The U.S. Can Still Curtail Coronavirus But Only With Better Testing

(Bloomberg Opinion) -- It is not too late to stem the predicted tide of Covid-19 in the United States. The key is getting widespread testing in place immediately.

Shanghai’s remarkable success at curtailing the coronavirus shows how successful testing can be: As the disease spread to thousands in nearby Wuhan, modelers around the world predicted that the dense megacity of Shanghai would soon see 800,000 to a million cases. As of Saturday, it had vastly defied all predictions with the city’s population of 30 million showing a total close to 300 cases and as of last weekend, two deaths.

But America’s ability to follow suit has run into some unexpected hurdles. Researchers are scrambling to get enough key components of the test, from the media needed to extract samples to the reagents needed to analyze results. In my state of Rhode Island, the already-glacial pace of testing was stopped for a more mundane reason — they ran out of swabs.

We have to put first priority on fixing these problems.

The next priority should be getting tests to the right people — not just to the sick, but to healthy people who might have been exposed. Results released from a massive testing effort in an Italian town show that people with no symptoms are likely to be spreading the disease. Doctors there found that about three percent of the population came up positive, and only half of those had any symptoms of illness. What’s still unknown is how many people, including children, may never get sick but spread the disease to others.

Experts predicted in early February that the U.S., where government-mandated lockdowns might be difficult, would need to rely on testing and contact tracing to identify and isolate people with the disease before they could spread it to others. What nobody anticipated was the complete failure of the government to roll out testing, the faulty tests issued by the CDC and the failure to allow rapid private industry tests.

Those failures are now why we’re seeing such aggressive public health measures, says Barry Bloom, a professor of public health at Harvard University. We’re hoping to bend or flatten the curve, as the catchphrase now goes. “But we don’t know where the curve is going,” or how current measures are working, he says. Still, if we can start testing, “I don’t see any reason why the levels have to get out of control.”

One caveat: in Shanghai, those who tested positive were taken to a special “fever hospital” where they could get non-urgent care if they needed it — and stay out of circulation. That would be hard to duplicate in the U.S., says Bloom. Here, we’re telling people who might be positive to stay home. “That means …it’s likely to go everyone in the household.”

Nonetheless, it’s essential to fix the testing problem, fast. Commercial tests were finally approved by the FDA on Monday. The companies making them, Roche and Thermo-Fisher, are planning to roll out hundreds of thousands in the coming weeks. According to a story in Wired Magazine, Thermo-Fisher plans to scale up to 5 million tests a week by April.

It’s taken so long for the private sector to get going because U.S. regulators failed to change accuracy standards, which, says Bloom, were set at a very high level. That’s appropriate for something like HIV testing, he says, where false negatives or positives can upend lives.  

But now, time is of the essence. In China, scientists realized the perfect was the enemy of the good. The tests used in China and other parts of Asia were around 90% accurate, says Harvey Rubin, an infectious disease expert at the University of Pennsylvania. That’s good enough.

The Covid-19 test works much like DNA fingerprinting used in forensics but with one catch — the virus caries its genetic information in RNA, which is a much more delicate molecule than DNA. “They can get DNA from a woolly mammoth,” says Rubin, and it will be intact, while RNA will fall apart if not in just the right kind of medium, and that medium is now in short supply.

Once the test kits are out there, they need to be free, and the results need to be coordinated.

Then we can finally start attacking this disease scientifically.

Stanford University professor John Ioannidis, who has long been a proponent of more evidence-based decision making in medicine, criticized the U.S. approach to Covid-19 today in an opinion piece for the medical website STATnews. “With lockdowns of months, if not years, life largely stops, short-term and long-term consequences are entirely unknown, and billions, not just millions, of lives may be eventually at stake,” he wrote. “If we decide to jump off the cliff, we need some data to inform us about the rationale of such an action and the chances of landing somewhere safe.”

It’s true that it’s very hard to make rational decisions without data — but to get that data, we need testing. We already have enough information from China and elsewhere to make educated guesses about where this could be headed. And one thing that the current data, flawed as they are, tell us: We need to put all resources possible into getting better data.

This column does not necessarily reflect the opinion of Bloomberg LP and its owners.

Faye Flam is a Bloomberg Opinion columnist. She has written for the Economist, the New York Times, the Washington Post, Psychology Today, Science and other publications. She has a degree in geophysics from the California Institute of Technology.

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