We're Testing the Wrong People - The Atlantic - 0 views
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We have a shortage of COVID-19 tests, and we simultaneously have the highest number of confirmed cases in the world. Consequently, not every American who wants a test can get one. Not every health-care worker can get one. Not even every patient entering a hospital can get one.
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To safely reopen closed businesses and revive American social life, we need to perform many more tests—and focus them on the people most likely to spread COVID-19, not sick patients.
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according to the COVID Tracking Project, a data initiative launched by The Atlantic in March, the number of tests performed in the United States has plateaued at about 130,000 to 160,000 a day.
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Rather than growing rapidly—as all experts think is absolutely necessary—the daily number of tests administered in some jurisdictions has even decreased. In New York, for instance, 10,241 tests were performed on April 6, but supply limits forced a huge drop a few days later to 25 total tests.
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Quest Diagnostics, one of the two biggest firms that run tests, just furloughed 9 percent of its workforce. In addition, news reports suggest that, as of last week, 90 percent of the 15-minute tests developed by Abbott Laboratories are idle due to a lack of necessary reagents and qualified personnel
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How many tests do we need in order to safely relax social-distancing measures, reopen nonessential businesses and schools, and allow large gatherings
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Even this has been criticized as insufficient for the task of identifying enough of the asymptomatic spreaders to keep the pandemic in check.
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Current guidelines from the Centers for Disease Control and Prevention give priority first to hospitalized patients and symptomatic health-care workers, then to high-risk patients
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This is an enormous mistake. If we want to control the spread of COVID-19, the United States must adopt a new testing policy that prioritizes people who, although asymptomatic, may have the virus and infect many others.
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We should target four groups. First, all health-care workers and other first responders who directly interact with many people
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Second, workers who maintain our supply chains and crucial infrastructure, including grocery-store workers, police officers, public-transit workers, and sanitation personnel.
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The next group would be potential “super-spreaders”—asymptomatic individuals who could come into contact with many people. This third group would include people in large families and those who must interact with many vulnerable people, such as employees of long-term-care facilities
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The fourth group would include all those who are planning to return to the workplace. These are precisely the individuals without symptoms whom the CDC recommends against testing.
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Symptomatic patients should be tested only in the rare case where a positive test would meaningfully change what type of care is delivered.
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To shift the focus of testing away from the sickest patients and toward the people most likely to spread the coronavirus, we will have to conduct millions of tests a day.
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How can we close this gap between our needs and current capacity? We need a national strategy over the next 10 weeks, one that draws on the many strengths of our research system
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We also need to encourage rapid adoption of the saliva test that now has an emergency approval from the FDA and expedite the approval of tests that require fewer reagents and staff.
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Another promising pathway is to pool many tests and run them together. If a pooled sample tests negative, everyone in the pool is negative. If it is positive, the members of the pool can be tested individually
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A more sophisticated version of this approach uses genetic “bar codes” that make it possible to trace back which of the many samples in a pool was the one that had RNA from the virus, without any retesting.
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How can we get this testing capacity up and running? One idea is for Congress to award in the next stimulus bill, say, $150 million in unrestricted research funds to the first five universities that can process 10 million tests in a week or less
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Another catalyst could be to subsidize businesses that agree to test all their employees as they return to work
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When someone tests positive, officials should identify close contacts, find them, and test them. To do the tracing, we may need to hire 100,000 to 200,000 additional public-health workers.
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This type of voluntary contact tracing is labor-intensive and requires some training, but it does not require highly specialized skills
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If we adopt and follow a coherent plan, we can have a testing regime that keeps us safe without compromising our freedoms