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Coronavirus Testing – Truth No One Will Tell You

coronavirusYou know the questions: When will we get access to coronavirus tests? When will we get antibody tests? The answers are important, complex – and no one’s fault.  Good questions need asking and answering. So here is the truth … no one will tell you.

When will everyone have a yes/no infection test?  The answer depends on layers of uncertainty, decisions made by individual governors, national and international businesses, small producers of test parts (like swabs and chemical reagents), availability of personnel and facilities (no cross infection), congestion within processing labs, and legal chain of custody issues.

Some states aligned the stars, administering tests quickly, processing and returning results fast. In New Mexico, for example, “tests are free and plentiful.” Roving one-day test centers backup permanent centers. As a result, one-in-eight residents are tested, totally 90,000 already.

Bureaucracy was shed, supply chains streamlined, access prioritized, outcomes understood to be vital – to slow transmission and calm troubled hearts. The Department of Health provided public transportation to test centers.  Similar numbers are being done in Oklahoma, Nevada, and South Carolina, and similar per capita numbers in states like Utah.

In other states, no fault of any one person, capacity shortages, government and business chokepoints, regulatory and bureaucratic hurdles, insufficient infrastructure, and personnel shortages bog down testing.

In Michigan, new cases outstrip capacity to test, but that is not new. Michigan has “lab space to do 16,000 tests” per day but has not been able to align test access, businesses, healthcare personnel, permanent and mobile test locations, citizen outreach for more than 11,000 per day.

As Michigan’s Governor Gretchen Whitmer admitted May 3: “We’ve never been able to get to full capacity because we are missing things in the supply chain.” She rightly ordered essential personnel tested, but state-specific issues have foiled the goal.

Michigan is not unique. While Detroit is a hot spot, the Association of American Medical Colleges noted: “There are limited supplies and there are differences in which labs have been able to order which supplies and how much of the order shows up.”

In short, mass demand on limited production capacity and fragile supply chains, combined with blameless but unprepared states, is creating predictable delays, chokepoints, and slow testing.

Not surprisingly, the same problems attach to antibody testing, made more complex by uncertainty within science. Not clear is how accurate antibody tests are, how long antibodies to COVID-19 last, what level of immunity they provide, whether they dissipate over time.

The good news is that markets do clear, that is, supply rises to meet demand, incentivized by good will, profit and public interest; state public sector leaders figure things out.  They reprioritize, realign resources, and catch up. Both are happening – for both sorts of testing.

As increased testing inevitably identifies more cases, prevention and self-help reinforce the public interest in staying well, until everyone is tested.  Widespread testing is coming.  The National Institutes of Health predicts a jump from 1.5 million tests early May to twice that by late May.

At the same time, waiting irritates people, triggers frustration, causes us to look for someone to blame. That is where we must pull hard – together – on the reins.  No one in the United States is at fault for this pandemic, even if the tendency in such tense times is to find fault.

No magic by any president, vice president, federal health care official, congressional leader, or for that matter state governor, corporate chief executive officer, or national pundit would have prevented this surprise – or prepared us for it.  The need is new to ramp up private capacity, coordinate resources within each state, respond to this Chinese-origin pandemic.

No federal stockpile of perishable tests would have fit the virus or lasted long. The right answer is to empower those closest to people and to each state’s unique problem set – the governors.

Each problem set is different, which is why the right answer is allowing independent management– with 24/7 federal support, though interstate coordination, cutting edge research and modeling, available money for hospitals, healthcare workers, businesses, and individuals.

All this has been and is being done. Sometimes truth is – without fault – frustrating.  As Johns Hopkins noted this week: “We have a patchwork of testing across the country.” True enough – and for a reason.

America is by constitutional design and operational reality, not a big monolith, not the Soviet Union, not China, but 50 free and independent states, plus five territories.  We will get through this just fine, if we remember the basics. Good questions need asking and answering. Truth needs telling and believing. Truth is important, sometimes frustrating.  That is the price of democracy.

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