Public health experts and many politicians agree that the pursuit of any next steps in dealing with the Covid-19 pandemic will rely on testing, testing, testing. The nation will need significantly more tests, with faster and better results, that show who is infected now. Further, many, many more people will need to take blood antibody tests to determine who was infected with the disease and may have some level of immunity from it.
This is the problem: Weeks after the novel coronavirus swept the nation, infecting hundreds of thousands and killing thousands, the testing available is too scant, takes too long, and — despite much bloviating and promises — is mired in unacceptable ways.
The gulf between the needed level of testing and what is occurring is Grand Canyon sized (see NYT graphic, based on Harvard University research, above), and this is a giant problem in potentially relaxing Covid-19 restrictions now in place.
President Trump and Vice President Pence, after first declaring that “anyone who wants a test can get one,” backpedaled, then advanced the idea that millions of tests almost miraculously would become available, particularly when the GOP-favored notion that private industry would step up.
The promises kept flowing, with claims in daily briefings about the progress made on testing and increasing the desperately needed supplies of personal protective equipment (PPE) for health care workers, first responders, and others in close contact with patients.
The big talk has failed to be backed up. Not only is PPE in short supply, but doctors, hospitals, labs, and public officials say, so, too, are vital testing products, including substances used to collect and process patient specimens.
To be sure, testing of the sick, affluent, and many health care workers has increased. But the number of tests each day has plateaued, such that, even with major increases in testing, only a sliver of Americans know conclusively that they are infected — or not.
Meantime, providers have only begun to ramp up the blood antibody testing that is supposed to provide a look-back about individuals’ possible immunity.
This means that state and local leaders in too many cases are steering blind, not knowing the disease’s current ravages, nor its recent extent and possible numbers of those at lower risk. News organizations have provided their own tracking systems, and authoritative statistics on Covid-19 continue to come from institutions outside the government, such as at Johns Hopkins.
The administration, after weeks of piques and outright tantrums by the president, has issued loose guidelines about how governors, especially, may want to think about lifting stay-at-home orders and restarting an economy staggered by job losses not seen in decades.
Public health experts at the federal level have counseled state and local leaders that testing will help them see crucial trends in hospitalizations, infections, and deaths that will help them decide their course of action.
But by inaction, the administration has failed to step into a vital role that federal officials might have played, especially in coordinating and using Uncle Sam’s formidable clout to prod businesses to provide needed supplies and tests. Instead, states not only have been left on their own, or they have found themselves competing in multiple, unproductive ways — with themselves, with the federal government, with shady middlemen, and with international competitors.
Big, populous states like California, New York, and Illinois might have the clout and expertise to build their testing and public health capacities, employing big numbers of workers to trace the infected and attack viral hot spots and outbreaks. But what happens, as is occurring now, when localized problems explode in rural South Dakota or Nebraska and those states lack the resources to respond as needed and situations worsen, fast, as already has occurred. The Federal Emergency Management Agency (FEMA) has been ordered to step in and help. The agency’s specialty is with urgent, shorter calamities, not a nationwide crisis that shifts and changes rapidly.
The administration’s guidance to the states also created jurisdictional nightmares: What happens, say, if leaders evaluate risks and keep shuttered the District of Columbia, while Virginia eases restrictions significantly? If Maryland decides its situation is still parlous enough to stay closed, what happens to travelers who fly, drive, or arrive in other ways, especially if they’re headed to D.C. or elsewhere? Within states, particularly where governors have looked to the White House for guidance, found it lacking, and acted in minimal fashion, peculiar oversight already has popped up: In Florida, beaches can be empty for a stretch because of city and county guidelines, suddenly becoming crowded and full across government lines.
This is a less than optimal way to deal with a global pandemic, particularly as angry partisans stir resentment against public health measures, as Trump did, attacking state officials and fomenting anger among extreme individuals who already have staged noisy protests in select U.S. capitals.
The current federal Covid-19 response, especially problems with testing and the absence of big boosts for public health systems, also does not bode well for what may occur if, as is happening in other nations, coronavirus outbreaks restart after the nation reopens.
In my practice, I not only see the harms that patients suffer while seeking medical services, but also the benefits they can enjoy by staying healthy and out of the U.S. health care system. The coronavirus threatens to swamp our health resources, which, in their better times, already had notable problems with infections acquired in hospitals, nursing homes, and other medical care giving facilities, as well as major challenges with medical error and misdiagnoses. The Covid-19 toll in nursing homes has hit a staggering and unacceptable toll of at least 7,000 deaths, while more than 9,000 U.S. health care workers have been infected with the novel coronavirus, notably due to a lack of personal protective gear and other safeguards.
That said, at this difficult moment, we need to support doctors, hospitals, and public health officials as they marshal science, evidence, and facts to battle the global menace of Covid-19.
We also need to see and support state and local leaders who are doing the tough, dirty work shrugged off by the administration and the federal government. The locals are banding together, cooperating, sharing, and helping each other. They’re mostly declining to take the bait that with which the president and his partisans continue to chum the political waters. They know that they have no choice but to lead and govern because the people need them to do so, the sick and the healthy, rich and poor, no matter their political leanings, gender, race, nationality, and sexual orientation. This is the great part of America — confronting a scary, big challenge, we rise to answer — we don’t duck and divide. We’ve got a lot of work to do.
