From a friend: “I had a follow up with my primary yesterday. From the trenches I can tell you no one, CDC or otherwise has reached out to her with any information on the virus. And testing? Nothing. No tests, no info on where to send them for a test. So people are coming in sick and contaminating the place for everyone else, there’s absolutely nothing she can do for them, and the rest of us coming in are screwed. That’s my update from ground zero.”

Another friend, who went to donate blood today said that, beyond asking about symptoms, nothing is being done to protect the blood supply. Donations are not being tested because of a lack of test kits.

In the face of a serious public health emergency, ignorance is anything but bliss. The death toll here has risen to 14 since yesterday, but, in the absence of a massive effort to test for the Covid-19 virus, it is impossible to even assess the risk of this disease, much less control it. No knowledgeable epidemiologist believes that the 70 confirmed cases in Washington State represent anything close to the total number of cases here. The policy, at least through yesterday, has been to limit testing to either patients with serious disease with signs and symptoms that fit the narrow profile of Covid-19 or the contacts of confirmed cases. This failure of the testing program, driven largely by policy at the federal level, has had the effect of guaranteeing the spread of the disease. 

We have had since early January to prepare for this epidemic. Two months to develop a plan for response, provide training to local health departments, stockpile resources in case it arrived here, and prepare for widespread testing. A quick look at the numbers reveals the degree to which, in terms of testing, the US response has been woefully and dangerously inadequate. China and S. Korea were testing tens of thousands of people every day by the beginning of March. As of March 2, the US had tested 472. Total. At which point they removed that number from their website. (The only other data point we have is from March 4, 2020, 1,526 patients had been tested at CDC. )

Which brings us to the other ingredient in the recipe for disaster. We have a President who is obsessed with controlling information flow and has done everything in his power to extend that obsession to the entire executive branch. That is the worst possible strategy for dealing with a public health emergency. In this environment, alternative facts are worse than no facts at all. Accurate and timely information saves lives.

Nothing captures the failings of the administrative response better than Trump’s comments yesterday to Sean Hannity on Fox News about the case fatality rate of 3.4% reported by the CDC.

“Well, I think the 3.4 percent is really a false number. Now, and this is just my hunch, and — but based on a lot of conversations with a lot of people that do this. Because a lot people will have this and it’s very mild. They’ll get better very rapidly. They don’t even see a doctor. They don’t even call a doctor.”

The numbers come directly from the World Health Organization data, which is compiled from data reported by every affected country. They list 100,347 confirmed cases and 3,408 deaths. The math is easy. The number is real. Trump is wrong.

The irony here is that, even though Trump has been pilloried for this statement, he is, at a certain level, correct. These are global data and they do not take into account the level of testing, the number of undetected cases, or the impact of the availability of adequate medical facilities on death rates. In South Korea, with excellent medical facilities and the most aggressive testing program in the world, the case fatality rate is 0.6%. I am sure someone on his staff told him this, but between his limited grasp of the science and his determination to take credit for the idea by referring to it has his own “hunch”, he completely bungles the delivery. Instead, he appears to be telling sick people to go to work and calling the WHO a purveyor of fake news.

And, the absolute failure to introduce widespread testing in the US makes the case fatality rate (CFR) look even worse in the US. If we go strictly by the numbers, the CFR in Washington State, with 79 confirmed cases and 11 deaths is 14%. It is likely that the number here will be higher than average because the major outbreak occurred in a nursing home among the most vulnerable population. In the course of the Chinese outbreak, 14.8% of confirmed cases over 80 died. But not all cases were in the nursing home, so there has clearly been spread outside of that age group, we just don’t know how much. 

The lack of testing also bleeds into how schools and businesses make decisions. The current policy seems to be to wait until someone is diagnosed and then close. Let’s call this barn door public health, waiting until a horse escapes and then shutting the door in hopes that a few are still left inside. Without adequate testing, the only other option is to close all schools and businesses preemptively. The University of Washington has chosen to do this. Microsoft, Amazon, and Facebook are advising employees to work from home. 

With testing ramping up rapidly, one hopes this lack of information can be addressed. The Congress has just approved $8.3 billion in emergency funding to fight the epidemic. This is about 6 times the annual budget for infectious disease at CDC, but emergency funding at this late stage is about the most inefficient way imaginable to address this crisis. It’s a bit like waiting until you get cancer and then going to the emergency room for treatment.

In Other News
– Death Count in Seattle area rises to 14
– Administration advises against travel to Seattle
– UW to move all teaching online
– Amazon, Microsoft, and Facebook tell employees to work from home
– UW virology lab begins testing for novel coronavirus

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