Coronavirus Testing in the US is Insufficient and Needs Improvement
A daily Covid-19 update from Andy Slavitt, former head of the Centers for Medicare and Medicaid Services
In my 53 years of seeing dumb things, defunding the World Health Organization (WHO) in the middle of a global pandemic, is the winner.
Since Trump decided to cut funding for the WHO, I decided I’d like to know what they do and what our contribution goes for. I called the head of one of the world’s most prominent foundations to get a breakdown.
WHO has a two year budget. We fund both membership and voluntary contributions that go for things like:
- Eradicating polio ($75M/year)
- Child & maternal health ($75M/year)
- HIV & TB ($50M/year)
- Outbreak monitoring ($75M/year)
You know, highly optional things. And vaccines. Which I for one am in favor of.
WHO did not do a great job with Covid-19. Oh, if only they were the only ones that had guilt. But they’re not. Casting blame is important to Trump in the middle of this crisis. We all understand that. It just means more casualties.
I also wanted to learn more about testing. I talked to three scientists, two lab CEO’s, one FDA expert, one White House person, three people in government agencies, and three different states. I had some questions:
Why don’t we have enough swabs?
- The swabs we need come from Lombardi, Italy. Yes, that Lombardi, Italy.
- The Federal government is airlifting them out.
- The states I talked to aren’t getting nearly enough.
What’s so magic about these swabs? Well, there’s an FDA paper saying the Roche machines need these swabs. Do they? Not according to the Gates Foundation. They swear they don’t. What I learn is that the labs don’t want to violate the FDA, and the FDA has been too busy to respond to the Gates suggestion. In the meantime, swabs must be sourced from Italy. People are calling the FDA tomorrow.
Others I called agreed the swabs from Italy are not required. But let’s say they are. They can be spec’ed and manufactured here in the US. A 3D printer required and they would need to be sterilized — I’m pretty sure we can do both. Bottom line is that this is a solvable problem.
Why is testing declining?
The biggest lie being told by the White House is that we have enough tests. All symptomatic people are not being tested. Most states don’t have enough for their nurses. We certainly don’t have enough to contact trace. The virus spreads and we remain ignorant.
There are government agencies hard at work on how to create the ingredients and kits at scale. That I can’t say more about. I don’t really know much more to be honest.
There’s actually a machine that can do 10x the volume of current tests — I’m hearing up to 10k/day each — but it is very inexpensive. The FDA is set to approve. There’s a catch — some of the big money making labs can’t make as much money and they don’t like it. If this turns out to be true, I will name names and they can defend themselves. The big labs are now going slower not faster while Trump hollers to open the country.
So, we’ve asked the FDA to go fast. And we complain when they don’t. So they’re giving EUA’s (emergency use authorizations) to a lot of tests that normally wouldn’t meet their standards. But we can’t have it both ways. There needs to be a lot of buyer beware.
So here’s a fact that will stun you. It turns out most tests are being done on whiter and richer populations. And those that need the most tests are, yes, poorer populations and people of color. The more tests we get, the more they will go to people who don’t need them.
Why are there so many bad tests?
Turns out that PCR tests have only 70–90% sensitivity (10–30% false negatives). But very good specificity — extremely low false positives. If they tell you you have it, you do. If they tell you you don’t, or you’ve been cured, take it again. This has something to do with epigenetics.
According to the person who told me about epigenetics, looking at RNA in your snot was like chasing a ghost. And there is a new kind of test that instead of looking for the RNA, it tests your bodies reaction to the virus. That test, he said, is much more accurate.
Now for the antibody tests which are supposed to tell you if you have immunity. The good news is if the test indicates you don’t have immunity, it’s probably right. But about half the people the test says have immunity actually don’t. There is an approved test that does better.
What treatments are being developed?
There are 621 trials going on for anti-viral treatments. The scientist I heard from thought plasma was by far the most exciting and promising. They also believe it would help lead to a vaccine.
Many trials are drugs or combinations that failed other viruses or are used for other things. Few things have worked with Covid-19 in a double blind trial yet. But doctors are trying whatever they can.
Most things they can only try on people with advanced illness. They strongly believe many work on people with early illness (like Tamaflu) but to know that we would need to diagnose people earlier. Which means more testing. Which brings us back to the same challenges.
This story is pulled from my daily COVID-19 updates on Twitter
