It's becoming increasingly clear that the really challenging thing about the public health response to #Covid19--the reason our horribly botched testing roll-out was so far from being up to the task, is that people who are infected, but asymptomatic play a huge role in spread.
That's also why the extreme social distancing and community mitigation strategies we're employing in many states now are necessary to get a handle on where the virus is circulating widely. govexec.com/management/202…
The population-level (ideally random-sample) testing of mildly symptomatic & asymptomatic cases we need to ID hotspots before hospitals become overwhelmed & target the public health response is a completely separate thing from clinical screening of the very ill
Hospitals & front-line healthcare workers in places that are already becoming overwhelmed are rightly saying that testing ill patients isn't the right focus now - they treat the very ill as presumed positive and don't need to wait for tests.
But the kind of testing hospitals/docs do to guide patient care is for a completely different purpose than widespread testing by public health authorities in drive-thru facilities, etc. to assess where the virus is circulating.
Right now, many cautious governors and mayors are making the only assumption that's safe to make in the absence of widespread testing. They're assuming transmission is severely widespread everywhere within their jurisdictions.
But eventually, we'll learn that community transmission is far worse in some places than others. Without testing, we'll learn that three-weeks too late, when death rates start to spike.
Numbers of reported cases by state are virtually meaningless right now. In some places there's almost no testing happening. In others a lot more. But widespread surveillance-level testing isn't happening anywhere in the US.
To have any hope of getting out ahead of this virus in places where it isn't already too late, to deploy critical healthcare resources to the places they'll be needed most, we have to implement surveillance.
It's also critical to understand that hospitalizations and deaths lag behind community transmission and infections by about 2-3 weeks. That means the measures cautious states have implemented now won't keep death rates from rising in the short-term.
When that happens, when death rates continue to rise in spite of school closures and business closures and stay at home orders, it DOESN'T MEAN it's not working. It just means we have to sit tight and wait for the curve to flatten.
But if death rates don't rise in some places, that doesn't mean it's safe to go right back to normal. Distancing can be eased slowly, using testing data. We have to continuously test/monitor to detect if/when community transmission returns. washingtonpost.com/opinions/when-…
TL;DR version:
Testing saves lives. Not necessarily the lives of patients who are already desperately ill, but the lives of people who are aren't even infected yet.
Testing saves lives. Not necessarily the lives of patients who are already desperately ill, but the lives of people who are aren't even infected yet.
