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But Where Are the Tests?

Terry H. Schwadron

March 12, 2020

I am baffled by why government officials are patting themselves on the back for figuring out adequate medical testing for coronavirus. Actually, I would argue that they have no idea and lack the data to know if the response to date is anywhere near appropriate.

And now I never will, since Donald Trump absurdly wants all information about response to coronavirus made classified.

But then, after listening to Trump making a confusing, defensive address to the nation suspending European travel to the U.S. except with Britain, for 30 days, believing that will stop spread of virus already in this country, I’m not really surprised. Rather than declaring an emergency under the Stafford Act, releasing FEMA and Medicaid to broaden treatment efforts, we’re still fighting the notion that border bans will stop or slow illness.

We have no idea how many people have been tested for the illness or how widespread the undiagnosed virus cases are. We only count the number of people ailing from the illness, and, of course, how many deaths have resulted.

The way the government public health numbers are collected, we know how many tests the White House says have been distributed to state and private labs across the country and how many have proved positive for disease.

But they don’t know what proportion of national or regional population that represents, or even.

So, Vice President Mike Pence goes on television each afternoon to announce solemnly that 1.5 million tests are available today, as compared with none two weeks ago, with millions more on the way. Then Secretary of Health and Human Services Alex M. Azar acknowledges that fewer than 8,000 tests have been given altogether.

In baseball terms, we know how many players got hits but not how many at bats they had, pitches faced, or their batting averages. It’s true that individual games are won by hits and runs, but you need the averages to know how to field a team altogether.


Unlike what we’re seeing in smaller countries like South Korea, where they are report doing 10,000 tests a day, we only give tests to people already reporting themselves as possibly ill.

The patient calls a doctor, who authorizes a test at a private lab, and follows up if the test is positive. Only then do public health investigators dig in to find out who the infected person has had contacted in the preceding two weeks.

Meanwhile, as a society, we’re deciding to shut down industry and commerce, public gatherings and transportation as a logical way to stop potential threat of contagion — without knowing a fuller picture of how the numbers of infection spread or direction.

Even when there is a confirmed virus case, as with the Conservative PAC meeting in Washington, it is not clear that those who came into contact with the individual — potentially including Trump himself, who minimally rode with two or three Republicans who were in contact with that virus-carrying individual, will agree to quarantine themselves.

Shouldn’t we be more widely test those who attended that conference, for example?

On that cruise ship that was held off California, 21 cases were confirmed after 46 tests. But there are 2,600 people aboard and another 1,045 crew. Why weren’t they all tested?

Instead, despite quarantine for some, most of these people will simply go home, where, naturally, they will come in contact with a dozen or so others.

I don’t know enough to come up with a better solution, but it seems clear that we’re drawing real and actionable conclusions from data that is very incomplete.


None of this deals with the cost issues, of course. While the government sat down with health insurers to get them to waive co-pays for these tests, the White House has remained silent about dealing with uninsured, low-income people.

On top of these statistical questions, there remain all kinds of questions about the efficacy of tests, especially in a testing program that had been delayed because the original tests did not work. One report said that while tests have started distribution, the precise chemical needed by labs to extract the testable portion of samples is backlogged in both U.S. and overseas chemical manufacturers.

Another question centered on the need for confirmation tests, meaning that patients were being tested twice, raising further questions about how many have been tested.

Meanwhile, the White House has ordered federal health officials to treat top-level coronavirus meetings as classified, an unusual step that has restricted information and hampered the government’s response to the contagion, according administration officials.

The White House told health officials testifying before Congress to halt their appearances and return to the White House this week.

Robert Redfield, director of the Centers for Disease Control and Prevention, testified that he was unaware of any indication that physical barriers along America’s borders would help halt the spread of the coronavirus in the U.S. — contradicting a Trump assertion. Immigration judges were told to remove informational signs in their deportation hearing courtrooms, only to restore them later.

Now that we have tests, we need to ask ourselves what they are showing.


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