Dead-End Testing

It’s the type of inertia that clearly frustrates Romer.  He calls the $2 trillion legislation passed by Congress “palliative care” for the economy. 
If you took $100 billion and put it into testing, 
he says, we would “be far better off.”

The article cited above makes more sense than almost anything else I have read about Covid-19 this year.  The quote is from NYU economist Paul Romer, who deserves more attention than our bumbling public health experts.

Here’s the point:  If U.S. coronavirus testing had been handled better, fewer people would have died, many people would have been spared a miserable illness and the national economy might not be careening into what looks like a very deep, very expensive recession.  (More about the economy another day.)

So let’s talk about testing, starting on January 20 of this year.

We all remember January 20.  That was the day the World Health Organization and China acknowledged, at long last, that Covid-19 was a contagious virus that was passed from person to person.  (This had been understood in China by December 6, 2019, and by everyone else not much later.)

Also on January 20, the United States and South Korea each announced the diagnosis of its first Covid-19 patient.

The differences between the two countries’ reactions — specifically, their testing rollouts — is worth a closer look.


South Korea

On January 27, when South Korea had a total of four patients, the South Korean Center for Disease Control sent an SOS to Korean medical labs, promising streamlined approvals for Covid detection tests.

The first test was approved on February 4, and a second one on the 12th.  By March 15, when a fifth test was approved, the country was testing 20,000 persons daily.  Daily diagnoses peaked at 909 on February 29, then dropped to 93 by March 18 and since then have rumbled at a very low level even as has testing has continued, as seen below.

South Korean testers also contacted and tested the friends and neighbors of those who had tested positive, and almost every single member of a large church where hundreds of congregants had tested positive.  Because the tests had been given quick approval, their results were cross-checked against each other as the rollout continued, to assure validity.

In the world of disease prevention, these activities are known as Public Health 101.  South Korea now is manufacturing and providing Covid tests for many other countries.


United States

In the U.S., the CDC preferred initially to design and release its own test, starting February 4.  Four days later, reports began to surface about the test’s unreliable results.

Another problem was the lack of tests.  Curiously, Kaiser Health News reports, the CDC distributed its first batch of tests in equal numbers to every one of the 50 states.  Sounds wacky to me, but, hey, I wasn’t there.

On February 27, California’s governor said the state had identified 33 persons with Covid-19 and was monitoring another 8,400 persons who had Covid-like symptoms.  Testing was going slowly, he said, because the state had only 200 CDC tests on hand.

(NB: California is home to 40 million people, about 80 percent as many as live in South Korea.)

On February 29, the Food and Drug Administration gave its first go-ahead for non-CDC tests developed by pharmaceutical companies, universities and medical laboratories.

One week later, the U.S. had conducted 2,000 tests and South Korea 80,000.

There were other problems.  Because U.S. tests still were scarce, the CDC recommended testing only for people who had been to Wuhan or who had met people from Wuhan or who had Covid-type symptoms.

This approach did nothing to seek out people who had been in contact with sick Americans.  It did nothing to identify infected persons who were pre-symptomatic and contagious, let alone to tell such persons to isolate themselves.  Later, state by state, the entire U.S. population was ordered to quarantine, an edict with no end date in sight.

 

The US version of the Korean chart, above, mostly tells us how much later testing started here.  Its fast-rising trend line most likely reflects the rising numbers of tests performed;  the tempting inference that infections may have peaked in the last week (five weeks after the peak in North Korea) may be true or may indicate a lull in the daily availability of tests.

Worst, the chart tells us nothing about the number of infected persons in the country, because, again, testing was reserved for symptomatic people who were lucky enough to get access to tests (plus a good sampling of politicians, celebrities and tigers in a zoo; one of the last group was heard coughing and so six were tested “out of an abundance of caution.”)   One hopes medical workers were given broad access to testing, but news reports suggest that may this may not have been the case.

In one possibly typical case, the state of New Jersey, a domestic hot zone for the virus, set up a drive-through test site in late March.  When it opened at 8 a.m., the line of idling cars was miles long.  After 35 minutes, the line was closed because there were not enough tests for all the drivers who were waiting.  Testing stopped by noon.
Last week, about six drive-through test days were announced in one New Jersey county, and persons with high temperatures and Covid symptoms were invited to make appointments for the limited number of tests available, roughly 100 to 250 per day.  The available appointments filled quickly, and 5,000 requests were denied.  Maybe in a couple weeks, or maybe in May ….

A friend shared the story of a Pennsylvania family man in his early 40s who ran a fever for two weeks and then got a Covid test whose results were promised four days later.  After two in-patient stints for major pulmonary interventions and after his second hospital discharge, he got his test result — yes, he did have coronavirus.  Good to know, huh?

You can read more about these matters in articles from Reuters and the increasingly valuable Kaiser Health News.

 

Warning from the editor: WordPress’ patented resistance to spacing between paragraphs ensues through the rest of this article.  It cannot be fixed.

—–

The conclusion here is this: After a late, slow start, the U.S. has piles of test results that reveal very little in the way of useful information.   We still have no idea how many people in the U.S. were infected, or are infected or might develop symptoms.  We never will know how many of this season’s “flu deaths” were actually Covid-19 deaths.  If we have flattened the curve, it was by curtailing the movements of everyone for a period of time whose end we cannot forecast.
“The system is not really geared to what we need right now,” the estimable and understated Dr. Anthony Fauci told a Congressional committee in March.

“That is a failing. Let’s admit it.”

—–
Given the cynicism engendered by the original testing program, it might sound odd to say this, but here goes:  The best hope for minimizing Covid damage in the U.S. is more tests.
The new testing would be for antibodies.  Testing for such, done with pinprick blood samples, could identify people who are Covid-19 survivors and who have developed immunity to the virus.
Theoretically (and I do mean theoretically, given recent history) many of these tests could be done fast and yield answers within hours.
The people who test positive for antibodies could go back to work and help start the revival of our comatose economy.  They could staff grocery stores, drive delivery vans, plow and harvest food crops and give medical workers some deserved relief.  They also could donate their plasma, which in very early testing has seemed to benefit seriously ill Covid patients.

This would NOT end basic coronavirus testing, however.  Those with no antibodies would need to be tested, probably repeatedly, for Covid infection and/or would need to remain quarantined until those slowpokes at the Department of Health and Human Services approve an immunization and get it to those who need it.  In a perverse way, those lucky enough to have avoided infection will have to limit their movements until immunization provides their get-out-of-jail-free cards.

(In my dark imaginings, HHS will deploy Google to monitor the compliance of those without antibodies or immunizations by tracking them using data from their cellphones.  This capacity was revealed in recent weeks when residents of some cities were admonished for walking or driving too far from their houses and — theoretically, again — endangering others.  It doesn’t take a Constitutional lawyer to wonder whether this isn’t a Fourth Amendment violation.)

In any event, no immunization is expected to gain FDA approval for at least 18 months.  The restriction on movement during that period will be less popular than the proverbial ants at a picnic.


Note

Another upside to antibody tests — again, IF we can organize and administer them — would be establishing how many persons, if any, acquired antibodies without experiencing a traditional case of Covid-19.  The hope is that there are many of these people, but, again, we don’t have the facts.
Such tests also would answer a nagging question in the American West:  whether many Americans caught minor cases of Covid-19 and, with it, acquired immunity last winter.  There is a developing belief that minor Covid exposures lead to less serious cases, and the cases at issue arose and were resolved before very sick people began clogging hospitals, at least in New York, in mid February.

This writer is one who would like the question answered.  I flew to California at the end of December and then coughed continually starting shortly afterward and for almost a month.  If what I had was a cold, it was a strange one (no stuffy nose, no fever) and my first in almost 20 years.  One of my siblings, in another state, had the same bug.  Another sibling flew out of a small town that later saw many Covid cases and arrived home with other odd symptoms.

For the record, if I do have coronavirus antibodies, I will be happy to donate as much plasma as I am able.

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