Testing for Covid19--what's the story?
Do we need more tests? The U.S. needs to improve its coronavirus testing to deliver results within two days, said Anthony Fauci, the top U.S. infectious disease official. “We need to do better,” Fauci, head of the National Institute of Allergy and Infectious Diseases, said Wednesday about testing in an interview with Bloomberg Television’s David Westin. “No excuses. It needs to be done.”
Do we need fewer tests? Trump praised testing in the U.S.: “50% of the country is short-term testing. ...you have to remember, we did 61 million tests. The next country is -- like Germany is at three. India with 1.5 billion people is at 11. We’re at 61. Nobody’s even close to us in testing.”“Our testing is the best ever, the best in the world....”
What are the nuances?
This is one of those "both are right" situations. Here's the world-wide graph for testing per capita, courtesy of Johns Hopkins Center for Disease Control:
Indeed, the US leads the world in both number of tests, and tests per capita. Are the counts accurate?And are they effective?
Fauci said the U.S. still has too many instances where testing results take days or a week to come back. “I can’t credibly defend that and say it’s a good thing, because it’s not,” he said. He said the goal is to have at least 95% of test results returned with a week. Fauci and other public health officials have said that faster test results are needed to prevent the spread of the virus. Waiting days for results means many people may unwittingly spread the virus before learning that they’re positive and take precautions. If the tests take longer than two days for results, contact tracing becomes impractical. And estimates are that less than 10% of US testing meets that criteria.
Other 'flies in the ointment' exist. Nearly all of these have been unique to the US, although Brazil and some European nations have endured similar situations.
A. Many states have been conflating infection tests with anti-body testing, notably high-incidence states such as Florida and Georgia.
B. The number of tests counted may not equal the number of people tested. Especially in the early months, it took three tests per person to obtain a clear answer, so the test counts were only one-third of the assumed total.'
C. The number of sequential tests given to preferential individuals may not be considered--Trump and his cabinet have each experienced dozens of tests per person; same for professional sports figures and many prominent national figures. And suspected individuals are often tested multiple times. Some states--Ohio and North Carolina, for example--have insisted that they only count 'the individual' rather than the actual number of tests given to a person.
D. Reliability of the "Confirmation"tests. Mike DeVine, the Ohio governor, this month experienced first positive, then negative, tests for COVID-19, providing fuel for skeptics of government pandemic mandates .... “I’m sure the internet is lighting up with ‘Well, you can’t believe any test,’ ” Mike DeWine said in a WCOL radio interview Friday, after a whirlwind of events the day before when the initial positive showing forced the Republican to scrub a planned meeting with President Donald Trump. And on Sunday, he told CNN’s “State of the Union” that “people should not take away from my experience that testing is not reliable or doesn’t work.”
Instead of seeing Trump at the Cleveland airport, DeWine returned to this state capital for new testing with his wife, Fran, through Ohio State University’s medical center. They then went to their southwestern Ohio farm in Cedarville, where DeWine said he planned to quarantine for 14 days. But within hours, he had received Columbus test results that were negative. The first test, part of protocol for people meeting with the president, was a rapid-result antigen test, while the Columbus testing was a genetic, laboratory test whose results are considered more reliable.
https://www.detroitnews.com/story/news/nation/coronavirus/2020/08/09/ohio-governors-positive-then-negative-covid-19-tests-spark-controversy/3330703001/
E. Reliability of the Antibody tests. This is also nuanced: the early flux of commercial, quick-to-market COVID-19 antibody tests were highly error-prone. And even after reputable manufacturers took time to develop reliable antibody tests, they can still provide inaccurate results--especially false positives. Additionally, recent data shows that COVID antibodies don't always last in people's bodies. Some who test positive on an antibody test may later test negative--even within 10-12 weeks. Source for these statements: https://www.sharp.com/health-news/the-truth-about-antibody-testing.cfm
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My personal experience was (and is) complicated. When I and my doctors first were concerned, on March 6, the day that Trump said at the CDC that the US had "a million tests ready', our county hospital claimed that there were no test kits available in the county. I was the first person in our county to be 'suspected'--the first validation would happen two days later. After first putting me in an isolation room, and asking a bunch of questions, they tested for pneumonia and sent me home.
A week later, the hospital story (since I was back again) was that "Yes, they now had two kits in the county, but they were reserved for 'important people'--which made me feel a bit second-class." Two weeks after that, they said the kits they now had were unreliable, in fact unusable, for lack of a key component. The LA Times reported on this, noting that only 1,138 people had been tested in the state, a week after Trump's boast--because of a re-agent that was missing. The governor called it -- "shipping a printer without the ink" https://www.latimes.com/california/story/2020-03-11/coronavirus-testing-kits-lack-key-ingredient-causing-confusion
After a month of this charade, five visits to ER and the hospital, the docs said, "Look, we've tested for everything else, including Valley Fever, echocardiograms, pleurisy, cardiac angiograms, COPD tests, etc., but just stay at home and self-quarantine" which I'd been doing all along. "We just don't think it is worth testing for COVID with the kits we have, and besides, you're past the 'infectious stage'. The antibody tests were just arriving--I even bought a few shares of Abbott Labs, excited by their new test, only to have it turn out to be only 50% reliable.
By the time antibody testing was deemed 'accurate', the docs all said, "No point in it--you'll test negative now because it will have worn off."
The next day, the President again told the nation: "Anyone who wants a test can get one--no problem"
I chagned the channel.