The Homa Files

Test kits are scarce and we are testing the wrong people.
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First, a quick primer on testing …

A testing system has two major components: the analysis machine … and a “kit” containing all the necessary chemicals (aka. “reagents”) and supplies (e.e. nose swabs).

Simple analogy: The analysis machine is like your trusty Keurig cup-at-a-time … and the testing kits are like the coffee pods that go into the machine. You need both parts to do a test or make a cup of coffee.

There are plenty of analysis machines around, but they are made by several different suppliers … all of whom have uniquely different test kits.

None of the suppliers routinely carry a pandemic level of kits in inventory … the economics of doing so would be burdensome and some of the reagents have shelf lives. Ramping up to pandemic levels is a challenge because many of the kits’ components come from, you guessed it, China.

So, we’ve got plenty of lab capacity (analysis machines) … but a shortage of test kits. That makes the test kits the constraint or “pacing item”.

The shortage will eventually be filled, but until then, it’s critical that the scarce kits be used to test the right people.

We’re not doing that …

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I don’t usually agree with Dr, Zeke Emanuel — a core ObamaCare architect  — but I’m in the boat with him on this one since he’s on the same page as I have been on for weeks.

• See: Let’s make COVID testing actionable for our  decision matrix and conclusions

Writing in The Atlantic, the essence of Emanuel’s message is: Instead of focusing testing resources on people who are already sick and already candidates for treatment based solely on their symptoms, focus on on the people most likely to spread COVID-19 virus. Find them and immediate isolate and treat them.

More specifically, Emanuel says:

Not testing suspected COVID-19 patients will not harm those patients.

Because we do not have any treatment targeted for the new coronavirus, confirming an infection generally does not change the way a patient’s symptoms are treated.

Patients suspected of having COVID-19 should be presumed to be infected and receive care accordingly.

Symptomatic patients should be tested only in the rare case where a positive test would meaningfully change what type of care is delivered.

Under current guidelines, asymptomatic individuals are not tested, even if they had contact with people who tested positive.

In fact, the CDC explicitly recommends against testing these asymptomatic individuals 

This is an enormous mistake.

So, who should we test?:

If we want to control the spread of COVID-19, we need to identify people who, although asymptomatic, may have the virus and infect many others.

First, all health-care workers and other first responders who directly interact with many people.

Second, workers who maintain our supply chains and crucial infrastructure, including grocery-store workers, police officers, public-transit workers, and sanitation personnel.

Third, would be potential “super-spreaders”— asymptomatic individuals who could come into contact with many people.

This third group would include people in large families and those who must interact with many vulnerable people, such as caregivers in long-term-care facilities.

The fourth group would include all those who are planning to return to the workplace.

Emanuel Adds: One route to testing returning workers is to turn responsibility over to employers, perhaps, by subsidizing businesses that agree to test all their employees as they return to work.
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Thanks to MC for feeding the lead

This entry was posted on April 22, 2020 at 10:00 am 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.