Testing mess leaves Texas in the dark as cases spike

“More than one-in-five Texans who are tested for coronavirus are positive, the worst statewide rate in the country. But the number of people getting tests has plummeted in the last two weeks, which could understate how widespread the virus really is as schools reopen and hospitalizations and deaths remain near record highs.”

“Public health experts say a number of factors may have depressed demand for tests, including long wait times and changing rules for who is eligible and the effects of Tropical Storm Hanna, which battered the southern part of the state late last month and disrupted services near the border with Mexico.
But the biggest reason may be an apparent false sense of security. The drop off in testing coincides with a decline in infections after Abbott ordered people to wear masks, reimposed seating limits in restaurants and closed down bars again. That worries disease trackers who suspect any positive news will breed complacency and make people willing to ignore the possibility they could be infected without showing symptoms. Without widespread testing, new Covid spikes could pop up and go unnoticed.”

“Texas’s drop in testing is part of a larger nationwide trend that’s seen the average number of coronavirus tests fall from more than 800,000 a day in late July to roughly 700,000 over the last week.”

“But the testing problems aren’t all linked to Texans’ behavior. There also are questions about flaws in the state’s data collection that may have distorted who was sick and where. Texas at the end of July had 1 million completed tests whose results had not been assigned to a particular county. Officials are now sorting through the backlog, which could have had the effect of making the tested population appear smaller than it really was.”

“Abbot said testing numbers should rebound in the coming days. There will be a surge in Houston, the governor said, where he aims to test an additional 50,000 people over a 10-day stretch.”

Covid-19 testing in the US is abysmal. Again.

“Covid-19 testing in the US improved dramatically over the first half of 2020, but things now appear to be breaking down once more as coronavirus cases rise and outstrip capacity — to the point that the mayor of a major American city can’t get testing quickly enough to potentially avoid spreading the virus.”

““Basically, two things are happening,” Ashish Jha, faculty director of the Harvard Global Health Institute (HGHI), told me. “One is the outbreaks are getting much bigger, so the amount of testing we need to get our arms around the outbreak is going up. And second, what we did [before] was some tweaking on capacity issues to get ourselves up to 500,000 to 600,000 tests a day, but didn’t fundamentally address the supply chain problems.”
He added, “This was supposed to be the job of the White House. … But they just never have prioritized really building up a robust testing infrastructure for the country.””

“The benchmark of 500,000 tests per day was particularly important, as it was the minimum experts had long called for in order to get the pandemic in the US under control.
But as the country neared that benchmark, attention to testing seemed to plummet. The Trump administration, which had already delegated testing down to lower levels of government and private actors, especially appeared to lose interest: The country’s “testing czar,” Brett Giroir, stood down and went back to his regular job at the Department of Health and Human Services. Trump falsely claimed in May that “America leads the world in testing”; at his Tulsa rally in June, he said he told his people to “slow the testing down” because the rising case count made him look bad. (He later asserted that his statement at the rally was not a joke, despite White House officials insisting it was.)

As all this happened, many of the underlying problems with testing capacity remained.

For one, there’s still a lot of variation between states. While most states, as of July 8, had 150 new tests per 100,000 people per day — the equivalent to 500,000 daily tests nationwide — 18 states still didn’t.”

“Earlier on, the hurdles with testing were linked to supply chain problems: not enough swabs to collect samples, vials to store them, or reagents and kits to run the tests. Over time, those problems were fixed or worked around.
The issue, experts say, is that these kinds of problems were always bound to come back as testing demand increased. Fixing a bottleneck for kits may let the country get to 500,000 tests a day, but that bottleneck can easily come back if, for instance, the nation needs 1 million per day and there are only enough kits for 700,000.”

“labs aren’t sure that making the massive investment for way more tests is financially sustainable, he explained, especially as Covid-19 outbreaks ebb and flow — and, as a result, occasionally deplete demand for those tests, as well as the number of people who need them.

Ideally, the federal government would be in charge of handling these problems. It’s the one entity that can go to labs across the country, see what the holdups are, then work along the global supply chain to see what can be done to address the issues. It has the funding ability to ensure labs and suppliers remain whole. And it can prioritize limited resources to specific cities, counties, or states that need them most, instead of leaving these supplies to a free-for-all.

This is, in fact, what the federal government does with other issues — such as when it ensures that a manufacturer has all the parts needed for an order of guns, tanks, or jets.”

“The Trump administration, however, has described the federal government as a “supplier of last resort.” That’s very different from the kind of proactive approach the feds take on other issues to get ahead of supply constraints.

So the problem is left to private actors as well as local and state governments, which often face legal, financial, and practical constraints that hinder their ability to move quickly. And the problem persists, even as Covid-19 cases continue to rise.”

“Lockdowns, however, were also supposed to buy the nation time to build up its testing system. As Natalie Dean, a biostatistics professor at the University of Florida, previously told me, “The whole point of this social distancing is to buy us time to build up capacity to do the types of public health interventions we know work. If we’re not using this time to scale up testing to the level that we need it to be … we don’t have an exit strategy. And then when we lift things, we’re no better equipped than we were before.”

It’s now clear that the US didn’t take full advantage of the time it bought with lockdowns. While testing did dramatically improve compared to the early days of the pandemic, it’s still not at a point where America can handle the higher demand brought on by another surge in coronavirus cases.

“It’s pathetic. This is not how a first-world country functions,” Jha said. “That people should not expect to access a test to an infectious disease many, many months into a pandemic — I find myself amazed that this is where we are as a country.””

Trump baselessly claims Covid-19 testing is “overrated” and people wear masks to spite him

“The US has conducted about 72 tests per 1,000 people, according to Our World In Data. That’s a lower rate than Portugal or Russia or Iceland and about the same as Australia and Italy. Good but hardly warranting “greatest of all time” designations. The number of tests in the US that are coming back positive also suggests we are still not adequately surveilling Covid-19 compared to European countries.”

“When you conduct more tests, you would expect the positive test rate to go down, because along with some more positive tests, you would get many more negative ones. So experts are concerned because in states like Arizona and Florida and Texas, the positive test rate is actually increasing. That is what suggests increased spread of Covid-19 is behind some of rising case numbers — not simply more tests being conducted.”

Mission Creep and Wasteful Spending Left the CDC Unprepared for an Actual Public Health Crisis

“Over the past three decades, the Centers for Disease Control (CDC) has seen its taxpayer-funded budget doubled. Then doubled again. Then doubled again. And then nearly doubled once more.

But spending nearly 14 times as much as we did in 1987 on the agency whose mission statement says it “saves lives and protects people from health threats” did not, apparently, help the CDC combat the emergence of the biggest disease threat America has faced in a century. In fact, a new report argues, inflating the CDC’s budget may have weakened the agency’s ability to handle its core responsibility by giving rise to mission creep and bureaucratic malaise.”

“In addition to combating dangerous infectious diseases like HIV and malaria, the CDC now also studies alcohol and tobacco use, athletic injuries, traffic accidents, and gun violence. While those things can indeed be important factors to public health, Minton notes, they don’t seem to fall within the agency’s original mission.”

“when the coronavirus did hit, the CDC only confirmed that it should not be trusted to make important decisions by forbidding private labs from developing tests for COVID-19. The federal agency’s monopoly on testing supplies produced inaccurate tests that had to be discarded en masse.

The initial testing delay has certainly cost lives. It is also at least partially to blame for the severe quarantine policies that have tipped the American economy into a deep recession—without adequate testing, there was little else for policymakers to do except close the country in the hopes of slowing the disease’s spread.”

America’s coronavirus testing numbers are really improving — finally

“Over the past couple of weeks, the United States has seen significant improvements not just with the raw number of Covid-19 tests but also with other metrics experts use to gauge the scope of the US’s coronavirus outbreak and its testing capacity.

During the week of May 5, the US averaged nearly 300,000 new coronavirus tests a day, according to the Covid Tracking Project. That’s nearly double the roughly 150,000 daily tests performed in early April, although it still falls short of the number of new tests a day experts say is needed to fully control the outbreak — a number that ranges from 500,000 on the low end to tens of millions on the high end, depending on which plan you’re reading.”

“Over much of April, testing numbers stagnated due to supply shortages for swabs, reagents, and other materials needed to collect samples and run coronavirus tests.

Experts have said that the federal government, led by President Donald Trump, should lead national efforts to boost testing. But Trump’s “blueprint” for testing explicitly leaves the problem to the states and private sector, saying the federal government will only act as a “supplier of last resort.””

” With overall cases, the country as a whole has seen its daily new reported Covid-19 cases drop in May. But much of that decrease originated in Connecticut, New Jersey, and New York — the three states included in the New York City metro area, which suffered the worst outbreak. When those three states are excluded, the US has seen daily new Covid-19 cases at best start to drop only in recent days — far from the two weeks of decreases that experts recommend.”

“Some of the upward trend in Covid-19 cases outside Connecticut, New Jersey, and New York in recent weeks is likely due to increased testing.”

“Taken together, these figures suggest that the majority of states are not ready to start to reopen just yet. While America has made decent progress throughout May in confronting the challenge of this pandemic, there’s still a bit more work to be done.”

Dr. Fauci Has Been Dreading A Pandemic Like COVID-19 For Years

“At the time, I didn’t find this quote particularly earth-shattering. It seemed like a reasonable concern, but not newsworthy. After all, Americans have lived through multiple pandemic scares — SARS, MERS, swine flu — and we largely dodged each bullet. This part of the interview was off-topic for the series I was making, and I left it on the cutting room floor.
Reading the transcript almost a year later, I am struck by how clearly Fauci described this current pandemic. Our nation’s top public health officials have known that this outbreak, or something like it, was a serious possibility, and they haven’t been keeping this information to themselves. But it’s hard to find the collective will to prepare for — and stop — a theoretical threat. COVID-19 may be unprecedented, but it wasn’t unpredictable.”

Could contact tracing bring the US out of lockdown?

“experts in contact tracing, and also in infectious disease, have forever believed and argued that contact tracing does not work with a respiratory disease. And the reason experts told us that contact tracing would not work with respiratory diseases is that respiratory diseases spread too easily — air is a lot easier to come into contact with than someone else’s blood — and that they also spread too quickly. So from the get-go, this country has not even attempted to do serious contact tracing. We didn’t try it in the first cases in the state of Washington. We didn’t try it after cases appeared in California, [we] certainly have not tried it since cases appeared on the East Coast. And in addition, contact tracing is immensely laborious. You need an army of thousands of people to do it.”

“In South Korea, in particular, in Singapore, both of which had very, very early cases, not surprising given their proximity to China, that’s what they did. Those countries did contact tracing. It worked. And suddenly that opened the eyes of experts who said, no, no, it could never be done.”

” You know, just as with the recognition that face masks actually can help, all sorts of assumptions about respiratory diseases are being rewritten and, in fact, overturned as a result of what we’re seeing in this pandemic.”

“we can have an exit from the very strict social distancing [and] physical distancing that we’ve had for the last month and a half. You know, whether it’s the governors talking about how to figure this out, testing and contact tracing is at the center of all of those plans. And the sequence is, test, in other words, you have to identify people who carry the virus, trace their contacts, you isolate people, and you hope that works.”

“there’s not going to be a vaccine in this calendar year.”

“here’s the problem. As we were saying earlier in the experts’ objection to contact tracing for a respiratory virus, it has to be done fast. On average, to identify a person’s contacts — just to identify them, let alone to track them down — takes something like 12 hours of asking, “Where were you? What were you doing? What was it like there?” So that’s an average.”

“The estimates are that the United States would need at least 100,000 tracers, possibly as many as 300,000. And, of course, we’re going to pay these people and value them and encourage them. So, you know, you’re probably looking at … upwards of 3.6 billion … dollars just to do that. And absolutely, it’s worth it. But that’s the order of magnitude that you’re talking about in terms of effort.”

“The technology that’s being discussed can be basically instantaneous. The way many of these systems would work is, again, you opt-in. And the opting in means that … you would … get an alert saying, “Yes, you came into close contact with someone. We think you should now isolate yourself for 14 days.” If you can get through those two weeks without symptoms, then that casual passing by the person did not infect you. That can be done virtually, instantaneously — certainly, you know, faster than human contact tracers. And the hope is that by doing it that quickly, you can snuff out any transmission chains that might crop up.”

“Singapore, South Korea, they used everything from security camera footage to smartphone tracing. Israel rolled out a system like this. What’s important to remember is that success does not mean zero cases. Success means that we do not have another instance where we overwhelm our hospitals and have the horrible situations that we’ve all seen, in especially New York hospitals. Bottom line, you can have way, way less than 100 percent opt-in and still have a really good chance of catching any incipient new infections after we’re over the current wave.”

South Korea has brought its reported spread of coronavirus infections to single digits per day

“The reduction of new cases in South Korea is a striking achievement for a country that earlier this year had the largest number of confirmed cases in Asia outside China. On February 20, confirmed infections skyrocketed exponentially after a parishioner of a megachurch in the southern city of Daegu infected other congregants during services, but the government’s aggressive testing and contact-tracing regime seems to have played a significant role in counteracting this rapid spike in cases quickly.”

“Experts say there are a number of measures it’s taken to achieve its results, including building a highly organized and massive testing capacity, and the government institution of tracing and isolation measures for people who have been in contact with the infected.

Notably, South Korea has generally avoided the wide-scale shutdowns that China and the US have pursued, according to Business Insider. It has shut down schools and imposed a curfew in some cities, but the government has sought primarily, in a highly targeted fashion, to isolate groups of people who are suspected to have been exposed.”

“the government organized mass production of coronavirus test kits earlier than many other hard-hit countries, which meant that in late March the country had a per-capita test rate “more than 40 times that of the United States.””

“South Koreans’ cellphones vibrate with emergency alerts whenever new cases are discovered in their districts. Websites and smartphone apps detail hour-by-hour, sometimes minute-by-minute, timelines of infected people’s travel — which buses they took, when and where they got on and off, even whether they were wearing masks.
People who believe they may have crossed paths with a patient are urged to report to testing centers.

South Koreans have broadly accepted the loss of privacy as a necessary trade-off. People ordered into self-quarantine must download another app, which alerts officials if a patient ventures out of isolation. Fines for violations can reach $2,500.”

“South Korea’s management of the spread of the virus does not mean that it’s out of the woods. Places like Hong Kong and Singapore have seen resurgences of cases, in part due to people entering the country from abroad. But South Korea does seem to have some tools — and a plan — in place to manage the spread for now.”

Why the national stockpile wasn’t prepared for this pandemic

“One thing that happened is that after the 2009 H1N1 pandemic there were a lot of masks distributed to states and localities and they simply weren’t replenished. Then there was a plan to purchase thousands more ventilators. A contract was signed with a small medical equipment company in Southern California. That company was then bought by a different medical equipment company, and in the end the contract wasn’t fulfilled. The new ventilators never came in.
So there are these matters of prioritization and inattention that can affect whether in fact we have the supplies that have been recommended in the stockpile.”

“There’s a key period that a lot of people are now focusing on, which is late January to mid-February. This is a point at which we were already aware of what had happened in China, and the World Health Organization had declared Covid-19 a “global health emergency of international concern.”

That was really the time to consider whether we had the supplies we needed of these essential items and to figure out whether the stockpile needed to be replenished rapidly and do whatever it took to make sufficient supplies available — whether that meant purchasing supplies from other sources or even using the DPA to force manufacturers to shift to production of ventilators, for example.

So even if it had not been replenished prior to this administration, there was a chance to do a better job at the outset.”