A good article on Covid-19 testing, a way forward, and where we screwed up

I commend to your attention this article in The Atlantic on Covid-19.  The authors, Robinson Meyer and Alexis Madrigal (staff writers on science and technology), discuss the best ways to stem the pandemic, the advantages and disadvantages of various tests for infection, and how the U.S. screwed up in its response. Click on the screenshot to read:

It’s very good and clear on the science, though I can’t judge the efficacy of their plan, which involves continual “spit testing”, a very quick but not completely accurate way of diagnosing the virus through its antigens, like the spike protein. PCR tests are much more accurate, but are expensive and take time, yet if we do continual antigen testing, the errors tend to go away, and we could get results in 15 minutes on a strip of paper. You could do this before flights, before entering restaurants, and so on.

The problems with PCR tests are numerous, the most serious being that it can’t distinguish between a new infection, which is contagious, and one that’s a month old, which isn’t contagious. And they’re much more expensive to distribute and more time-consuming to diagnose. The authors discuss “pooling”, a cute way to cut down on money and time by bundling together swab results (or spit) from a bunch of people. If there’s no positive in the mix, you needn’t go further. If there is, you subdivide, and so on.

The main reason we screwed up is, of course, Trump. In this case the authors indict him for failing to invoke the Defense Production Act, a wartime regulation, still on the books, that allows the government to force companies to mass-produce things in case of a national crisis, like this one. One excerpt:

. . . the Trump administration has addressed the lack of testing as if it is a nuisance, not a national-security threat. In March and April, the White House encouraged as many different PCR companies to sell COVID-19 tests as possible, declining to endorse any one option. While this idea allowed for competition in theory, it was a nightmare in practice. It effectively forced major labs to invest in several different types of PCR machines at the same time, and to be ready to switch among them as needed, lest a reagent run short. Today, the government cannot use the Defense Production Act to remedy the shortage of PCR machines or reagents—because the private labs running the tests are too invested in too many different machines.

Because of its trust in PCR, and its assumption that the pandemic would quickly abate, the administration also failed to encourage companies with alternative testing technologies to develop their products. Many companies that could have started work in April waited on the sidelines, because it wasn’t clear whether investing in COVID-19 testing would make sense, Sri Kosaraju, a member of the Testing for America governing council and a former director at JP Morgan, told us.

The Trump administration hoped that the free market would right this imbalance. But firms had no incentive to invest in testing, or assurance that their investments would pay off. Consider the high costs of building an automated testing factory, as Ginkgo is doing, said Stuelpnagel, the Illumina co-founder. A company would typically amortize the costs of that investment over three to five years. But that calculation breaks down in the pandemic. “There’s no way that we’re doing high-throughput COVID testing five years from now. And I hope there’s not COVID testing being done three years from now that would require this scale of lab,” he said. Companies aren’t built to deal with that level of uncertainty, or to serve a market that would dramatically shrink, or disappear altogether, if their product did its job. Even if the experimentation would benefit the public, it doesn’t make sense for individual businesses to take on those risks.

So nothing happened—for months. Only in the past few weeks has the federal government begun to address these concerns.

Even if you don’t see the use of mass antigen testing as a big step forward until (and if) we get an effective vaccine, this article will teach you a lot.

23 Comments

  1. GBJames
    Posted October 2, 2020 at 1:53 pm | Permalink

    Sub

  2. Diana MacPherson
    Posted October 2, 2020 at 1:58 pm | Permalink

    The whole management of the virus in the US has been a gong show. I hope things turn around. I really wish the US would collaborate with others better as well – Trump didn’t sign on to a collaboration between Europe and China like other governments have. That’s a shame. Working together is how we have always defeated major things….maybe the US will come around later, like in WWII.

    • phoffman56
      Posted October 2, 2020 at 4:34 pm | Permalink

      “I really wish the US would collaborate with others better as well – Trump didn’t sign on to a collaboration between Europe and China like other governments have. That’s a shame.”

      This is not strictly disagreeing with you, but:
      Would it be considered crude and pretty awful to have the following thoughts?

      Suppose the Drumpf regime had done as you wished they had. Suppose then they were re-elected (but won’t be now because they didn’t). Suppose that in the next several generations of humanity, perhaps 500 million premature deaths occurred from climate change, of which 100 million could have been avoided because of the not-instituted policies of the non-elected Biden regime.

      I don’t think any of these hypotheticals are at all exaggerated fantasies, except maybe the Mass Murderer regime having behaved decently for a change.

      If that were the case, it seems the more moral attitude is to be happy we got 100 thousand extra premature USian deaths over the last half-year, in exchange for the 100 million which won’t occur because Biden wins.

      I do think less than half the 210,000 deaths to the present laid at the door of the Mass Murderer is being overly charitable to him. His niece apparently thinks the same. Actually, 210,000 is likely to be much closer to 280, 000, once the difference between actual and statistically expected deaths becomes known. And there will be others his fault occurring after Biden takes over.

      • Diana MacPherson
        Posted October 2, 2020 at 5:15 pm | Permalink

        I think sorting out those variables of what if’s requires Laplace’s Demon and we really should just try to be decent people working together.

      • Posted October 2, 2020 at 5:16 pm | Permalink

        I suspect you have a ready answer to the Trolley Problem, too!

  3. Steve Gerrard
    Posted October 2, 2020 at 2:21 pm | Permalink

    Hopefully people will catch on to the difference between a screening test and a diagnostic test.

    A screening test means if it is positive, you can’t get a haircut or watch this movie or board this aircraft, and you should probably go get a PCR diagnostic test because there is a good chance you are infected, so call your doctor.

    A diagnostic test means if it is positive, you have COVID-19.

  4. Mike
    Posted October 2, 2020 at 2:45 pm | Permalink

    “Companies aren’t built to deal with that level of uncertainty, or to serve a market that would dramatically shrink, or disappear altogether, if their product did its job. Even if the experimentation would benefit the public, it doesn’t make sense for individual businesses to take on those risks.”

    Those are risks and costs that government should take on, but when one major political party is invested in the idea that government is the problem then no government solution is ever considered as the first option. Only when the market declines to get involved do Republicans seem to consider may doing a half-hearted job via government.

    In this case there is still (afaik) no government-led development of testing technology. Governments run facilities, but they buy the testing technology from private companies. Maybe others here know that’s not the case?

  5. Randall Schenck
    Posted October 2, 2020 at 2:46 pm | Permalink

    This was an excellent article on the testing and an education in what we could be doing. It would require a national effort which cannot be done with this administration but maybe next year. Such a waste of human life that we have such an idiot in charge. Probably few people will take the time to read all of this but they should. I should say not only the loss of life but the destruction to the economy that could be prevented. The aircraft industry is going down the tubes right now and a national testing program would have prevented this.

  6. jezgrove
    Posted October 2, 2020 at 4:04 pm | Permalink

    Could they do “pooling” for a whole Trump rally and if it tests positive for a brain cell do further tests to find the owner? (Sorry if that’s a little offensive, it’s been a very l-o-n-g week…)

  7. Posted October 2, 2020 at 4:44 pm | Permalink

    the Trump administration has addressed the lack of testing as if it is a nuisance, not a national-security threat.

    That is too kind by far. The Trump administration has acted as if the *availability* of testing is a threat to them, because it is. Trump wanted to avoid scaring Wall Street away from stocks, and to avoid having the general public see how bad this pandemic is. In August the CDC modified its official guidelines, and no longer recommended that those who have been exposed to the virus but currently lack symptoms get a test. This, after many comments by Trump saying, right out loud, that testing makes the situation look bad.

  8. Posted October 2, 2020 at 4:46 pm | Permalink

    “the Defense Production Act, a wartime regulation, still on the books, that allows the government to force companies to mass-produce things in case of a national crisis, like this one.”

    It isn’t even as draconian as this makes it sound. It is not a matter of the companies not wanting to mass-produce things and they need the DPA to “force” them to do it. After all, they will be paid for what they produce. Instead, a DPA invocation greatly reduces their business risk. One of the biggest risks faced by manufacturing companies, especially with modern just-in-time manufacturing, is producing a large amount of product for a demand that doesn’t materialize. This can put a company out of business. The DPA mitigates that risk.

    https://en.wikipedia.org/wiki/Defense_Production_Act_of_1950

  9. Torbjörn Larsson
    Posted October 2, 2020 at 10:26 pm | Permalink

    The main reason we screwed up is, of course, Trump. In this case the authors indict him for failing to invoke the Defense Production Act, a wartime regulation, still on the books, that allows the government to force companies to mass-produce things in case of a national crisis, like this one.

    So that is what US has been doing!? Irony:

    ‘Our Big War.’ As Coronavirus Spreads, Trump Refashions Himself as a Wartime President
    President Lyndon Johnson declared a war on poverty. President Richard Nixon declared a war on drugs. Now President Donald Trump has gone to war with a virus.
    The fight to slow the spread of COVID-19 is “our big war,” Trump said Thursday. “It’s a medical war. We have to win this war. It’s very important.”

    https://time.com/5806657/donald-trump-coronavirus-war-china/

    On tests, FWIW I believe PCR tests are used here mainly to vet people with symptoms of ongoing infection.

  10. infiniteimprobabilit
    Posted October 3, 2020 at 12:55 am | Permalink

    Well, guess who just got Covid. Gotta love the irony.

    Apparently Biden has pulled his political attack ads, as any decent opponent would. I can’t help wondering, if it was Joe Biden who had just caught it, would Mr Trump soft-pedal his slurs on Biden’s fitness?

    Umm, schadenfreude, anybody?

    • Nicolaas Stempels
      Posted October 3, 2020 at 1:13 am | Permalink

      Yes, some schadenfreude indeed, some (illusionary) cosmic justice.
      After all, the man did ask for it, with his completely irresponsible behaviour.
      I hope that he gets pretty sick (although I doubt it will teach him a lesson not to f.ck with a highly contagious virus), but recovers in time to lose the election. Allowing for him (hopefully) to be convicted & sent to jail.

    • Posted October 3, 2020 at 2:28 am | Permalink

      I’d advise waiting a b while with the Schadenfreude, at least until some Schaden has actually occurred.

      It’s worth noting that the press is assuming that everything the White House says about this is a fact and reporting it as such. Whatever the truth is — whether he really has it or not — he will emerge from it “healed” by whatever he says “healed” him, and will be immune from the accusations of heartlessness and deliberately placing Americans at risk.

      Meanwhile, it has completely stuck a spanner in the works of Biden’s campaign, swing voters will feel relief and gratitude at his recovery/”recovery”, and will be able to say that his opponents wished death on him.

      • infiniteinprobabilit
        Posted October 3, 2020 at 3:54 am | Permalink

        Oops, yes, it seems I did actually believe something the tRump camp said. Not a mistake I make very often (if it was a mistake). We shall see…

        cr

      • infiniteimprobabilit
        Posted October 3, 2020 at 3:58 am | Permalink

        … and it further occurs to me, what remarkably convenient timing, just when the disgraceful state of his tax dodging has come out.
        It seems I was just caught off guard and had a cynicism failure relating to Mr Trump. Damn.

        cr

        • Posted October 3, 2020 at 7:40 am | Permalink

          I seem to have overestimated the likelihood that it’s a ruse, but I do think the result will be same whether he is sick or not — it will play well for trump and completely derail the Biden campaign.

          • GBJames
            Posted October 3, 2020 at 8:56 am | Permalink

            I don’t see how this plays out to benefit tRump or hurt Biden. Biden’s campaign is on track. They’ve been taking the virus seriously all along. They look like responsible people. Meanwhile, Republican after Republican is falling ill, the logical consequence of pretending that the pandemic doesn’t exist. tRump will be in no position to make any more super spreader rally appearances. Of course, he will not be further damaged by debate catastrophes, so there’s that in his favor.

            The Biden campaign pulled it’s negative (contrast) ads but most of their ads have been positive anyway, so again… hardly “derailing” the campaign.

            • Posted October 3, 2020 at 9:01 am | Permalink

              I hope it turns out that you’re right and I’m just indulging in cheap and easy speculation.

  11. veroxitatis
    Posted October 3, 2020 at 6:50 am | Permalink

    Just as with his tax records Trump hasn’t released authentic medical records so who knows what he has and to what extent. Who knows if hospital admission was necessary or even a reasonable precaution. What can be said however is that there may be some advantage to the Trump re-election campaign. When Boris Johnson was admitted to hospital his popularity went up by 36% ( from negative to positive figures ) by reason of the ‘caring’, sympathy vote. They were right back down however within a month. A month would be long enough for Donnie. But perhaps Americans may be of a less sympathetic nature than the British!

  12. Ben Murray
    Posted October 3, 2020 at 1:01 pm | Permalink

    Michael Mina, who is prominently featured in the article as a “spit test” proponent, is scheduled to speak on October 27 in the MIT COVID-19 course.

  13. Filippo
    Posted October 5, 2020 at 9:15 pm | Permalink

    ” . . . this article will teach you a lot.”

    Apparently it won’t teach Trump acolyte Candace Owens anything. Heard her on a recent “Rubin Report.” She declines to wear a mask, so effulgently confident is she in the efficacy of her “gut instinct” about such matters. Not one grudging word of acknowledgement from her about, not one word of sharp questioning from Rubin regarding, data, rational thinking, and the scientific method.

    I guess I’ve heretofore labored under a misapprehension about Rubin’s regard for things rational. I look forward to hearing from both of them imaginative pearls of spin about Trump’s being infected.


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