Testing for disease takes many forms and may utilize a number of methods. COVID 19 testing is no different. However, like the media fails to make the distinction between legal and illegal immigration when they discuss the topic, they are failing to explain the nuance in medical testing. All of the information about the current activities of the Coronavirus Task Force were contained in the daily press briefing that have occurred on Saturday and Sunday.
Screening Tests
Let me start with one example that I hope will make what is going on more clear. Forgive me if I gross you out, but it is illustrative. If a patient has symptoms of a urinary tract infection, they go to the doctor. The pee in a cup. In a fairly short period of time the doctor comes into the room. They tell the patient they do indeed have a urinary tract infection. Then the doctor prescribes an antibiotic that is effective against a large number of bacteria that commonly cause urinary tract infections.
The patient received a screening test in the doctor’s office. We have these for common viruses like seasonal varieties of the flu and strep throat. We do not have a test like this for COVID 19 yet. According to Dr. Birx, the Coronavirus Task Force Coordinator, an effective in office screening test for the virus is probably six months away.
Laboratory Testing
What you may not know, is the urine sample is then sent to a lab to be cultured. The bacteria is identified. This ensures the antibiotic you received will effectively kill the specific bacteria causing your infection. The doctor changes your medication if it is not effective for the bacteria that was found.
The part of the sample that is sent off to the commercial lab is evaluated in a high throughput test. This test is automated to identify a specific bacteria or virus. It does this by looking for specific markers such as unique proteins. Depending on the test, this can take hours or several days. This is where we are heading this week with COVID 19. In order to conduct tests at the volume required for people displaying COVID 19 symptoms, an automated test had to be developed and distributed to the high volume commercial labs.
Because the symptoms of COVID 19 can mimic an allergy attack, a cold or the the flu, the volume of potential subjects needing to be tested far exceeded the capability of the manual tests the CDC, state labs and university labs were conducting. This has been explained in painstaking detail by the Task Force. Yet the media is not explaining this nuance to you.
Manual Testing
By the coverage you would think the same test the CDC was doing just needed to be given to the commercial labs. This is simply untrue. The CDC had the capacity to process only 40-60 tests a day using the manual method. State and university lab capacity would be about the same. They were operating under the Flu Surveillance Program until the regulatory structure was relaxed in short order to pursue more innovative solutions. The previous protocol was simply not adequate for the current challenge.
The development of an automated high throughput test will exponentially increase this capacity as they come on line this week. According to the Task Force press conference, the development of this test has been underway for a period of weeks and received approval from the Food and Drug Administration in an astounding five hours.
It is in the process of being distributed to 2,000 of the largest commercial labs. The predicted turn around time is 24 hours through the automated test. It was several days not including transport through the CDC, state and university labs. Yes, there was an issue with the testing media in some of the initial CDC tests. That was weeks ago and continuing to conflate this with where we are today is dishonest and deliberate.
Large Scale Testing
In addition to the high through put tests, the Public Health Service in conjunction with FEMA has developed a detailed plan to conduct the tests at scale. These testing sites will roll out first in the areas with the most community spread. Then they will roll out nationally. In a historic public-private partnership, corporations like Walmart and Walgreens will devote portions of their parking lots to set up testing sites.
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This serves two purposes. First, it helps prevent further spread by not requiring people to enter waiting rooms and hospitals to be tested. It also helps prevent stress on the healthcare system by distributing testing facilities broadly and off-site. In those areas that have conducted a large number of tests, the COVID infection rate is between 1-2% of tests. If 100% of those tested arrived at a hospital, the wait would be hours. It would also interfere with emergency care for patients with other health issues. The infected 1-2% would also be exposing much larger numbers of people if traditional health sites were uses.
Other Good News
The Task Force has learned from the experience of other nations that experienced outbreaks prior to the United States. Health and Human Services Secretary Alex Azar has been granted emergency authorities by the President to manage the crisis. The HHS has a complete inventory of the healthcare assets we have, including those held by Department of Defense and other agencies. We are protecting our healthcare facilities and personnel by taking testing off site. However, Azar says we must plan for the worst in any event.
Most of the patients with COVID 19 will not require hospitalization or specialized care. Azar said one learning is to limit the number of facilities where these patients are housed. This may include community hospitals and even mobile hospitals or MASH units used by the military. This limits the need to protect uninfected patients and limits the number of healthcare providers who could be exposed.
In addition vaccines are in various stages of testing in Israel, Australia and the United States. This is happening in record time. Three medications are also already in use to help mitigate the symptoms of the infection. One is a new medication developed for SARS 9 (also a coronavirus) that is being used off label for COVID 19. The other two are generic medications that have been used for years to treat malaria and severe inflammation.
Please Listen to the Experts
As testing rolls out, not everyone needs a test. If you are asymptomatic, the task Force asks you to follow the guidance put out by the CDC and your state and local governments. This is so those in the most vulnerable populations can be tested quickly and efficiently. Also, our supply chains for food and other necessary items are intact. Both the Task Force and the executives from the retail groceries are asking everyone to do normal weekly shopping. Store hours may be modified to provide for deep cleaning and stocking, but they will remain open.
With increased testing, we will see an increase in the number of cases. This makes sense as testing scales up to cover large portions of the population. This was seen in every country that has scaled testing and you should not be unnecessarily alarmed if you see sensational coverage.
The Coronavirus Task Force is full of career professionals who have been working to protect public health for decades. They are giving daily press conferences to update Americans that may not be broadcast on news channels. However, you can go to the White House Youtube channel and see if a press conference is scheduled for today and set a notification so you may watch.
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