A Neglected Point about COVID-19 Testing

There’s an excellent New Yorker article about the failure to provide enough tests to detect COVID-19. Here’s a point I haven’t seen made elsewhere, but that is really crucial (boldface mine):

The public-health-laboratory network was never intended to provide widespread testing in the event of a pandemic. To offer tests to anyone who wanted them, as President Trump did, on March 6th, was always going to require commercial testing facilities to come on line. Still, the three-week delay caused by the C.D.C.’s failure to get working test kits into the hands of the public-health labs came at a crucial time. In the early stages of an outbreak, contact tracing, isolation, and individual quarantines are regularly deployed to contain the spread of a disease. But these tools are useless if suspected cases of a disease cannot be tested. The void created by the C.D.C.’s faulty tests made it impossible for public-health authorities to get an accurate picture of how far and how fast the disease was spreading.

Public health departments, when it comes to testing, don’t have the capacity to test millions of people, any more than public health departments (including the CDC) would be able to perform the daily burden of antibiotic susceptibility testing (‘AST’)–determining if bacteria are resistant to certain antibiotics. At that scale, AST occurs at either the individual facility or large-scale commercial facility level. That doesn’t mean public health departments don’t know how to do AST, or are unable to do so. When carbapenem-resistant organisms were first observed, and testing methods hadn’t really been mass produced yet, public health labs did this work (now, it has been commercialized and distributed).

The key thing, however, is that carbapenem-resistant organisms were very rare initially. By contrast, a public health lab couldn’t handle even the daily AST requirements of a single large city without diverting other services.

This is why the testing failures, which at a broad level can be laid at the Trump administration’s feet, is so devastating. It’s not just that we lost the chance to contain this virus, it’s that we lost weeks in which the test could have been broadly distributed–and to be clear, this wasn’t just due to reagent problems, but also regulatory ones, problems that an involved president could have removed (the executive branch routinely defies Congress and the law, yet, when speed was of the essence, FDA regulators were able to prevent approval of desperately needed testing).

Finally, this is what happens when people running the country don’t understand the capacities of the institutions they purportedly run.

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