Making coronavirus testing easy, accurate and fast is critical to ending the pandemic – the US response is falling far short

https://theconversation.com/making-coronavirus-testing-easy-accurate-and-fast-is-critical-to-ending-the-pandemic-the-us-response-is-falling-far-short-142366

Making coronavirus testing easy, accurate and fast is critical to ...

For many people in the U.S., getting tested for COVID-19 is a struggle. In Arizona, testing sites have seen lines of hundreds of cars stretching over a mile. In Texas and Florida, some people were waiting for five hours for free testing.

The inconvenience of these long waits alone discourages many people from getting tested. With the surge in cases, many public testing sites have been reaching maximum capacity within hours of opening, leaving many people unable to get tested for days. Those that do get tested often face a week-long wait to get their test results.

Every person who isn’t tested could be spreading COVID-19 unknowingly. These overstretched testing programs are a weak link in the U.S. pandemic response.

study public health policy to combat infectious disease epidemics. The key to overcoming this pandemic is to slow transmission of the virus by preventing contagious people from infecting others. A widespread quarantine would accomplish this, but is economically and socially burdensome. Testing offers a way to identify contagious people so they can be isolated to prevent the spread of the disease. This is especially important for COVID-19 because an estimated 40% or more of all people infected with SARS-CoV-2 have few or no symptoms so testing is the only way to identify them.

Some states are doing much better than others. But as a whole, the U.S. is falling far short of the amount of testing needed to control the pandemic. What are the challenges the U.S. is facing? And what is the way forward?

Testing should be free, easy, fast and accurate

The ultimate goal of testing is for everyone, regardless of symptoms, to know at all times whether they are infected with the coronavirus. To achieve this level of testing, tests should be free, very easy to perform and provide accurate results quickly.

Ideally, free COVID-19 tests would be delivered to everyone directly. The tests would be simple to perform – like a saliva test – and would give a perfectly accurate result within minutes. Everyone could test themselves weekly or anytime they were going to be in close contact with other people.

In this ideal scenario, most, if not all, contagious people would be detected before they could spread the virus to others. And because of the rapid results, there would be no burden of quarantining between doing the test and getting the result.

Researchers are working on better-quality tests, but access is a problem of infrastructure, not science. Right now, nowhere in the U.S. comes close to meeting surging demand for testing.

One of the worst cases: Texas

The difficulty of getting a COVID-19 test varies by state, but currently, people in Texas face some of the biggest obstacles, which results in far fewer tests being done than is needed to control the pandemic.

First, Houston – which is experiencing a surge in cases – and many testing sites across the state recommend or offer testing only to people who have symptoms, were exposed to a COVID-19 case or are a member of a high-risk group.

Even people recommended for testing still face challenges. It is possible to request an appointment for a free COVID-19 test, but testing facilities can handle only so many patients a day and testing slots fill up quickly. Even if someone gets an appointment, they may face an hours-long wait at the testing site.

Finally, public health experts recommend that people who may have been exposed to COVID-19 should quarantine at home for 14 days or until they receive a negative test result. In Texas, patients are supposed to get results through an online portal in three to five days, but many labs have been taking seven to nine days to return results. These long delays mean people face a much higher burden of quarantining while waiting for results.

All of these challenges make it clear that Texas is simply not testing enough people to keep the spread of COVID-19 in check.

To gauge the success of COVID-19 testing programs, epidemiologists use a measure called test positivity. This is simply the percentage of tests that come back positive. The lower the test positivity, the better, because that means very few cases are going undetected. A high test-positivity rate is usually a sign that only the sickest people are getting tested and many cases are being missed.

The World Health Organization guidelines say that if more than 1 out of 20 COVID-19 tests comes back positive – a test positivity of more than 5% – this is an indication that a lot of cases are not diagnosed and the epidemic is not under control. 

Texas currently has a test-positivity of around 16%, which means that a lot of infected people are not getting tested and may be unknowingly spreading the disease.

One of the best cases: New Mexico

In stark contrast to Texas is New Mexico, which has one of the strongest testing programs in the U.S.

First, public health officials there encourage everyone to get tested for COVID-19 regardless of symptoms or exposure. The state has also prohibited health providers from charging patients for tests. People seeking a test have the option to walk in or to make an appointment ahead of time, whichever is more convenient.

All of this relatively good access to testing has resulted in one of the highest per capita testing rates in the country, at over 20,000 tests per 100,000 people, and test-positivity rate of around 4%. New Mexico’s testing program is diagnosing a relatively high proportion of cases despite the state experiencing a recent surge.

New Mexico still has room for improvement. Long lines, wait times and limited capacity are becoming more common as cases surge, but the foundation of a strong testing program has helped the state cope with the increase in cases.

 

The big-picture problems

The pre-pandemic infectious disease testing capabilities in the U.S. are clearly unable to meet the current demand. A nationwide response is needed, and there are three things that Congress, the federal government and local governments can do to help ensure COVID-19 tests will be easy to get, fast and accurate.

First, Congress can provide funding to stimulate the testing supply chain, scale up existing testing programs and promote innovation in test development.

Second, governments can improve the management and coordination of testing programs to more efficiently use existing resources.

And third, innovative testing methods that reduce the need for lab capacity – like paper-strip tests and pooled testing – need be approved and implemented more quickly.

Every little improvement in testing capabilities means more COVID-19 cases can be caught before the virus is transmitted. And slowing the spread of the virus is the key to overcoming the pandemic.

 

 

 

 

Cartoon – Our National Coronavirus Strategy

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Cartoon – We’re way beyond Rational Thinking

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Public’s disconnect from COVID-19 reality worries experts

https://thehill.com/policy/healthcare/507334-publics-disconnect-from-covid-19-reality-worries-experts

Public's disconnect from COVID-19 reality worries experts | TheHill

The United States is being ravaged by a deadly pandemic that is growing exponentially, overwhelming health care systems and costing thousands of lives, to say nothing of an economic recession that threatens to plague the nation for years to come.

But the American public seems to be over the pandemic, eager to get kids back in schools, ready to hit the bar scene and hungry for Major League Baseball to play its abbreviated season.

 

The startling divergence between the brutal reality of the SARS-CoV-2 virus and the fantasy land of a forthcoming return to normalcy has public health experts depressed and anxious about what is to come. The worst is not behind us, they say, by any stretch of the imagination.

 

“It’s an absolute disconnect between our perceived reality and our actual reality,” said Craig Spencer, a New York City emergency room doctor who directs global health in emergency medicine at New York Presbyterian/Columbia University Medical Center. “To look at the COVID case count and the surge in cases and to think that we can have these discussions as we have uncontrolled spread, to think we can have some national strategy for reopening schools when we don’t even have one for reopening the country, it’s just crazy.”

The number of dead from the virus in the United States alone, almost 136,000, is roughly equal to the populations of Charleston, S.C., or Gainesville, Fla. If everyone in America who had been infected lived in the same city, that city would be the third-largest in the country, behind only New York and Los Angeles. More people in the United States have tested positive for the coronavirus than live in the state of Utah. By the weekend, there are likely to be more confirmed coronavirus cases than there are residents of Connecticut.

There are signs that the outbreak is getting worse, not better. The 10 days with the highest number of new coronavirus infections in the United States have come in the past 11 days.

Case counts, hospitalizations and even deaths are on the rise across the nation, not only in Southern states that were slow to embrace lockdowns in March and April.

California, the first state to completely lock down, has reported more than 54,000 new cases over both of the last two weeks. Nevada, about one-thirteenth the size of California, reported 5,200 new cases last week. States where early lockdowns helped limit the initial peak like Pennsylvania, Illinois and Ohio are all seeing case counts grow and hospital beds fill up.

Only two states — Maine and New Jersey — have seen their case counts decline for two consecutive weeks.

 

“We are nearing the point where pretty much most of the gains we had achieved have been lost,” said Christine Petersen, an epidemiologist at the University of Iowa. “All of us are hoping we magically get our acts together and we can look like Europe in two months. But all the data shows we are not doing that right now.”

It is in that dismal context that schools are preparing some sort of return to learning, whether in person or remote. President Trump and Education Secretary Betsy DeVos have threatened schools that do not fully reopen.

But even though the coronavirus appears to have less severe consequences among children, sending them back to schools en masse does not carry zero risk. Children have died from the virus, and the more who are exposed mean more opportunities for the virus to kill again, even before considering the millions of teachers who may be vulnerable or the parents and grandparents asymptomatic children might be exposed to.

Already, school districts in Los Angeles and San Diego have delayed reopening plans as case counts rise.

“We do know that kids can get sick and they can even die. It’s definitely a much lower number,” Petersen said. “Even if they aren’t as infectious, if there are millions of them gathering in schools not having great hygiene, it’s a multiplier effect.”

 

The painful lockdowns that were supposed to reduce viral transmissions bought time to bolster testing and hospital capacity, to speed production of the equipment needed to test patients and protect front-line health care workers.

But that hasn’t happened; laboratories in the United States have tested as many as 823,000 people in a day, a record number but far shy of the millions a day necessary to wrestle the virus under control. Arizona and Los Angeles have canceled testing appointments for lack of supplies. Hospitals are reporting new shortages of protective gear and N95 masks.

The Trump administration used the Defense Production Act to order meat processing plants to stay open; it has only awarded contracts sufficient to produce 300 million N95 masks by the end of the year, far short of what health experts believe will be necessary to protect health care workers.

 

“A failure of national leadership has led us to a place where we are back where we were before, no national testing strategy, no national strategy for supply,” said Kelli Drenner, who teaches public health at the University of Houston. “States are still on their own to scramble for reagents and swabs and PPE and all of that, still competing against each other and against nations for those resources.”

There are troubling signs that the promise of a vaccine may not be the cure-all for which many had hoped. Early studies suggest that the immune system only retains coronavirus antibodies for a few months, or perhaps a year, raising the prospect that people could become reinfected even after they recover. A growing, if still fringe, movement of anti-vaccination activists may refuse a vaccine altogether, putting others at risk.

“A vaccine is not going to solve this. People die of vaccine-preventable diseases every day. All the failures with testing and diagnostics and all the inequities and access to care with those are going to be the same things that are going to be magnified with a vaccine,” said Nita Bharti, a biologist at Penn State’s Center for Infectious Disease Dynamics.

 

More than a dozen states hit hardest by the latest wave of disease have paused or reversed their reopening processes. But only 24 states and the District of Columbia have ordered residents to wear masks in public, and compliance varies widely by both geography and political affiliation.

“This is the critical time. If we are going to try to reverse this, we have to get back to the mental space and the resolute action we had in March. I’m not sure we have the energy and the wherewithal to do it,” Petersen said.

 

Without a dramatic recommitment to conquering the virus, health officials warn, the new normal in which the country exists will be one of serious and widespread illness, and a steady drumbeat of death.

“None of this was inevitable. None of this should be acceptable. There are ways we can do better,” Spencer said. “This will continue to be our reality for as long as we don’t take it seriously.”

But after months of repeating the same warnings — wear a mask, stay socially distant, stay home if possible, avoid places where people congregate in tight quarters — some health experts worry their message has been lost amid a sea of doubt, skepticism and mixed signals.

“It’s like a learned helplessness when we’re not helpless,” Drenner said. “There are some pretty effective strategies, but we don’t seem to have the political will to do it.”

 

 

 

 

Fauci has been an example of conscience and courage.

https://www.washingtonpost.com/opinions/fauci-has-been-an-example-of-conscience-and-courage-trump-has-been-nothing-but-weak/2020/07/13/7c9a7578-c52b-11ea-8ffe-372be8d82298_story.html?fbclid=IwAR0n0o67FMhhUjxqU11cfrd4daMkW0ZWZtIg–I1P3ioLPA7ka7Ew0XT_EA&utm_campaign=wp_main&utm_medium=social&utm_source=facebook

Opinion | Fauci has been an example of conscience and courage ...

When historians try to identify the most shameful documents from the Trump administration, a few are likely to stand out. For unconstitutional bigotry, it is hard to beat the initial executive order banning travel to the United States from Muslim countries. For cruelty and smallness, there is the “zero tolerance” directive to federal prosecutors that led to family separations at the border. For naked corruption, there is the transcript of the quid-pro-quo conversation between President Trump and the president of Ukraine.

But for rash, foolish irresponsibility, I’d nominate the opposition research paper recently circulated by the White House in an attempt to discredit the National Institute of Allergy and Infectious Diseases’ Anthony S. Fauci. As reported by The Post, the document recounted a number of instances — on community transmission, asymptomatic transmission and mask wearing in particular — where Fauci’s views have shifted over time. As far as I know, this official record is unique: A White House attack on the government’s leading infectious-disease specialist during a raging pandemic. It indicates an administration so far gone in rage, bitterness and paranoia that it can no longer be trusted to preserve American lives.

From a purely political standpoint, it is understandable that the administration would want to divert attention from its covid-19 record. Trump’s policy of reopening at any cost is exacting a mounting cost. Five months into the greatest health crisis of modern U.S. history, there are still serious problems with supply chains for protective equipment. There are still long wait times for testing results in many places. The contact tracing process in many communities remains (as one health expert described it to me) “a joke.” More than 132,000 Americans have died.

Rather than addressing these failures, Trump has chosen to sabotage a public official who admits their existence. Rather than confronting these problems, Trump wants to ensure his whole administration lies about them in unison. The president has surveyed America’s massive spike in new infections and thinks the most urgent matter is . . . message discipline.

It is true that a number of Fauci’s views on the novel coronavirus have evolved (though some of the administration’s charges against him are distorted). But attacking a scientist for making such shifts is to willfully misunderstand the role of science in the fight against disease. We do not trust public health officials during an emerging pandemic because they have fully formed scientific views from the beginning. We trust them because 1) they are making judgments based on the best available information and 2) they have no other motive than the health of the public. If, say, health officials were initially mistaken about the possibility of asymptomatic transmission, it is not failure when they change their views according to better data. It is the nature of the scientific method and the definition of their duty.

In the inch-deep world of politics, amending your view based on new information is a flip-flop. In epidemiology, it is known as, well, epidemiology.

Meanwhile, the president is failing according to both requirements of public trust. Trump is not making judgments based on the best available information. And he clearly has political goals that compete with (and often override) his commitment to public health. The president is hoping against hope that the public will forget about the virus until November, or at least about the federal role in fighting it. To apply a veneer of normalcy, he is holding public events that endanger his staff and his audience and is planning a Republican convention that will double as a petri dish.

It now seems likely that the most decisive moment of the American pandemic took place in mid-April when new cases began to stabilize around 25,000 a day. Even four or six more weeks of firm presidential leadership — urging the tough, sacrificial application of stay-at-home orders — might have reduced the burden of disease to more sustainable levels, as happened in Western Europe. And this would have relieved stress on systems of testing, tracing and treatment.

But Trump’s nerve failed him. Instead of holding firm, he began siding with populist demands for immediate opening, pressuring governors to take precipitous steps and encouraging skepticism about basic public health information and measures. This may well have been the defining moment of the Trump presidency. And he was weak, weak, weak.

It is typical for Trump to shift blame. But in this case, the president has selected his fall guy poorly. Fauci has been an example of conscience and courage in an administration that values neither. When Trump encourages a contrast to his own selfishness and cravenness, he only damages himself.

 

 

 

 

“What is it that America has failed to hear?”

https://mailchi.mp/9f24c0f1da9a/the-weekly-gist-june-5-2020?e=d1e747d2d8

The Peace Alliance's tweet - ""A riot is the language of the ...

“What is it that America has failed to hear?” asked Dr. Martin Luther King, Jr. in March of 1968, calling riots the “language of the unheard”. “It has failed to hear that the promises of freedom and justice have not been met.” Stubbornly, shamefully, we continue to turn a deaf ear: to structural racism; to institutionalized inequality; to a pandemic of police brutality and bigotry that chokes off the breath of black Americans as surely as a virus in the lungs or a boot on the neck. But the sound in the streets is thunderous.

We in healthcare must listen. We must hear that what killed George Floyd, and Breonna Taylor, and Eric Garner, and Tamir Rice, and Philando Castile, and Trayvon Martin, and Ahmaud Arbery, and countless others, as surely as the terrible actions of any single person, was the pervasive, insidious virus of racism, long since grown endemic in our country.

This week’s protests are a kind of ventilator, providing emergency breath for a national body in crisis. We must work—urgently—on the therapeutics of structural change and the vaccines of education and understanding.

At Gist Healthcare we are listening, and learning. As a team, we’ve committed to each other to be attentive, invested, empathetic allies, and to dedicate our individual and collective time, talents and treasure to antiracist work, in healthcare and beyond. Our contribution may not be large, and it will never be enough, but at least we hope it will be positive. We’d like to hear your thoughts and suggestions as well. For the moment, and for our colleagues, friends, and families, we stand with the protestors.

Black Lives Matter.