By Jose Orozco
The COVID-19 pandemic has drastically affected everyone and therefore pandemic controls have been put in place. Controlling a pandemic requires testing, isolating infected individuals, contact tracing and quarantining.
But testing has for the most part been openly opposed by President Donald Trump, and only recently has he made the announcement to invest in coronavirus testing.
This is definitely a good move forward, but it is potentially done for the wrong reasons. First off, the reason for these tests is questionable since it seems to be a potential excuse to increase the opening of businesses.
The commentary and actions by the Trump Administration lead one to believe that they are not looking for a lasting solution. There have been no guidelines on how each state should proceed and yet there has been plenty of commentary on how this will allow schools and businesses to open.
Overall, however, this is positive news. Currently, testing is mainly available to those whose lives depend on it. Having more people tested can give us a more accurate interpretation of how we should continue with aspects of pandemic control, like with quarantine.
On Sept. 28, CNN reported that Trump had officially announced his plan to begin the distribution of the 150 million COVID-19 rapid tests by Abbott Laboratories.
“But without detailed federal guidance on how to distribute the tests, states and cities remained divided… on how to best use those types of rapid tests and others for the testing technique known as ‘screening.'”
There are three main tests for coronavirus: PCR, antigen and serology tests.
PCR tests look for pieces of RNA from the virus, antigen tests look for pieces of proteins that make up the virus and serology tests look for antibodies in the blood.
The FDA states that PCR (molecular) tests are “typically highly accurate and usually do not need to be repeated.” On the other hand, antigen tests usually have “highly accurate [positive results] but negative results may need to be confirmed with a molecular test.”
There is an unidentified issue here because Abbott is making antigen tests. Antigen tests can give false-negative results.
The Texas Department of State Health Services states, “It does not accurately rule out those who are not infected.”
This is concerning since negative results can provide a false sense of safety.
It should be known though that these tests are better than serology tests because they are diagnostic. This means that PCR and antigen tests show “if you have an active coronavirus infection.” Serology tests show if you have been infected in the past.
Unfortunately, the way that Abbott’s antigen tests have been promoted is misleading.
It has been presented as a quick way to solve the massive closure problem caused by the pandemic.
CNN reports that the majority of the tests “will be given to states and territories to support efforts to reopen their economies and schools immediately and (as) fast as they can.”
What is more concerning is the lack of structure. The government has already allowed many schools to open without enforcing COVID-19 tests.
This looks like testing is not a priority but opening everything back to normal is.
Indeed, this “pivot by the Trump administration and by the President, who has repeatedly and inaccurately claimed that more coronavirus testing in the U.S. would lead to more coronavirus cases” is confusing.
The President’s recent change of viewpoint is bizarre. Since he has been known to have multiple idées fixes, the cause of his change of mind might be due to the current election. People’s concerns for COVID-19 might have predisposed him to invest.
Notwithstanding his reasons, Trump’s change of pace is beneficial to everyone.
And although this is a good step forward, it is certainly not enough, according to healthcare experts.
CNN explains: “Fewer than 25 million tests are now reported monthly but a basic screening strategy will require as many as 200 million each month –– far more than the 150 million Abbott antigen tests purchased by the government.”
The issue is that tests are not on a one-time basis. They must be taken periodically by every individual. A total of 150 million tests will not do much in the grand scheme of things.
Another concern is for COVID-19 asymptomatic cases. Several politicians seem to think that people who do not show symptoms should not be tested.
Dr. Mark McClellan states, “What we don’t have is a national strategy that we’re actually implementing to get those asymptomatic screening tests to everybody who most needs them right now to reopen schools safely, to reopen the economy as effectively as possible.”
Asymptomatic tests are integral to providing a safer environment for everyone. Not doing so defeats the purpose of testing. We want to stop the virus from spreading, but we do not test those who are infected and show no symptoms?
The lack of a plan from the government creates challenges for each state as they must figure out what to do. Even though reopening businesses is the ultimate goal, it definitely should not be rushed by the government.
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Jose,
Thanks for this very ambitious article. My comment is personal, about the experiences of my now-adult children. It centers on how testing, regardless of type, is only as good as the people who choose to use it.
My daughter is a distance only science teacher. Her partner is a university pathologist. Fairly safe jobs one would think. Wrong! The pathologist’s immediate supervisor had symptoms for at least a week which she attributed to the poor air quality & so did not initially test. When she did test, it was positive. This resulted in the bulk of the pathology department for a major university hospital having to quarantine until they tested negative. 48 hours with an essentially disabled department and who knows how many affected although our family member tested negative.
Fast forward to my son. He is a sports trainer currently employed at a high school. His SO works for an assisted living facility. She works in close proximity daily with this woman who employes very lax masking practices on the job. She tested positive again forcing massive testing and quarantine. My son notified his employer who had no protocol in place at all, but agreed with the plan formulated by guess who? My son in phone consultation with me.
What is the point of this little personal rant?
1. There has been no clear articulation of the nature of the problem from the federal government.
2. There has never been a clear articulation of best practices involving safety precautions for various work situations
3. There has been no national prioritization of the epidemic.
4. There is no presentation of the idea that there is no foreseeable return to “the way things were” that does not involve massive loss of life. No guidance whatsoever on a mitigation strategy that would reward adaptation to our new reality and the spread of practices that provide the greatest safety.
5. Individual states, counties and workplaces have been left to devise their own techniques in a fragmented health care setting.
The results of this lack of a unified, cohesive approach are obvious. And they are not good. Humans being human will act in what they see as their own best short term interests. The two stories illustrate this point. These are busy professional women in high-pressure jobs. They want to do their best. They want to work. And so they minimize or come up with alternative explanations for symptoms or cut corners at work. This is happening all over the nation. These women are not evil, they are doing what they have been taught all their lives. To get ahead you have to be tough. You have to work even when you are not at your best.
I would argue this is a life long learning we are simply going to have to change. We need a kinder, gentler and more outwardly focused approach. We need to adapt to a form of life that is more “other focused”. We need to develop both local and national integrated health care systems. And we need to stop pretending that this particular pandemic, and others that we will encounter will just go away if we ignore them.