Mass Testing for COVID – 19

Controversy abounds over this topic. Smaller countries that subscribed to this process early on seemed to have gained control of of new cases as they isolated patients with positive tests but no symptoms (around 50% of those testing positive. Keeping these asymptomatic patients quarantined controlled the increase in new cases. South Korea was successful in isolating contacts by tracking cell phone contacts in those that tested positive.

Now the virus is too far spread to think that testing all except perhaps in high density areas of infection would help control the spread. The prioritization of testing outlined in the CDC guidelines may be a reasonable approach at this late stage.

The blame game of too little testing too late reminds me of the argument during the healthcare reform debate. It is not reasonable to compare countries the size of a single small state in the US to the US response and control process. Geographic disparities in demographics preclude uniform approaches used in smaller countries.

What I find fascinating about a week ago is that when you overlay the maps of SARS-COV-2 infection (test positive for COVID-19) with the maps of major US International airports they are nearly identical. The FAA may find themselves playing critical role in future pandemics. Ease of international travel has always been a major concern in epidemiology.

Pandemics of old were controlled with local attrition. Cohorting the diseased was a natural process as the diseased were almost always relegated to the ghettos. The destitute with poor hygeine, poor nutrition, and no way out.

Economic prosperity paradoxically has abolished the “COVID-19 Gini coefficient” with respect to those who are at risk for contracting the disease. Socialized medicine has exacerbated the limitations in delivery of intensive medical needs. Social media has woefully degraded the tolerance of isolation and quarantine. Global supply chains and outsourcing of goods have catastrophically impacted not only the economic health of our country but also has restricted our ability to respond and protect those that need it most in their efforts not only to manage the critically ill but also to be protected from the virus itself.

Perhaps mass testing should be shifted to areas of low viral penetration to protect these areas by identifying asymptomatic infected individuals and appropriately quarantining them and the people they have exposed. Small pockets of this country remain relatively disease free. The virus stays airborne for about 3 meters. In many cases this may turn out to be across county lines. The areas of the healthy may lead the recovery by staying virus free.

The current paradigm of mass testing of the hospitalized and those in high density areas may need to shift to the above outlined approach. In the highly penetrated areas assuming the patient with symptoms has COVID-19 , identifying their contacts and treating both symptomatic and asymptomatic with medicine having a risk benefit ratio in favor of treatment could go a long way to limiting hospitalizations, maintaining quarantine, limiting exposure of healthcare personnel, and potentially slowing the spread.

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