The Homa Files

Seriously, who should get priority for COVID testing?

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COVID-19 testing has been getting a lot of attention recently since availability of test kits has been late and slow.

• TV pundit-doctors complain that they can’t get tests done on their patients.
• Some people are anxious to know if they have been infected.
• Scientists are dismayed that they don’t have enough data to accurately calibrate the problem.

The current answer: Google-enabled pop-up, drive-thru testing stations for people who have COVID symptoms (and want to be tested).

My question: Is that the right answer?

I think not…

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Let’s start with a taxonomy: a simple classification scheme.

My take: we can sort people by 2 main factors:

• Symptomology: Are they “presenting” any COVID symptoms (“symptomatic”) or not (“asymptomatic”)? Think: very high fever, cough, breathing difficulty.
• Vulnerability: How likely are they to suffer serious (possibly fatal) effects if they get COVID-infected? Think: old, chronically ill with heart or respiratory issues, compromised immune system.

Now, let’s lay that taxonomy into the MBA tool-of-choice: a 2 by 2, 4-square matrix:

Thanks to former student MC for nudging
me to practice what I used to preach…

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OK, that gives us 4 groups to consider.

Quiz time: (1) Into which box do you slot yourself?  (2) How would you prioritize the 4 groups for COVID testing?

The recently announced drive-thru testing program is aimed at the right hand column (B & D) — people who are symptomatic.

Frankly, that doesn’t make any sense to me.

I finally heard an interviewer ask one whining pundit-doctor the question: If patients are presenting with COVID symptoms, would you treat them differently whether they tested positive or negative?

The answer: “NO”.

Why waste a scarce test kit if you’re not going to change the course of action?

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What about the symptomatic people who voluntarily get a drive through test?

A negative test result may reduce some of their anxiety … but it may also be wrong and give them a false sense of security (it’s called a type 2 statistical error — a false negative) … so,  they may keep circulating  … and, any way,  the negative result was for a specific point in time … they may be COVID positive tomorrow or the next day.

Said differently, in my opinion, all of the people who are symptomatic should self-quarantine. PERIOD. No test required.

Consider COVID to be GUPI (Guilty Until Proven Innocent) if you’re symptomatic!

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OK, so back to the question: who to test?

My view: test the people in the left hand column … those who are asymptomatic.

Consider Box A first … say, somebody in an eldercare facility who is not exhibiting the symptoms.

I’d test them pronto for 2 reasons: If they test positive, (1) you’d want to get them away from the other facility residents (2) you’d want them to be closely monitored and treated before the do exhibit symptoms and devolve to, say, needing a scarce respirator.

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What about Box C?

At 1st gush they seem like the innocents … least in need of a test.

Not necessarily.

They may be “hidden carriers” of the virus who stay in circulation and infect people around them.

Take an extreme case: somebody who has contact with a non-institutionalized vulnerable.  Think: a grandma living with her kids and grandkids.

Grandma is, by definition, vulnerable and should probably be self-quarantining.

But, what good is her quarantine if the folks around her are infected — knowingly or not.

My take: the family, friends and caretakers of vulnerables living at home should be a high testing priority … not far behind the symptomatics in the testing line.

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That’s my take … about 180 degrees different than the announced priorities.

What do you think?

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This entry was posted on March 16, 2020 at 1:30 pm and is filed under Coronavirus - Covid 19. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.