Is America doomed to endless lockdowns and rising COVID cases?
The answer is yes, unless we dramatically change our broken testing system.
Nearly a quarter of a million Americans have already died as the virus continues either growing or treading water in all 50 states
It will be many months until an effective vaccine is available to the general public
A recent survey of more than 50,000 Americans reveals the abysmal state of testing and contact tracing in the U.S.
We are now in month nine of the coronavirus crisis in the United States. After infiltrating the country through asymptomatic travelers last winter, COVID fully struck the American people in the beginning of March. Life as we knew it came to an abrupt halt as schools, businesses, restaurants, houses of worship, and many other staples of normalcy closed their doors overnight. What started as a short term situation with a shelter-in-place solution has spiraled into an unprecedented public health calamity with no end in sight.
In the beginning, tests were so scarce that it was almost impossible for most Americans to access them unless they were in the ICU and actively displaying COVID symptoms. State after state erupted with COVID outbreaks, and case numbers in the United States quickly overtook those in China, Italy, and other early hotspots. As the death toll climbed, the economy imploded, and the gravity of the situation sunk in, it became apparent that the United States was losing the fight to control the disease.
That was in the spring. We now find ourselves in the middle of a dreary fall, with the colder weather aiding the spread of the virus by forcing people to cluster indoors. Various commentators have spoken of a first, second, or third wave of COVID, but the reality is that the United States never came up for air after the initial wave that began in March. As I write this, America has again broken its own record for the most new daily COVID cases, with well over 100,000 confirmed just yesterday. Nearly a quarter of a million Americans have already died from the disease, and the virus is either treading water or actively growing in all 50 states.
In the country with the most developed biomedical sector in the world, how on Earth has it come to this?
The answer is complicated and multifaceted, but a large share of the blame can be placed on inadequate COVID testing and outbreak management infrastructure. The long asymptomatic period and extremely broad variety of symptoms experienced by COVID patients make the disease uniquely difficult to contain without data from comprehensive rapid testing. In the absence of such data, policymakers have few tools besides blanket rules prohibiting interpersonal contact, which are only halfheartedly obeyed and enforced. While this was understandable when the disease was breaking news, it is inexcusable that the same issues are still vexing us today.
On October 16th, a joint study conducted by a consortium of researchers from Harvard, Northeastern, Rutgers, and Northwestern Universities laid bare the lackluster state of COVID testing in the United States. Between July and September, researchers spoke with over 52,000 Americans from every state and territory and asked them about their COVID testing experiences. Of this sample, 13,000 reported getting tested for COVID. 9,000 of these respondents received nasal swabs. Due to the accuracy of this type of testing, these 9,000 individuals became the subject of the consortium’s study.
The data produced by this study was collected and weighted in a manner which accounts for factors such as age, race, gender, and urbanization so as to accurately reflect the country as a whole. The findings, summarized in a very readable report, are extremely concerning. Here are some key takeaways:
On average, August and September respondents reported that 6.2 days elapsed between making the decision to get tested for COVID and actually receiving their test results.
This period can be broken down into two roughly equal blocks – 2.5 days to access COVID testing services in the first place, and a further 3.7 days to see their results.
A significant racial disparity exists among respondents. African American and Hispanic respondents reported substantially longer wait times than their White and Asian counterparts across all survey months.
Contract tracing isn’t even being attempted in a startlingly high fraction of positive cases. Only 56% of respondents who tested positive for COVID report being contacted by tracing staff of some kind.
As if all that wasn’t bad enough, consider that in September – a full six months after COVID was declared to be a global pandemic – 8% of respondents reported that they wanted to get a COVID test, but were unable to. This amounts to about 4,200 people. Of these, 29% said that a medical professional told them they didn’t need a test, 31% didn’t know how to get tested, 29% said wait times were too long, 23% said that test sites were too far away, and 14% said that testing was too expensive.
It should be apparent to all that this testing paradigm is totally incapable of supporting any sort of modern outbreak management strategy. Accepting a 6.2 day testing timeline is tantamount to waving a white flag at COVID while it ravages our population. With winter weather closing in and several months or even years left before an effective vaccine is widely available, how is the United States ever going to get better?
The answer requires us to imagine an utterly different form of testing and tracing that’s unlike anything we’ve ever seen before. Kert Sepkowitz, a physician and infection control expert, vividly explained the challenge facing us in a recent opinion column for CNN:
“…the basic principle for controlling the Covid-19 pandemic is the same as for every infectious disease: it is necessary to have a rapid and reliable test to identify who is potentially infectious. Otherwise we are simply trying to swat flies in a pitch-dark room, hitting and missing, missing and hitting, with no hope of knowing anything at all about the effectiveness of our efforts.”
It is clear that we need a radical departure from the reactive, belated, and irregular testing regime that has dominated thus far if we are to avoid swatting at flies in the dark. As a country, it is time for us to critically think about what we have done wrong so far and begin considering some truly fundamental changes in how we test people for this disease.
We need truly rapid tests, not tests that take an average of three days to process. Same day results are needed for contact tracing to work, and instant results would be even better. Furthermore, why should patient samples need to be collected in-person by healthcare professionals and physically shipped to a laboratory for testing? A system that compels potentially sick people to congregate at physical locations is outdated and inconsistent with our knowledge of how COVID spreads. Ideally, COVID tests should be simple and easy enough that untrained patients can self-administer them, with triage-level results available in the comfort of their own homes.
The analog era is over for most people, but it persists in the world of contact tracing. Why are we relying on flesh and blood humans to call people on the phone when instant, digital communication has been the norm for years now? Our COVID tests must be compatible with modern communications networks in order to easily share results and connect patients to telemedicine services in real time.
The truth is that we’re only at the halfway point of this pandemic at best, which means that there is ample time to build better tests, develop better outbreak management infrastructure, and save many, many more lives. C2Sense is attempting to rise to this challenge, as are scores of other companies around the world.
As scientists, doctors, engineers, and politicians consider our testing problem in the months ahead, they must know that success will not look like a slightly improved version of what we have now. In order to contain and reverse the spread of COVID, we must dramatically raise our testing standards and work to rapidly develop and implement modern, lightning fast testing solutions.
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