The Trump administration is considering a new testing strategy as coronavirus cases rise: testing groups of people together.
Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told me in an interview last night that health officials are having “intense discussions” about what is known as “the pool test”. The idea is that by testing samples of many people all together, officials could test more people with fewer resources. And those who are infected could be found and isolated more quickly.
Pool testing would allow managers to cast a much wider net to find cases faster.
This would represent a dramatic change from the way coronavirus testing is currently performed in the United States, but which may be badly needed as virus hotspots worsen and new ones emerge.
“Something is not working,” said Fauci of the current approach. “I mean, you can do whatever diagram you want, but something is not working.” “
The approach works this way: Samples of, say, 20 people are combined into one pool. A coronavirus test is used across the entire pool. If the test is negative, the researchers know they can move on to another group of samples. If it comes back positive, then only each individual will be tested.
“What you need to do is find the penetration of infected people into your society,” said Fauci. “And the only way to find out is to throw a large net. ”
The criteria for who can take a test still varies by state, depending on their resources and testing capacity. But if group testing allowed more people to get tested, there might be a better chance of finding asymptomatic people who could quietly spread the disease.
The United States set a record of single-day infections for the second day in a row.
States have reported nearly 38,500 new cases. Texas, Alabama, Missouri and Nevada have reported daily highs, according to my colleagues. The death toll also increased, to around 2,500, while New Jersey added 1,854 probable deaths. Even California, which was the first state to close and one of the last to reopen, sets daily records this week for new cases.
Recently, President Trump’s mantra has been that cases only seem to increase due to the increase in testing.
This is not true, as I explained in this issue of Health 202. The President reiterated that it took yesterday:
The number of ChinaVirus cases is increasing, due to LARGE TESTS, while the number of deaths (death rate) is decreasing considerably. The Fake News don’t like to tell you that!
– Donald J. Trump (@realDonaldTrump) June 25, 2020
White House officials told Nancy Cook of the Politico that there would be no change in the White House’s strategy to fight the pandemic. A senior administration official told him that the “vast majority” of the country has seen no increase in cases.
Yet Fauci told me that the growing crisis means that the nation needs a paradigm shift in its approach to fighting disease.
Fauci reconsiders whether the traditional tools for fighting infectious diseases – identifying, isolating and tracing contact – are even effective against the new coronavirus, given the ease with which asymptomatic people can spread it.
Throughout spring and early summer, Fauci and other officials stressed that this three-pronged approach was essential to contain the virus and allow Americans to return to something that resembles normal life. But it’s true, Fauci told me, if almost everyone who has spread the virus has symptoms.
But research suggests up to 40% of people infected with a coronavirus may be asymptomatic. It’s like someone threw an adjustable wrench into the normal system to contain viruses, said Fauci.
“We now know that the level of virus in an asymptomatic person is about the same as the level of virus in someone who has symptoms”, Said Fauci. “So it’s like, oh my god, how do you approach this? “
Pool testing could work because the vast majority of Americans were probably uninfected.
Scientific American recently described group testing this way:
“Group tests are a game of numbers. Suppose you are examining 100 people and one of them is positive. Normally, you would do 100 diagnostic tests, looking for genetic material of the virus in each individual. But with group tests, you can divide these 100 people into five groups of 20. This gives you five pools with 20 samples, and you use one test per pool. If the first four sample pools are negative, you have eliminated 80 people with four tests. If the last group tests positive, you test each sample from that last group individually to identify the one with the disease. In the end, you did 25 tests instead of 100.”
The approach would not work as well if many people were infected, because then most of the group tests would come back positive and people would have to be tested individually anyway.
But Robert Redfield, director of the Centers for Disease Control, estimated yesterday that 92 to 95% of the population is still susceptible.
However, Redfield also said that the number of Americans infected was probably 10 times higher than the 2.3 million confirmed cases, report The Post’s Lena H. Sun and Joel Achenbach. “Our best guess right now is that for every reported case there are actually 10 more infections,” Redfield said when calling journalists.
According to this methodology, there would be at least 23 million cases in the United States. “Redfield said the most important estimate is based on blood samples from across the country that look for antibodies to the virus,” write Lena and Joel. “For each confirmed case of covid-19, an additional 10 people had antibodies,” he said.
Laboratories already have the capacity to pool tests, said Fauci.
Switching to this style of testing would require the cooperation of health services, laboratories and private manufacturers, all of which play a role in carrying out around 15 million tests per month today.
Researchers in Israel and Germany are also studying this testing strategy to fight coronaviruses.
Ahh, oof and ouch
AHH: The Trump administration is asking the Supreme Court to strike down the entire Affordable Care Act.
The briefs, due to the court yesterday, reiterated the arguments that the Department of Justice and the states have now advanced for months in a long court battle against the 2010 health care law. The administration is completely on the side of republican states seeking to overthrow him, while California and other Democratic-led states defend the law.
Oral arguments could come before the November elections, giving Democrats a great opportunity to compare their approach to health care to that of Trump and the Republicans.
“In the brief, Solicitor General Noel J. Francisco argues that the entire ACA should be canceled because one of its basic provisions, the individual mandate, is unconstitutional, which makes the rest of the law also invalid, “Tim Elfrink of the Post and Meagan Flynn report.
“Francisco argues that the individual mandate provision became unconstitutional when Congress reduced the penalties to zero in 2017. Without any remaining tax penalties, argued Francisco, the provision could no longer be considered a constitutional use of power of congressional taxation – the reason the Supreme Court confirmed it. in a previous challenge. ”
Democrats, who made the administration’s refusal to defend the ACA a key part of their campaign strategy for 2018, said yesterday that ending health coverage for millions of Americans would be particularly dire during the pandemic.
Former Vice President Joe Biden, the alleged Democratic candidate, said on a field trip to Pennsylvania yesterday that he would be is equivalent to a double blow for the survivors of Covid-19. He suggested that insurers would consider covid-19 as a pre-existing condition, and without the ACA protections, would be free to deny coverage to survivors (it is not clear that this would be the case).
“These survivors, having struggled and won the fight of their lives, would have had their peace of mind stolen from them when they needed it most,” said Biden. “They would live their lives caught in a vice between the twin legacies of Donald Trump: his failure to protect the American people from the coronavirus, and his heartless crusade to remove medical protection from American families.”
White House spokesman Judd Deere has dismissed fears that the dismantling of Obamacare could worsen the pandemic crisis. “A global pandemic does not change what the Americans know: Obamacare was an illegal failure and further illustrates the need to focus on patient care,” he told Tim and Meagan.
OFA: Public health experts warn that Arizona has lost control of the pandemic.
“Arizona became the epicenter of the coronavirus crisis in early summer, as the epidemic spread, crossing new parts of the country and, in particular, infecting more young people,” says Isaac Stanley. -Becker and Chelsea Janes of the Post, as well as Jeremy Duda.
Philadelphia Children’s Hospital disease screeners warn Maricopa County, which includes Phoenix, is now “eclipsing New York neighborhoods even on the worst days”, as it records up to 2,000 case per day.
“Arizona faces more cases per capita than a European country or even Brazil, which has been hit hard,” they write. “This week Arizona reported not only a record single-day increase in new cases – Tuesday’s number reaching 3,591 – but also record use of hospital beds and ventilators for suspected and confirmed cases . Public health experts warn that hospitals may be so stretched that they may have to start screening patients by mid-July. “
“But doctors, public health experts, lawyers and local officials say the crisis was predictable in Arizona, where local orders for masks were banned until Governor Doug Ducey (R) reversed decision last week, “they add. “State leaders have failed to take the necessary precautions or behave in a safe manner, say these observers, even in the face of compelling evidence and repeated calls from authoritative voices.”
“We have failed on many levels,” said Dana Marie Kennedy, director of AARP Arizona.
OUCH: Almost a third of behavioral health service providers have not yet received funding for coronavirus relief.
This is according to Chuck Ingoglia, president of the National Council for Behavioral Health, writing about the results of a member survey. Of those who received funding, 39% received less than $ 50,000 and 44% of members say they only have enough funds to stay open for up to six months, he wrote in a blog.
Health care providers serving low-income people had to wait weeks to receive relief funds provided by Congress because the Department of Health and Human Services tried to distribute it through a complicated process (we have writes about it here). Behavioral health centers suffered particularly from this delay, wrote Ingoglia.
“Legislators understood the value of quickly providing resources to hospitals and other health care facilities when the pandemic started, but they did not understand the value of quickly extending that same assistance to behavioral health clinics,” he writes.
“We can already quantify the impact of this failure: an increase in suicide rates, an increase in drug and alcohol consumption, relapses due to isolation, an increase in depression, anxiety, post-traumatic stress disorder and even more caused by lust. 19 pandemic. ”