries.  The WHO declared the COVID-19 pandemic on March 11, 2020.  Nearly six weeks later, the U.S. had tested about five million patients.  To summarize U.S. testing:  

What makes these statistics more interesting is that the H1N1 virus, a.k.a., swine flu, was a variant of other “swine flu” experienced before in the world and specifically in the U.S.  This similarity helps streamline diagnostics.  However, the COVID-19's virus origin is from a particular bat in China.

When I graduated from college almost 50 years ago, I wanted to go into biomedical engineering.  I took a job in El Monte, California.  As a chemical engineer, I had spent much time in the lab, so the work was interesting.  Our company worked closely with CDC.  We were considered one of the premier disease testing developers in the world.  The basic premise for testing was immunofluorescence.  Simply put, the target antigen to be tested for has an affinity for its antibody.  You “tag” the antibody with a fluorescing dye.  Mix the tagged antibody with the serum containing the suspected antigen; filter it; and look under the microscope with ultraviolet light. If you see a yellowish concentration under the microscope, voila! you have a positive result.

Imagine that you have a new type of deadly virus and you need to rapidly accelerate this tried-and-true method for detection.  You need to get one heckuvalot of tagged antibodies in test kits, right?  To get the antibodies you need to get people recovered from the flu who have them in their system to have fought off the flu.  All this takes time.

What impact did the  2009 H1N1 have on African-American communities?

According to the CDC, 2009 H1N1 and seasonal flu data on racial and ethnic groups have been taken from a wide range of sources and geographic areas and show differing results. For instance:

• Behavioral Risk Factor Surveillance System data show self-reported influenza-like illness and having sought medical care for that illness was similar among racial/ethnic groups.¹
• From April 15-August 31, 2009, 35 percent of people hospitalized with 2009 H1N1 in 13 metropolitan areas of 10 states were non-Hispanic black. Only 16 percent of the catchment area population studied, however, was non-Hispanic black.²
• Non-Hispanic black children less than 5 years old had higher seasonal influenza-associated hospitalization rates (1.2/100,000) than non-Hispanic white children of the same age (0.5/100,000) in university medical centers serving Rochester, Nashville and Cincinnati.³
• Black children younger than 18 years of age account for 16.6% of 210 reported influenza-associated deaths in 2009.⁴ Their representation in the U.S. population is 16.8%.⁵

Because the geographic spread of influenza varies over time, findings may vary depending on when and where data were collected. However, any influenza-associated hospitalization or death is tragic. It is important to better understand the causes and take steps to prevent these hospitalizations and deaths.

What factors contributed to 2009 H1N1’s impact on African American communities?

Again from the CDC, many medical conditions are associated with an increased risk of serious complications from influenza. Disparities in underlying medical conditions, such as asthma and diabetes, may have contributed to the impact of 2009 H1N1 on African American communities.

From April 2009 — September 2009:

• Almost one-third of people hospitalized with complications from 2009 H1N1 influenza were persons with asthma. Asthma-related hospitalization and mortality rates from all causes, not just influenza, are approximately two to three times higher among non-Hispanic blacks compared with non-Hispanic whites.⁶
• Approximately 10 percent of people hospitalized with complications from 2009 H1N1 influenza have been diabetic. Among adults 20 years of age and older, diabetes is more prevalent among non-Hispanic blacks (12%) compared with non-Hispanic whites (7%).⁷

Some African-Americans may also face barriers to accessing health care, such as lack of insurance or transportation. There is no epidemiological or clinical evidence that suggests that African Americans are more susceptible to either 2009 H1N1 or seasonal influenza, or to poorer health outcomes by virtue of their race alone.  Therefore, further investigation is essential to more clearly elucidate factors that might contribute to the disproportionate influenza-associated hospitalization among non-Hispanic blacks.

It is very clear that under the Trump administration, testing for a novel COVID-19 corona virus ramped up much faster than for a swine flu variant, H1N1, under the Obama administration.  It is hugely sad that the previous administration drew down strategic medical supplies from the strategic reserve, yet did not replenish them to prior levels.  The usual “racist” implications of the African-American community’s higher than average rate of infection were debunked during the H1N1 pandemic and clearly is applicable today for similar comorbidity exposure. Enemies in the media of the Trump administration continue to distort these truths.

I have one final tidbit to offer.  One of the largest pork producers in the U.S. is Smithfield.  I have to admit that I am a big fan of salt-cured country ham biscuits, a treat that my dad from coal country in the tri-state area of Virginia used to give us on many occasions.  Smithfield country hams were the best that we would get from the Piggly Wiggly supermarket.  Smithfield was bought in 2013 by the Chinese.  H1N1 was also known as the swine flu.  Tainted pork was in the “flu delivery system.”  Food for thought, right?  And don’t forget where the H1N1 virus originated.  It was Mexico and brought into California through Imperial and San Diego counties and then in Texas.  Border control is a must!

Image credit: Centers for Disease Control and Prvention, public domain