A National Strategy for COVID-19 Testing

By Dick Hall-Sizemore

The President does not seem able to formulate a national strategy for COVID-19 testing. So, I am proposing one:

  1.  Say to Abbot Laboratories, “Here is $1 billion. Turn over the rights to your new testing machine to the government.”
  2. Say to Abbot Laboratories, “Here is $100 million. Train an army of technicians to use your testing machines.”
  3. Invoke the National Defense Procurement Act and say to various labs and manufacturers, “Here is $2 billion. Manufacture xx number of the Abbot testing machines and the needed reagents and other supplies and deliver them to the federal government.”
  4. Announce a national schedule for distributing the Abbot machines and supplies to state governments, based on need and demonstrated level of virus outbreak.
  5. Say to the nation’s governors, “Set up a testing schedule and procedures that best suit your state and allow people to start working as soon as you determine it is safe, based on testing.”

The dollar amounts are somewhat arbitrary and subject to change, based on better projections than my SWAG.

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33 responses to “A National Strategy for COVID-19 Testing

  1. You skipped step 0.5: have an executive branch leader who can hold a coherent and consistent train of thought for more that 24 hours.

    Agreed with the rest of the points. Other than you need a 6: provide a national reporting standard and portal.

  2. Dick. Very good ideas. Peter

  3. There has to be a National strategy and some kind of designation of uniform standards that then can go out to the States.

    Without that, we have 50 different states working essentially at cross purposes to each other – and actually competing against each other for testing machines and test kits. If there are not enough to go around, as Dick says, it is incumbent on the National Govt to invoke the National Defense Procurement Act to have all the laboratories work to produce the same standardized testing products and then distribute them to the States.

    To give an example – State have arbitrary boundaries that really don’t matter in some cities that are MSAs.

    These MSAs that are made up of two or three states must have some coordinated approach.

    Some states actually have several different MSAs on different state boundaries.

    Here’s some examples:

    Washington-Baltimore CSA = 5 (DC, MD, PA, VA, and WV)
    New York City MSA and CSA = 4 (NY, NJ, CT, and PA)
    Boston-Providence CSA = 4 (MA, RI, NH, and CT)
    Philadelphia CSA = 4 (PA, NJ, DE, and MD)
    Chicago MSA and CSA =3 (IL, IN, and WI)
    Cincinnati MSA and CSA = 3 (OH, IN, and KY)

    In all the other countries they have had a central govt approach to setting standards for testing and it flowed out to each state to implement.

    There has to be a centralized registry of people who have been infected and recovered, others who have tested positive and the need to track down their contacts…which may well cross state boundaries.

  4. The approach makes sense to me…. although I’d like to know how Abbott intends to roll out its testing machine under the current circumstances. How much capital has it committed itself? What training does it intend to provide itself? And what arrangements with manufacturers has it already made?

    Perhaps Uncle Sam can expedite the rollout. But the last thing we need is for the feds to reinvent the manufacturing/distribution/training wheel if Abbott already has that figured out.

    • If Abbot has the ability to supply testing for the entire country AND has a plant to do that – turn them loose and pay them what it takes.

      If they do not have that capability and/or no plan, the next step is to get more companies who make testing equipment to all make standardized testing units and test kits AND figure out which company is responsible for which geography.

      It doubtful that one company has all the resources and likely that several companies will have to do it – and that requires a National approach IMHO.

  5. Abbott’s EUA test results.

    https://www.molecular.abbott/sal/9N77-095_SARS-CoV-2_US_EUA_Amp_PI.pdf

    They conducted tests against prepared formulations. 21 sterile, 21 COV2 prep. One of each was declared invalid. Confidence intervals for prob detect and prob false positive included.

    20. Hmmm. And why were two results declared “invalid”? One failure would significantly change those intervals.

    As an aside: I’ve eaten my last steak from Ruth’s Chris’

  6. Why a national strategy? Trump went to take the lead, and the Governors told him no. So he has put something up and now its their time to lead. So let the Governors who are dictating we can’t see friends and family, speak up and lead.

    Sheesh I’ve never followed Trump and am independent, but the I’m in power as the Governot, and then wah on it, blame the feds is getting ridiculous.

    • Can’t blame the Feds. They did nothing.

    • The governors never said that the federal government did not need to take a major role in this crisis. They just rejected the president’s declaration that he called all the shots.

      • Trump may have, for once, played the reopening brilliantly from a political perspective. He insisted that he and he alone would decide when and how to reopen the economy. The governors and main stream media took the bait and insisted that Trump was wrong and “America does not have a king”. Now the ball is in the governors’ courts. If they wait too long there will be more and more unrest like in Lansing and, to a lesser degree, in Richmond. If they open too early there will be a resurgence. Either way, Trump can credibly claim that he wanted to run the reopening nationally but that offer was rejected by the governors.

        Had Northam been a little more clever than he is he would have embraced Trump’s offer. “We in Virginia look forward to President Trump’s specific instructions on reopening the economy in Virginia as soon as safely possible”. Guess who goes straight to the top of the list for federal support and aid? Guess who gets the testing kits?

        Oh Ralph, it was right there. Do you ever play poker? Call his damn bluff.

  7. Here’s an idea for Virginia. Borrow from Oregon. Develop a self-reporting website/800# and ask citizens who did not seek medical attention to report symptoms, dates, zip codes, for any cold/flu-like symptoms beginning from Dec 2019.

    True you won’t know the cause, but it provides a floor for the total of the diseases. You could also ask for flu vaccinated or not.

  8. Love you guys, love this game, but ignorance + no data = nonsense. Add political bias and it’s total nonsense.

    VCU is using somebody’s rapid test, now, and trusts it to screen patients going into NON-elective surgeries. If they trust it, I trust it. Those surgeries are still happening, of course, and understandably the hospital is testing those patients on the way in. Don’t know who’s machine they are using, might even be their own concoction. But the non-symptomatic people who are still infectious DO trigger a positive. So that is going to the gold standard going forward, it is a way to find the people who are not sick but are contagious. Whether entering a workplace or an airport or a hospital. TSA lines in the fall are gonna be a bitch….

    If you have symptoms in VA, it is now easy to get a test in several ways, and the rapid test is spreading. Testing is better this week than it was last week, and better last week than it had been the week before. Neither the federal government nor the state government made it happen, the people on the front lines just did it. But I suspect the rapid testing will continue to be concentrated where most needed and it may still be a while before, as I said before, regular folks with no reason to think they are infected can go to CVS or a Doc in a Box and get a rapid test. Then the anti-body test (finger stick) will be the gold standard for returning to work once you’ve recovered.

    What I still don’t think is there is the full reporting – hey, the hotline does sound like an idea worth trying. But in general, the people on the front line are doing this while the rest of us sputter, whine and bloviate.

    • The COVID-19 data project now has Virginia #50 out of 50 states for per capita testing. The project continues to give Virginia good grades for data quality. So, I’m wondering why you think we’re doing better with regard to testing. Better than we were doing? Maybe. But we’re still dead last. Is there “full reporting”? Who knows. However, if I were running an effort that was rated as worst in class and I thought the data behind the rating was flawed I’d scream bloody murder about that data. Is Northam screaming bloody murder?

      Something tells me that our testing regime just plain sucks out loud compared to other states. It may suck less than it did last week but it still sucks.

      https://www.buzzfeednews.com/article/peteraldhous/coronavirus-maps-charts-states-testing-deaths

  9. “Say to Abbot Laboratories, “Here is $1 billion. Turn over the rights to your new testing machine to the government.”

    And then what? The government will use the IP to manufacture testing machines? If so, you’ve got to be kidding me. America’s government can’t protect people from robocalls they certainly won’t be able to manufacture much of anything.

    “Say to Abbot Laboratories, “Here is $100 million. Train an army of technicians to use your testing machines.”

    You’re getting warmer. Interesting that you didn’t come up with asking America’s public colleges and universities to train people in how to use these (and other) machines.

    “Invoke the National Defense Procurement Act and say to various labs and manufacturers, “Here is $2 billion. Manufacture xx number of the Abbot testing machines and the needed reagents and other supplies and deliver them to the federal government.”

    Maybe this is what you meant with regard to #1. If so, it makes sense. Reduce government’s role to confiscating money earned by citizens so that money can be transferred to private enterprises capable of doing something useful with the money.

    “Announce a national schedule for distributing the Abbot machines and supplies to state governments, based on need and demonstrated level of virus outbreak.

    Coordination with transparency. Very good. A legitimate and achievable role for government at all times but especially during a crisis. However, you forgot to ask that McKinsey or Accenture or some other private program management concern be hired to actually manage the program.

    “Say to the nation’s governors, “Set up a testing schedule and procedures that best suit your state and allow people to start working as soon as you determine it is safe, based on testing.”

    Good first step. In Virginia that should immediately be followed by asking the leaders of jurisdictions in each of Virginia’s health regions to make this determination. As is always the case, what makes sense for Fairfax County doesn’t make sense for Wise County. Our state government, as usual, is an unnecessary middleman and bottleneck. One size does not fit all in Virginia. It almost never does.

    • re: ” America’s government can’t protect people from robocalls they certainly won’t be able to manufacture much of anything.”

      DJ – you know the government DOES preside over the manufacture of Trident missiles, submarines, humvees and Gawd knows how much other stuff.

      yeah, there are $600 toilets.. but we are the finest outfitted military on the planet and the govt is in charge of all of it and all of it done by the private sector per the specs of the Govt.

      • Like I wrote … “Reduce government’s role to confiscating money earned by citizens so that money can be transferred to private enterprises capable of doing something useful with the money.”

        Just like they do with Trident missiles, etc. I just wouldn’t spend a lot of time “presiding” right now. And remember, Dick’s article isn’t a description of what our government is doing. It’s a list of things that government should be or could be doing. Right now it’s unclear what America’s many different governments are doing with regard to COVID-19 testing.

        • DJ – when you say “confiscating money”, are you aware of the massive bailout now ongoing?

          The Federal govt “builds” a LOT of stuff – all that Army Corp stuff, river navigation, interstate highways, airports, GPS satellites, NOAA satellites, nuclear facilities, on and on…

          • Lockheed Martin builds GPS satellites. I don’t know but I'[d guess that civilian subcontractors do most of the river dredging. As I recall the Army Corps of Engineers determined that the invasive hydrilla in the Potomac had to be dredged out before it choked out the river. Unfortunately, they didn’t realize that even a small fragment of a hydrilla plant can break free, settle in mud and grow a new hydrilla plant. The dredging to remove the hydrilla rapidly spread the hydrilla. But all’s well that end’s well. The hydrilla can only live in relatively shallow water so it never choked out the river. It also held down sediment that helped more sunlight reach deeper depths allowing native vegetation to flourish. Finally, the hydrilla became a virtual nursery for various aquatic life including large mouth bass. The fishermen of NoVa benefitted from federal spending. Go Army!

            Now, the residents of the Lower 9th Ward in New Orleans may have a less charitable view of government’s efforts around river management.

          • re: ” Lockheed Martin builds GPS satellites”

            under contract to the Govt and according to Govt specs per most of the stuff the GOvt pays for.

            The govt often actually has one contractor write specs then puts it out for bid.

            The GPS your phone uses is a govt product.

    • As you ultimately surmise, I was not proposing that the federal government go into the business of manufacturing testing machines. The infrastructure already exists in the private sector. Use it.

      • re: ” The infrastructure already exists in the private sector. Use it.”

        exactly – When the govt “builds” an interstate highway, for instance, they don’t build it themselves, they use the private sector but they dictate the design, materials, construction specs, etc… They set standards so that –
        for instance, the roads are sized so they can accommodate tractor trailers, the strength of the pavement, the shoulders, the height of the bridge/overpasses, the access ramps, etc.

  10. johnrandolphofroanoke

    What about a physical for everyone? About 200 bucks a person. 8.4 million Virginians. About 1.7 billion bucks. If we do blood work it is going to be a 1000 bucks a person. So that price tag comes in at 8.4 billion bucks. Create a passport for good health and off to work. It would be a great statewide snapshot of the people’s health.

  11. According to Dr. Brax, we are far from using the full testing capacity currently available – esp. the Rouch machines [app. 70% not being used] which are scattered around many labs, doctor offices, and hospitals. The reason for this is easily understood by anyone who works logistics. People hate having to order & maintain multiple systems… so the old system sits idle while the new system only is used for testing.

    Additionally, the Abbot machine can only do one test at a time — taking 2-15 minutes. Do the math. It is NOT a high through-put technology – which is what is needed.

    • I am not wedded to any one machine. I singled out Abbot because that has been touted on this blog and by the President. If there is another one out there that is better, use it. It would be more efficient to use a single machine–all the factories named in the National Defense Procurement action would be using the same specs.

      • As NN has pointed out – the different machines and different test kits have differing error rates and that is an issue also.

        The error rates – have implications on how the testing regime is done.

        There is one more HUGE difference.

        Right now, we are basically testing people with symptoms and health care providers and EMS crews.

        What is being envisioned is what they did in South Korea and Germany which is to test people who show no symptoms but will be in work environments with others workers and customers and are vulnerable to being infected and in turn infect others.

        So you test them and when someone is found to be infected – you find out all their contacts and test them.

        I don’t know what the scope differential is but it’s probably 5-10 times as much testing as we are currently doing.

        The only way to get back to work is to test the workers – not once – but repeatedly if they are exposed to others beyond their work group – like customers… not a whole lot different than health care providers who are exposed by new contacts – every day.

  12. In a bit of good news Northam seems to be starting to function as a leader. He sent a letter to Virginia’s US Congressional delegation with a list of things to straighten out at the federal level. Excellent! Northam is publicly leaning on others who should be contributing to Virginia’s efforts to get us out of this mess and telling them specifically what they need to do. This, on the heels of hiring McKinsey, shows that Northam is starting to see his role as that of a quarterback rather than an individual contributor. He and his band of merry men and merry women in Richmond were never going to solve this on their own. Next up – get Virginia’s localities on track and operating effectively.

    https://www.wavy.com/news/local-news/richmond/northan-requests-additional-federal-support-for-virginians-and-state-economy/

  13. Catch this very pregnant article full of goodies, and canaries in Virginia’s coal mine, including Uva.’s next money grab play with all its heavy political implications;

    https://www.virginiamercury.com/2020/04/17/as-coronavirus-crisis-drags-on-virginia-republicans-escalate-calls-to-reopen/

  14. I have been trying to follow this virus story through daily reports put out by Johns Hopkins and Mass. Institute of Technology. These of course are research powerhouses, among the few very best in the world. But I’ve found here that MIT’s report are be better by far than those of Johns Hopkins. John Hopkin’s reports are highly politicized and obviously so. Politics obviously dilutes its science. What a great shame.

    Now, I suspect I’ve discover why in this quote from today’s Johns Hopkin’s Report:

    “What Have Epidemiologists Learned About the Coronavirus? (The New Yorker) Justin Lessler, a professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health, models disease transmission, and has been studying the novel coronavirus. …”

    Reading it brought to mind Mike Bloomberg’s effort a few years back to buy the Virginia Attorney General’s office. This before he tried to buy America’s Democratic Party lock, stock and barrel, and well as many democrat politicians, including many within Virginia’s Democratic Party.

    This rise of the Billionaire class trying to buy the America’s Government and its politicians is a real threat to the American people. Though Billionaires are real blessings to America in so many other ways, including right now, that blessing turns into a threat when Billionaires try to buy and corrupt governments simply by trying to buy people, political power, and science with their own money to suit themselves.

    Why might one believe Trump is different?

  15. Did anyone else notice VDH added 3 new categories to the existing 4 in the priority testing guidance?
    . Person with COVID-19 symptoms* AND underlying condition that increases the risk of severe COVID-19 (e.g., aged 65 years or older, person with chronic heart or lung disorder, diabetes, or on dialysis, etc.). Until more information is available, VDH is including pregnant women in this category.
    . Un- or underinsured person with COVID-19 symptoms*
    . Newborn of mother diagnosed with COVID-19 at time of delivery

    They also added a list of symptoms, but left out loss of smell and taste:
    *COVID-19 symptoms can include fever or cough or shortness of breath or difficulty breathing or sore throat. Fever might not be present in some persons, such as the very young, older adults, or immunosuppressed persons. In older adults, atypical symptoms may include new or worsening malaise, new dizziness or increased falls, mild mental status change such as confusion, nausea, diarrhea, or sore throat.

    They also added other notes about submitters to DCLS and under resourced communities (wonder how they’ll define that one!):
    Submitters must be willing and capable of collecting and packaging specimens, and either delivering them to a DCLS courier site or shipping them via commercial courier (e.g, FedEx).

    The health department may also provide testing at DCLS for groups from under resourced communities who have limited access to testing and other testing on a case-by-case basis.

    http://www.vdh.virginia.gov/coronavirus/health-professionals/vdh-updated-guidance-on-testing-for-covid-19/

    • In the front page of FLS this morning!

      There was an article yesterday that alluded to grocery workers and the fact that in the Fredericksburg area, some have tested positive after they developed symptoms.

      I guess I would have thought that those who are still working and in close proximity to the general public, ought to be regularly tested prophylactically and any who tested positive , promptly isolated and contact tracing to determine who else they had been in contact with – then those folks tested.

      Perhaps when we see that start to happen, we’ll know that VDH is ramping up to be able to test others that may return to work.

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