Coronavirus Testing


Leonard Zwelling

         As this blog has written, it is still way too early to know the full extent of the coronavirus infection of the United States’ population. Why?

         First, it is not clear how infectious this agent, putatively originating in a Wuhan, China animal market, really is?

         Second, we have no idea how common the infection is in the American population. It could be everywhere if the asymptomatic carrier state is common and those carriers are still infectious.

         Third, we really have no idea how many true cases of symptomatic covid-19 there are as the symptoms can mimic the flu and distinguishing one disease from the other is not a widely available ability of physicians without access to a definitive coronavirus laboratory test which has been slow in coming.

         Why has America been so slow in knowing what to do? Because America has been so slow with testing.

         As the two articles I have attached demonstrate, the capability of doing the reverse transcription polymerase chain reaction technique to make the diagnosis is trivial, widely available, and if every lab that could do the test was pressed into service, we would have the answers to the prevalence and incidence questions by now. What’s the lesion?

         Apparently it is the government. Only certified labs can do clinical testing and the ability to test samples recently stored for other purposes which would facilitate tracing the evolution of the disease is being inhibited because those people whose samples are stored did not give informed consent to have their samples tested for coronavirus. Why these samples cannot be anonymized is beyond me and why a national emergency cannot be declared is equally baffling as the only consequence of a positive test is quarantine, probably at home. It’s not like a positive test would lead to a risky therapy. Treatment is based on clinical presentation, not test positivity.

         This lack of testing seems to be uniquely American according to MSNBC as the rate of testing per million people is much higher in Italy, Japan and South Korea, giving those countries a better handle on the degree to which the population is infected and a way to know when the threat is abating. We have none of that yet.

         My sources are telling me the test is simple and any CLIA-approved lab can do the test and do a lot of them in a day. Where is the government leadership mobilizing the vast resources of the private sector to address the needs of the people of America? Nowhere to be seen.

         The obvious immediate solution to the coronavirus pandemic is knowledge. A vaccine would be great, but that’s probably for next year at best. Preventative drugs would be even better, but that requires the early identification of the potentially ill thus necessitating a good, fast, cheap and foolproof test. One exists. It must be widely deployed.

         As mayors and governors all over the country are grappling with the tough decisions with regard to school closing, event cancellation (the NCAA and NBA basketball seasons are over for now), and caring for those over 60, the only thing our public servants in Washington, DC had to do was to keep us informed and to expedite and facilitate testing. The federal leadership is deficient in this task and that’s too bad as it will undoubtedly prolong the anxiety in the American people and raise the level of skepticism of the government to even higher levels. It will also prolong the effects on the economy just as the stock market moves into bear territory. A monetary stimulus won’t help either. The economic problems are fear, jittery markets, interrupted supply chains, and people hunkering down and not spending. A payroll tax cut won’t help especially for people who have lost their jobs. The only thing that can curb this thing is widespread testing and a more complete picture of the true threat accompanied by a federal plan to deal with it.

         I can’t even say this is really a serious health disease yet. All I can say is that most local leaders are making the hard calls with inadequate data and that inadequacy is due to the lack of widespread testing. That’s a shame as the science is there and so are the labs ready to do the tests. Let’s get on with it.            

Addendum: Dr. Hagop Kantarjian and I just published this yesterday (3/12) on The Baker Institute’s web site:

Leonard Zwelling