In op-ed at the Wall Street Journal Paul Romer and Rajiv Shah highlight the importance of testing:
For now, social distancing is the best America can do to contain the Covid-19 pandemic. But if the U.S. truly mobilizes, it can soon deploy better weapons—advanced tests—that will allow the country to shift gradually to a protocol less disruptive and more effective than a lockdown.
Instead of ricocheting between an unsustainable shutdown and a dangerous, uncertain return to normalcy, the U.S. could mount a sustainable strategy with better tests and maintain a stable course for as long as it takes to develop a vaccine or cure. The country will once more be able to plan for the future, get back to work safely and avoid an economic depression. This will require massive investment to ramp up production and coordinate the construction of test centers. But the alternatives are even more costly.
Two types of testing will be essential. The first test, which relies on a technology known as the polymerase chain reaction, or PCR, can detect the virus even before a person has symptoms. It is the best way to identify who is infected. The second test looks not for the virus but for the antibodies that the immune system produces to fight it. This test isn’t so effective during the early stages of an infection, but since antibodies remain even after the virus is gone, it reveals who has been infected in the past.
Together, these two tests will give policy makers the data to make smarter decisions about who needs to be isolated and where resources need to be deployed. Instead of firing blindly, this data will let the country target its efforts.
We’ve got to do more, faster. Local, state, and federal governments need to clear the path and use the powers at their disposal to accomplish more testing. The first priority will necessarily be health care workers. Then onwards to the whole population.
Waiting six months to mobilize such an effort is far too long. We’ve got days or, at the most, weeks, not months and years.
It’s all so obvious. An adequate testing regime was a clear necessity from the beginning and yet here we are, still dithering.
I am not aware of anyone putting a 6 month estimate on the availability of testing. Also, my own interpretation of “dithering†is hesitating to making definitive choices in the process of problem solving to reach a solution. IMO, there have been many immediate responses to both slow the virus down, as well as cooperative private/public energy directed towards better testing and treatment of this virus – conventional and unconventional ones. What is missing, though, is a magic wand to instantly erase all the hiccups usually married to big central government involvement. And, unfortunately, magic wands are a product of “magical thinking,†often going part and parcel with partisan divisiveness, in which we are drowning in during this pandemic.
Lack of testing also appears to be a problem in European countries, except for Germany. The broader explanation appears to be that Asian countries prior experience w/ SARS had pre-existing policies / structures in place. While Germany distinguished itself for maintaining a larger and more decentralized laboratory base.
OTOH, the U.S. appears to have more ICU beds / 100,000 than other major OECD countries.
“And, unfortunately, magic wands are a product of “magical thinking,”
Didnt need a magic wand, just competent management. When we didnt have a test in 2 weeks someone at the highest level needed to step in. Didnt happen.
Steve
Test your asses off. Have fun. Noncompliance dwarfs testing. Have you seen pictures of New Orleans, NYC parks or subways, Miami, Joysy? How about Colorado cities? Have you read Dave’s dog walk observations? Have you actually been outside recently?
Getting to work, getting drunk and getting laid trump public health pleas. You will get partial compliance, and it will retard the curves. But you will still have the critical mass to spread widely. We are headed to herd immunity whether we like it or not. Enjoy your moment in the sun, “expert public health and front line officials,” but years from now when sober analysis can be conducted, you will look like the biggest fools in a century.
PD, indeed you could say that “SARs”, “MERs” has somewhat “inoculated” countries that were affected by them from a policy perspective — Saudi Arabia (just look at its numbers vs Iran), Singapore, Taiwan, Hong Kong, South Korea, China (yes, consider how fast things moved once the government decided not to cover it up), and Canada.
Or maybe German testing is a mirage . . .
“Every day, tens of thousands people in Germany seek to get tested for the novel coronavirus. Often, though, they run up against a lack of testing capacity. And it is likely to only get worse.”
Germany Reaching the Upper Limit of Testing Capacity
“”These aren’t just any random chemicals that can be mixed together,” Streeck says. “We need enzymes that are produced through biological processes by cells or yeasts. Such complex processes “can’t be ramped up at will on short notice.” Manufacturers, some of which are based in the U.S., are currently receiving inquiries from all over the world.
“But the biggest bottleneck at the moment isn’t even due to the lack of reagents, with which the genetic material of the coronavirus can be specifically detected, says Hendrick Borucki from the Bioscientia laboratory network. There’s also a shortage of the substances that can be used to break open the virus envelope and isolate the genetic material for the actual test. Other laboratories complain that even plastic pipettes or carrier plates that are calibrated for the analytical instruments are becoming increasingly difficult to obtain.”
Drew,
The point of testing is to have the information to make informed decisions. This doesn’t just apply to policymakers, but to everyone, even individuals who don’t know if they are infected and can’t find out because of the lack of testing.
Colorado cities? I live in one. The first deaths were in my county. My best friend here had Covid symptoms, managed to get a test which the state lab took 8 days to get the results. Meanwhile, he isolated himself and all the people he came in contact with had to decide what measures they would take. This includes a local USAF base and another federal government facility where he worked.
And the reason it took 8 days is because the CDC and FDA wouldn’t allow testing at any other labs. And, at that time, even results from the state lab were only “presumptive” and any positive cases had to be retested at a federal lab to become official.
Much of that could have been avoided. The result of federal incompetence was a deficit in information and a complete inability to track the pandemic in this country – a problem that is only now starting to be corrected.
And since we didn’t have the information to understand, much less track, the scope and course of the pandemic, policymakers felt the need to take extraordinary blanket actions that is going to have severe consequences. With better information earlier, we might have been able to make more focused and less draconian efforts.
And how will we know when to end the shutdowns? Without the ability to determine the status of the pandemic through analysis of the necessary data, we are only guessing.
Considering no country except South Korea successfully employed the “test, test, test” strategy to control an outbreak — I hope planners are planning a backup strategy for the case testing doesn’t scale up until it doesn’t matter.
Is there more ways of lowering the so called “r0” without testing? Lockdowns is one way but not the only technique.
There is masks (plain cotton cloths ones), there is aggressive sanitization of public places. How about gloves? The Chinese employed central quarantine, is that worth exploring? How about environmental effects like putting humidifiers in public places, UV light everywhere?
“Considering no country except South Korea successfully employed the “test, test, test†strategy to control an outbreak — I hope planners are planning a backup strategy for the case testing doesn’t scale up until it doesn’t matter.”
It’s not primarily about control, it’s about information. You don’t even know if you have an outbreak, much less the size and scope, unless you can get data and much of that data will, by necessity, come from testing of various kinds.
How can we tell if lockdowns are working? Unless one can collect data and track the spread of the pandemic, we are just guessing.
As I have been saying for some time it isn’t just testing. It’s systematic testing. Not just testing people who present themselves at hospitals, showing symptoms of COVID-19. Epidemiological testing.
Another problem. These strategies don’t scale well.
The ID NOW tests cost about $22 each. Testing everybody is the crudest kind of systematic testing. 330 million X $22 is about $8 billion. And you can’t just test once. You’ll need multiple tests per individual and for those at risk more than that.
That isn’t how I’d approach it. I’d wall off some high risk area (like Kings Country, Washington) and test everybody in it. That takes availability, time, money, manpower, and courage. We have a deficit of all of those now.
“As I have been saying for some time it isn’t just testing. It’s systematic testing.”
I agree. Systematic testing is testing. Epidemiological testing is testing. I have never said we should only be doing clinical testing but it’s pretty obvious we still don’t have enough capacity for that either.
I don’t understand why I get pushback here when I mention testing when testing is a primary source of information when it comes to an epidemic.
We don’t even have a solid handle on the CFR because we don’t really know how many are infected (or were unknowingly infected and are now past it). Predictive models of the pandemic are all over the map because the inputs are so uncertain because our data sucks. We are talking about worst-case scenarios because we don’t have the information necessary to make an accurate judgment. People are freaking out because so much about this disease is unknown.
The most important thing we need now, IMO, is good information and to get good information on this pandemic we need to do a lot more testing – and yes, obviously it needs to be conducted in a systematic way and should include serological testing.
There are only two known countries so far that have successfully contained an outbreak of Coronavirus — South Korea and China.
China did it without adequate testing — the Chinese themselves believe it was a combination of central quarantine, lockdown, mask wearing and sanitation policies.
The other aspect is testing can be used in two ways.
(1) for surveillance — to decide if there is an outbreak and policies like a lockdown need to occur. For that, the number of tests needed a tiny. San Francisco decided to lockdown based on the results of 180 tests.
https://hotair.com/archives/john-s-2/2020/04/03/study-prompted-first-county-wide-shutdown-u-s-plus-californias-testing-backlog/
(2) as part of the strategy to contain spread between individuals, so called “test and trace”. Someone tests positive, and you isolate and test every person the patient could have infected.
For doing (1), performing 100000 tests / day is an order of magnitude more than what is necessary. For (2), even 10 million / day may not be sufficient.
But (2) is becoming the main strategy based on South Korea.
But here’s the rub, Singapore which is the other cited example for doing test and trace — just went into lockdown due to increasing spread. I think it is a clear warning the coronavirus is too contagious for “test and trace” to work as a primary strategy.
“I don’t understand why I get pushback here when I mention testing when testing is a primary source of information when it comes to an epidemic.”
Because it is perceived as criticism of Trump. The guy who said “if you want a test you can get one”.
I think people forget a couple of things about S Korea. First, they did a lot more of a shutdown than is thought. Second, in the culture it is normal to wear a mask if you feel sick.
Steve
Taiwan’s response seems to have been effective as well: 348 cases, of which 9 were new today, and 5 deaths. That one a population of over 23.5 million. But I don’t think anyone is allowed to mention Taiwan.