We are learning as we are fighting a novel virus, the learning curve is steep, the price paid is high. This is why I constantly look for exemplary “models” among the countries fighting along with us, or better yet, took the fight before we did.
Widespreading
testing is the common denominator of the success
If the low death rate is selected as a measure of success, then Germany, South Korea, New Zealand and Taiwan emerge as the models. There is a common denominator for the success of these countries：wide spread testing.
Mortality rate as of 4/17/2020 according to Johns Hopkins University coronavirus resource center:
United Kingdom 15,498/115,314 (13.4%）
Italy 23,227/175,925 (13.2%)
USA 38,664/732,197 (5.28%)
If the low death rate is selected as a measure of success, then Germany, South Korea, New Zealand and Taiwan emerge as the models. There is a common denominator for the success of these countries：wide spread testing.
Mortality rate as of 4/17/2020 according to Johns Hopkins University coronavirus resource center:
United Kingdom 15,498/115,314 (13.4%）
Italy 23,227/175,925 (13.2%)
USA 38,664/732,197 (5.28%)
Germany 4,459/143,342 (3.1%)
South Korea 232/10,653 (2.17%)
Taiwan 6/398 (1.5%)
New Zealand 11/1,422 (0.7%)
Taiwan 6/398 (1.5%)
New Zealand 11/1,422 (0.7%)
Across
the globe the success of the curb of coronavirus spread and the
relatively low mortality rate are corresponding to the level of
widespread testing.
The
initial flawed test developed by CDC cost US several precious
weeks
WHO delivered 250,000 diagnostic tests (designed and manufactured by German Lab, later proved to be dependable) to 70 laboratories around the world, US health officials decided to go on their own way. Unfortunately the initial test developed was flawed due to contamination; it took several weeks to correct it. CDC also didn’t send virus samples to private labs and university research centers to develop the tests until late February.
WHO delivered 250,000 diagnostic tests (designed and manufactured by German Lab, later proved to be dependable) to 70 laboratories around the world, US health officials decided to go on their own way. Unfortunately the initial test developed was flawed due to contamination; it took several weeks to correct it. CDC also didn’t send virus samples to private labs and university research centers to develop the tests until late February.
U.S.
lost several precious weeks in rolling out testing at the crucial
moment—at the beginning of this scourge, even Dr. Anthony Fauci so admitted in yesterday’s (4/17/2020) White House press conference.
Without
testing capability the U.S. can only play mitigation, not containment
This
led to all the “hot spots” to lose the chances of containment,
viruses are ahead every step of the way. All they can do is chasing
the viruses through mitigation. America is now poised to gradually
enter the three-phased economy re-opening, containment is all the
more important. Widespread testing capacity is the prerequisite of
entering the Phase 1.
Whether
we have testing capacity to enter Phase 1 to “open America”, it
is all depends on what you read or watch. CDC messed up early on, no
doubt. But it has since been ramped up tremendously and the capacity
is growing everyday.
 |
| Dr Anthony Fauci |
Dr.
Anthony Fauci seemed to be confident that we do have testing capacity
to enter Phase I, although he also admitted that his colleagues on
the front lines telling him otherwise. He explained that it is most
likely due to the logistics, the gap or disruption between the supply
and demand. Testing can be more complicated than you thought, supply
of swabs and testing reagents can be the issue.
Nobody knows what is considered the adequate testings per capita, but one thing for sure is the more the better, as testing is the only way to “see” this invisible enemy.
Nobody knows what is considered the adequate testings per capita, but one thing for sure is the more the better, as testing is the only way to “see” this invisible enemy.
Wide
spread testing capacity is the indispensable tool for containment,
which is achieved by quickly identifying the infected, followed by
isolation and contact tracing and this cannot be done without testing
in a timely fashion.
The
level of testing separates the countries with success and
otherwise
The U.S. is not alone running into testing problems. The countries shared the mishap of testing with the U.S. are also the countries most ravaged in this horrendous pandemic, such as Italy, Spain, France and United Kingdom.
The U.S. is not alone running into testing problems. The countries shared the mishap of testing with the U.S. are also the countries most ravaged in this horrendous pandemic, such as Italy, Spain, France and United Kingdom.
Countries
(Germany, South Korea and Taiwan) are in stark contrast with the U.S.
United Kingdom has medical technology know-how, but lack the scale to
mass produce. The healthcare system reform over the past 10-20 years
enables Germany to have nearly100 private laboratories that can be
mobilized quickly. I read “drive through” test in German
newspaper almost one week before I first heard in the U.S. Being a
role model though Germany may be, a recent study commissioned by the
government said Germany has to speed up the testing capacity in order
to gain an upper hand on virus. Lothar Wieler, the head of the
Robert Koch Institute (RKI)—equivalent to our CDC—shared the same
view.
German Minister of Health declared worldwide pandemic on March 4, a week before WHO did on March 11. Dr. Christian Droston (a noted virologist) is German's answer to our Dr. Fauci, but not his experience.
 |
| Dr. Christian Drosten, Jens Spahn, Dr Lothar Wieler |
There was an article on March 3, 2020 the Journal of American Medical Association (JAMA), chronicling the success story of fighting coronavirus in Taiwan: proactive testing is one of the most important tools.
 |
| President Tsai of Taiwan on Time |
Some technology issues and concern on testing
Many
pharmaceutical giants and biotech companies (Roche, Abbott, Hologic,
Labcorp, Cepheid, etc.) rose to the occasions in developing various
testing kits. Abbott's NOW COVID-19 takes 5 minutes for positive
results, 13 minutes for negative results. Abbott has had three testing kits so far and is working on the fourth.
This New England Journal of Medicine showing how to do a nasopharyngeal swab, which is more complicated than you thought, one may have false negative result if the specimen is not obtained deep enough into the nose.
This New England Journal of Medicine showing how to do a nasopharyngeal swab, which is more complicated than you thought, one may have false negative result if the specimen is not obtained deep enough into the nose.
The
standard way is doing throat and nose swab, it can be labor-intensive
and the healthcare worker needs PPE. Germans are trying to do it on
sputum, but it requires good sputum coughing up from deep chest and
that is not an easy task.
FDA
approves a test done on saliva, but a negative saliva test has to be
double checked by standard throat or nose swab.
A
Q-tip type test kit is being developed and it is funded by Gates
Foundation and UnitedHealth. Gates Foundation is also funding 8 of
the vaccines being developed, thank you, Bill and Melinda.
All of these diagnostic tests are “approved” through FDA Emergency Use Authorization (EUA), the approval process was expedited at the expense of stringent evaluation. Two days ago a UPMC pathologist reported the Abbott's rapid test can have false negative result when the virus load is low.
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