Flying Blind to No Where (April 9th).

So these are going to be two rough weeks in the USA, cases of infected are growing and the death toll is mounting. We will start to see New York peak, but NYC will be replaced by other epicenters around the USA. On the surface it may appear that the country is peaking and the curve is flattening, but that is a false narrative right now. Our testing capacity has peaked, therefore our ability to detect more cases has also peaked. We are consistently seeing 30,000 new cases per day, or 20% of all people tested are positive. If we tested more, there would be many more cases. We are missing most of the cases.

We are still flying blind in this pandemic.

The narrative you may have heard is that we have tested more people than any other country. Yes, that is true. We have done 2.3 million tests, an incredible feat. But, we are also one of the most populous countries in the world. We have tested 0.7% of our population. Which puts our testing at 45th in the world, around about the same level a Russia. While Norway, Switzerland, Germany, and Italy have all tested about 1.5-2.5% of their population. Strikingly, Iceland has tested 9.5% and Faeroe Islands a staggering 11% of their population.

I find the Faeroe Islands testing amazing and personally inspiring. The type of thing that happens when the government listens to scientists. Basically, a local fish virologist/immunologist saw the pandemic coming, he relayed his concerns to the local government and told them what the Faeroe Island response should look like (from his experience with dealing with outbreaks of infectious disease in fish farms). That is, test early and test often, isolate the sick, quarantine those suspected of being sick. The government said go for it! He then designed the diagnostic, retooled his lab, and became the go-to person for testing. So while the virus did get a foothold on the island, they were able to dramatically limit community spread and get it under control.

The only way we get on the other side of this pandemic soon is to test, test, test. Every single country that is doing well is testing hard, isolating the sick, performing contact tracing and quarantining those people. We, on the other hand have decided to only test the hospitalized and withdraw funding from the 40 (FEMA) Federal testing sites this Friday (4/10/2020). It has now been left up to the individual States to manage their own testing with their own resources. It’s like the Federal government does not want us to know the true extent of the outbreak. AND it is clear that they are not preparing us for the next phase of the response where we can actually emerge from our homes. (where's that plan?)

On the good news front, there has been some shimmers of hope peeking its way through.

A study earlier this week showed that monkey’s infected with the virus could not be reinfected with the virus 2 months later. That is good news, we now know there is short-term immunity from experimental infection. As time passes, those animals will be tested again to see if immunity persists. We also need to watch people closely to see if it also holds for people.

Another serological study showed that roughly 70% of all people infected and recovered from COVID-19 had suitably high neutralizing antibody titers. Often, high antibody titers are associated with protection. Some news outlets presented this finding as a negative; 30% have low titers, but basically everyone mounted a B-cell response and importantly they all survived infection. There were very few that had no neutralizing titers (those few dots at the bottom of each age group), but again, all of them survived infection. This is another piece of evidence that supports the idea that a vaccine can be created to protect us from infection. But also suggests tht cell mediated responses might also be important to control of the disease.

Finally, the last piece of news was the preliminary findings from the first serological surveys. Basically, scientists going hunting to find how many people in the population have anti-SARS-CoV2 antibodies in their blood. You will only have these antibodies if you have seen the virus. The group studied a town in Germany that was particularly affected by COVID-19. They found that 14% of the population surveyed had evidence of past infection (antibody assay), while only 2% had an active infection (PCR assay). A separate study in Denmark suggests 2.2% of the population have been infected and recovered.

So this finding has a bad part and a good part. The bad part is that sickness you had back in December or January, was not COVID-19. The good part is, those areas hardest hit had quite a lot of cryptic asymptomatic or mildly symptomatic transmission throughout the community. This resulted in a significant chunk of the population becoming, at worst, temporarily immune to reinfection. That 14% needs to get to 60% before it is really meaningful to returning to normal life, but it is a start.

In summary, our Federal Government is still letting us down. We need to test more and not get caught up in the hype that we are leading the world in this measure. We are not.

Despite these challenges, the scientists and engineers are smashing this. They are moving at breakneck pace, almost completely unfunded for this work. What? Yes, unfunded. No one was working on this virus 3 months ago, we all had other projects. When this outbreak occurred, many people pivoted their focus and energy, but the funding in their labs does not pivot, it stays with the original project. The incredible work being put out by these scientists is happening off their own dime, tiny pots of money researchers may have stashed away for a rainy day. This will change, but it will be too little and too slowly.

The US economy is losing $15bn a day while it’s closed. Shortening the closure requires us to address the virus. Allocating $1bn on vaccines and $8bn testing are probably orders of magnitude too low to end this soon.

Statement from President George W. Bush (2005).

A pandemic is a lot like a forest fire. If caught early it might be extinguished with limited damage. If allowed to smolder, undetected, it can grow to an inferno that can quickly spread beyond our ability to control it. To respond to a pandemic, we need medical personnel and adequate supplies of equipment. In a pandemic, everything from syringes to hospital beds, respirator masks and protective equipment would be in short supply. If a pandemic strikes, our country must have surge capacity in place that will allow us to bring a new vaccine online quickly and manufacture enough to immunize every American against the pandemic strain.

If we wait for a pandemic to appear, it will be too late to prepare. And one day many lives could be needlessly lost because we failed to act today

We need some Federal leadership on what the National plan is. Without a national plan, and just letting the States choose their own plan, is like having a peeing section in a swimming pool.


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