Nizana Brautmann found out her 6-year-old son had been exposed to coronavirus via a note on the locked door of his Berlin daycare center on Monday morning. It told parents to take their kids home and wait.
That was the last clear information she got. The center asked parents to decide whether to quarantine their families. Her doctor told her to stay away from his office and take over-the-counter cold remedies. A medical hotline advised herbal tea. Though her son had a cough and Brautmann was running a slight fever and had some trouble drawing a full breath, a test was surprisingly hard to come by.
Brautmann is just one among many. As the focus of the new pandemic shifts to Europe, authorities there have been slower to embrace the aggressive testing credited with helping to curb the spread in Asia. The UK changed its rules late Thursday to test only the most severe cases -- people who require hospitalization -- as officials there warned that as many as 10,000 Britons may be infected.
Meanwhile, a shortage of tests in the US has left the true scope of the pandemic unclear. While restrictions help prevent authorities from wasting precious detection kits and staff time on hypochondriacs, not casting a wide enough net can give the pathogen a chance to spread undetected. The World Health Organization issued a stern warning on the matter this week as case numbers spiked.
"You can't fight a virus if you don't know where it is," WHO Director-General Tedros Adhanom Ghebreyesus said Thursday. "That means robust surveillance to find, isolate, test and treat every case, to break the chains of transmission."
Though four out of five people will probably have mild symptoms, the new coronavirus can be deadly for the elderly and people with conditions such as diabetes and high blood pressure.
There are signs things could start to pick up in the US Legislation to make tests free was approved by the House of Representatives. Roche Holding AG has won emergency approval from the federal government for a highly automated test, potentially speeding up tenfold the ability to diagnose patients. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, told MSNBC on Friday that testing will accelerate within the next week because of increased coordination with private companies.
Meanwhile, the challenge of tracking the chains of infection when this coronavirus gives some people barely any symptoms means the existing number of worldwide cases, currently above 135,000, is an understatement. The UK estimate of 10,000 is more than 12 times the official tally of confirmed cases as of Friday.
"Testing only the most severe cases is a disastrous public-health decision," said Ralph Baric, a professor at the University of North Carolina's Gillings School of Global Public Health and a veteran coronavirus researcher. People with few to no symptoms can easily pass the virus, he said, predicting "hundreds of thousands of additional infections" from uncontrolled spread without broader testing.
When Spain expanded its criteria in early March beyond just those with a link to recent travel to China, its case tally surged from just a handful to several hundred. A death that had been attributed to another cause was swiftly uncovered. In the Seattle area, the virus began circulating in January but remained undetected until patients at a nursing home started dying.
In France, health authorities readily acknowledge that the official figures don't reflect reality. Only "the tip of the iceberg" is visible, says Jerome Salomon, France's director general for health. But he points to other ways of identifying clusters: One person in the hospital means at least six or seven others must have a more benign form of the virus, he said at a briefing Wednesday. One death signals that at least 100 others are infected in the area.
Others say Europe at least has moved past the point of trying to diagnose everyone with the sniffles, especially in a context where there aren't enough tests.
"Testing anyone with mild complaints seems sympathetic but burns resources," said Marion Koopmans, who heads the department of viroscience at Erasmus University Medical Center in Rotterdam and advises the WHO. "Better to have an aggressive stay at home policy and social distancing."
In European countries including France, Germany, Switzerland and Austria, authorities are sticking to a policy of testing mainly those who had traveled to a virus hotspot or had contact with a confirmed Covid-19 patient, even as the infection spreads more broadly through the community.
The WHO is urging countries to test anyone with unexplained respiratory illness who has been in an area where the virus is being passed locally. Such community transmission is happening in much of Europe, as well as in the US
"Diagnostic testing algorithms that only test a small proportion of people who are likely to be Covid-19 is not the way forward in this epidemic," said Michael Ryan, head of the WHO's emergencies program.
In Germany, authorities are doing some broader testing as part of a working group on influenza. Patient samples are also being checked for coronavirus, according to the Robert Koch Institute, the country's public health authority.
There's evidence that broader testing helps. In South Korea, where authorities are assessing 10,000 people a day, there were more coronavirus recoveries than fresh infections for the first time this week. Proactive testing was part of the arsenal that Taiwan and Singapore used to limit the outbreak in their countries despite strong ties with China, where the virus originated.
Casting a wider net could create its own set of problems, however, according to Rosanna Peeling, director of the International Diagnostics Centre at the London School of Hygiene and Tropical Medicine. Random testing would certainly uncover additional cases, but might also cause panic.
"You'd want to isolate or quarantine them, but still it's so late by the time we know this that the virus has already taken off," Peeling said in an interview last week.
Brautmann, the mom in Berlin, could have taken her sick child to a testing station in Berlin. The line at the location in her district was more than four hours long on Monday. She opted not to go, reasoning that if they were positive, they would expose others. Instead, she put herself and her son in home quarantine for two weeks.
They go outside once a day, before the neighborhood begins to stir, to run around a nearby soccer field. Her son's daycare will remain closed until March 20, operator Kindergaerten NordOst said.
Brautmann, 40, believes the official number of cases that have been identified in Berlin -- 158 as of Friday -- is misleading.
"It's a joke because nobody is testing us," she said.