Bringing Testing to People

One point I try to make on the Twitter machine and on this crappy blog is that we need to bring testing to people. It’s not enough to have the ability to conduct X number of tests, if that capacity is never actually used to test the people we need to test (boldface mine):

To get out of this pandemic, we need fast, easy coronavirus testing that’s accessible to everyone. From the way people often talk, you might think we need a technological breakthrough to achieve this. In fact, we don’t have a technological problem; we’ve got an implementation problem. We could have the testing capacity we need within weeks. The reason we don’t is not simply that our national leadership is unfit but also that our health-care system is dysfunctional…

To fix testing, we have to accelerate two lines of operation: test collection and test processing. The primary challenge of test collection—sticking a fifty-cent swab in someone’s nose—is last-mile logistics, which can be more intricate than most realize. You’ve got to manage people flow; it can be a challenge just to find locations where potentially infectious people can turn up without infecting others. Then there’s the flow of supplies, which involves having adequate quantities of the swabs and tubes that your particular lab requires, plus the personal protective equipment required for the staff. There’s the information flow—gathering and linking a patient’s information, the provider information, and the bar code on the specimen tube in a way that the laboratory can deal with. And there’s the financial flow—figuring out the billing system required to get reimbursed by the correct payer, which, for a particular person, could be Medicare or Medicaid, a private insurer, an employer, the state, the patient herself, or any number of other sources. Running a test-collection operation can be a nightmare for scores of reasons. You have to navigate supply shortages, neighborhoods that object to having lines of cars turn up at a pharmacy or clinic parking lot, business-insurance plans that may not cover you if you provide testing, and building owners with liability concerns. You may be unable to use your label printer and computer system if there’s no Wi-Fi in the parking-lot drive-up location you’ve picked…

Yet we have other laboratories with large amounts of untapped processing capacity ready to provide next-day results. In July, for instance, I visited the Broad Institute, a large academic laboratory affiliated with M.I.T. and Harvard, in Cambridge, Massachusetts, which has provided coronavirus testing for area hospitals, clinics, and others. As Sheila Dodge, the senior director of Broad Genomics, explained as she walked me through its molecular-testing operation, they had the capacity to process up to thirty-five thousand tests per day. With a few weeks’ notice, they could expand that to a hundred thousand a day—more than fifteen per cent of the nation’s current capacity. But, when I visited, they were receiving just a few thousand test specimens per day. I saw an entire room of machines standing by, mostly idle.

It’s the same story elsewhere. I spoke to leaders at the University of Minnesota’s Genomics Center, who reported that they have unused capacity to deliver up to twenty-five thousand tests a day. And there are numerous other university-based and independent molecular-diagnostics laboratories with the ability to expand the country’s testing capacity. Several companies—including Guardant Health and Helix, in California; Kailos Genetics, in Alabama; and Ginkgo Bioworks, in Boston—are rolling out advanced molecular-testing techniques that could enable them to collectively process hundreds of thousands of tests a day. Whereas the usual charge for test processing is a hundred dollars or more, most of these labs are willing to charge much less—from fifty dollars to as little as twenty dollars. What’s missing is the logistics operation to connect their supply of tests to the people who need them and to the entities that pay for them.

On a local level, what I find frustrating in D.C. is that we really could have enough tests and be able to deploy them to people. It would not be hard to generate thousands of tests for D.C. But when I look at the data for D.C., we’re only testing ~1,000 D.C. residents every day (D.C. also tests about an equal number of out-of-state residents). It wouldn’t be hard to get rapid turnaround time for thousands of tests. But D.C. also has another advantage: geography. That is, D.C. is small. You don’t have to drive for four hours to reach someone. If we lowered prevalence a bit more, we could bring tests to people–I mean that literally. Maybe not all contacts, but we could do a lot more testing–and do it faster.

But right now, we’re not connecting the testing with people who should be tested, and we’re not giving them (and the health department) that information quickly. It doesn’t have to be like this.

Anger is still the appropriate emotion.

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2 Responses to Bringing Testing to People

  1. Where I live (Buffalo, NY), there is free testing but you have to 1. have a car to access the tests because 2. the testing sites are in the suburbs 3. off a bus line.

    You can go to a place like Quest Diagnostics but you have to 1. make an appointment which means 2. waiting several weeks to get in & 3. taking whatever time they give you & 4. having insurance, which isn’t free.

    Why doesn’t the County Health Department set up free testing here in the city? At one of the MANY closed businesses? In one of the MANY vacant lots/parking lots? So that people can 1.walk 2. ride a bike 3. take the bus 4. or use some other form of transportation.

    I haven’t been tested. For all I know, I already had the coronavirus last February, when I was so sick “with the flu” that I couldn’t breathe & I quit smoking cannabis for over a week just to give my lungs a chance to recover. For an old pothead like me, that was really something! I know plenty of people with the same story …. but none of us have been tested.

    • ElHongo says:

      Can you get pulmonary function testing? If so, do so.

      The effect of Covid-19 on the lungs is widespread but superficial scarification. It should be quite diagnostic in a PFT, and if not, the data should be helpful to your health anyway. Particularly since any damage by flu or other more usual respiratory viruses should be well healed by now; that of Covid-19 is more persistent (because you also get endotheliitis which hits far harder than it hurts, and keeps the lung damage from healing). The general pattern of Covid-19 lung damage is otherwise uncommon and unusual; even many specialists have only known it in theory if at all before this year. (I guess it is part of the standard curriculum, but since asbestos was phased out, bilateral interstitial fibrosis has become rather exotic, until now that is)

      From the cases I have second- or third-hand knowledge of, it is not so hard to distinguish from flu. Flu leaves you feeling beaten to a pulp. Raw all the way to the fingers and toes. Covid-19 leaves you feeling weak like a sick puppy. High fevers are rare in Covid-19 and usually occur in those about to die, almost always there’s persistent slightly elevated temperature (100-101°F for several days, up to a week); in flu you usually go to 105°F and above, but usually only 1-3 days (except if you’re dying).

      The difference is due to the fact that Covid-19 is not really a respiratory disease, but a circulatory system disease that uses the lungs as point of entry, causing fairly superficial but widespread damage to them in the process. Arguably, the actual Covid-19 fatalities – those who die of SARS-CoV-2 infection, and nothing else – are victims like Michael Ojo. Those “typical Covid victims”, people like Herman Cain, are killed by their own immune system as much as by that virus, if not more so.

      A more quick’n’dirty and less informative way to be fairly sure is taking an antibody test.
      In this case, be absolutely, categorically sure that you get a Federally vetted and certified test with the lowest false-positive rate you can possibly get. The US is the second-worst country (after India) as regards proliferation of unreliable Covid-19 antibody tests. Apparently the human immune system cannot distinguish between coronavirus species, meaning our T cells can bind to all of them, but only weakly. This causes a) the immunity against all those viruses to wane within weeks to months, and b) all antibody tests except the highest-grade ones to actually test for any of the 5 species of coronaviruses that were common early this year – and 4 of which cause the more severe (flu-like) cases of the common cold and are common as, well, the common cold.

      But I’d recommend a pulmonary function test. It gives much more useful information.

      Apparently (though I can’t remember the papers, they’re from like 15 years ago) not mixing your Cannabis with Nicotiana is less hard on the lungs; vaping is even better.

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