Has COVID-19 Testing Become an End in Itself?

Who was that masked man? Photo credit: Washington Post

by James A. Bacon

Virginia ranks near the bottom of the U.S. states and territories in tests per million population. Its rate of testing is on a par with Guam’s. So reports the Washington Post today (finally getting around to noticing the exact same point that contributor James Sherlock made a week ago on this blog).

The article quotes House Minority Leader Todd Gilbert, R-Shenandoah, as criticizing Governor Ralph Northam for a supposed failure to ramp up testing.

“At first Governor Northam blamed the Trump administration for not getting Virginia the resources needed to conduct tests. Then we learned that Virginia has testing capacity sitting idle,” Gilbert said. “The Governor then said we lacked the swabs and other testing materials. Yet other states have managed to obtain these resources. Something is fundamentally different — and possibly wrong — with the way Virginia’s testing is being handled. Virginians deserve answers, and they deserve them now.”

The criticism may be valid as long as you accept the assumption, which Northam obviously does, that more widespread testing is going to tell us something that we don’t already know. If there’s a scientific “consensus” about COVID-19 among experts around the world, it’s that more testing is better. What bothers me is that no one in Virginia has effectively explained why more testing is better.

As the WaPo article observes, “despite the testing lags, Virginia’s per capital covid-19 deaths have been far lower than in Maryland.”

How about that. Maybe testing is over-rated.

Northam has tied a rollback of emergency COVID-19 shutdown measures in Virginia to a significant expansion of testing, and he has appointed a task force to figure out how to ramp up from 4,000 tests daily to 10,000. Yesterday, he attended a function — duly wearing a face mask — highlighting the testing of low-income African-Americans in Richmond.

“In order for us to eventually start easing the [business and social] restrictions, we’ve got to be able to test,” Gov. Ralph Northam (D) said at the testing site. “It is very important to let all Virginians — whatever neighborhood they come from, or whatever walk of life — know that we’re here for them,” Northam continued. “We want to take care of them.”

Virginians have yet to hear how Northam picked that figure of 10,000 tests. It’s a nice round number that sounds like it would play well in the media. But what is the scientific justification? What will the testing regime look like? And how will it help us to better combat the epidemic?

The testing initiative that Northam visited yesterday had a strong social-justice component. As the WaPo put it:

With dozens of medical personnel and volunteers decked out in masks, face shields and bright gowns, the site offered a possible way out of the pandemic — for a city where 13 out of 14 coronavirus fatalities have been African Americans, and for a state where testing has lagged most of the nation.

The article alluded to the possibility that African-Americans have been under-tested, quoting an individual by the name of Lawrence Washington, who noted fears of a “Tuskegee”-type trap. Washington was alluding, of course, to the infamous Tuskegee institute study of syphilis in 600 black men without their informed consent. And the article quoted Richmond Mayor Levar Stoney as urging residents not to be deterred by “myths” about testing.

What’s the point of this particular testing initiative — other than accomplishing the political aim of demonstrating his sensitivity about race, as Northam habitually has done since his blackface scandal?

I could see the point when hospitals were prioritizing patients with COVID-19-like symptoms for testing. The idea was to isolate them from other patients and ensure they received appropriate treatment. I could see the point when hospitals were prioritizing health care practitioners interacting with COVID-19 patients to ensure that they were not infected and unintentionally spreading the disease. I could see the point when nursing homes were testing as a means to detect a threat to their highly vulnerable patient populations. I could see the point when the Department of Corrections was testing to see if anyone in its cloistered prison populations had the disease so they could be quarantined. In each of those cases, testing had a tangible, identified purpose.

Well, if affluent white people can afford to go to Patient First and get their noses swabbed and find out if they have the virus, social justice advocates might say, it’s only fair that poor black people can get tested, too.

That may or may not be a valid point — but it misses the larger picture. What I want to know is how this particular testing event contributes to the larger understanding of the COVID-19 epidemic. And what does it tell us about the purpose of the larger testing regime that Northam has in mind?

Here’s what might make sense but we have not heard: The Virginia Department of Health, Virginia hospitals and allied organizations are undertaking a testing regime that encompasses all geographic regions in Virginia, all racial and ethnic groups, and all age categories. And they will do so in large enough numbers and in a randomized manner that will enable them to draw statistically valid conclusions about the prevalence of the disease — its intensity, where it is progressing, where it is receding — in order to inform decisions on how to roll back emergency shutdown measures.

But that’s not what we’ve heard. A lot of scattershot testing, even at the 10,000-a-day level, by urgent care centers, physicians offices, hospitals, nursing homes, employers, public health authorities, and social-justice activist groups — all using different protocols and focusing on their own particular priorities — may not give us the kind of data we need to extract us from our collective misery.

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29 responses to “Has COVID-19 Testing Become an End in Itself?”

  1. LarrytheG Avatar

    Virtually even single epidemiologist says that we need more testing.

    If you disbelieve this, ask yourself why the military is testing all of it’s personnel including on deployed ships.

    Why are the prisons testing all?

    what are they doing it in nursing homes?

    Why do companies like Ford and meat packers say it is needed?

    There seems to be a fundamental misunderstanding of what testing is for.

    I’m really surprised that Jim is asking what it is for and if it is necessary.

    looking at after-the-fact data like hospitalizations only tells you what has already happened. Testing is how you affect how many get infected and end up hospitalized. If you do not test, you have almost no control over the rate of infection.

    Perhaps I do not understand and Jim can further explain his view.

    1. Here’s my suggestion, Larry. Go back and re-read the post. And read it all the way to the end. Then come back and re-phrase your question so that it addresses what I actually said.

      1. LarrytheG Avatar

        ” The criticism may be valid as long as you accept the assumption, which Northam obviously does, that more widespread testing is going to tell us something that we don’t already know. If there’s a scientific “consensus” about COVID-19 among experts around the world, it’s that more testing is better. What bothers me is that no one in Virginia has effectively explained why more testing is better.”

        What does this mean? Why is it up to Virginia to explain testing to you when almost every recognized epidemiologists already affirms it?

  2. “A lot of scattershot testing, even at the 10,000-a-day level . . . — all using different protocols and focusing on their own particular priorities — may not give us the kind of data we need to extract us from our collective misery.” I think that’s a valid criticism of testing aimed at determining a baseline of what infections are out there. There’s another use for testing, however: not to establish a broad baseline but, in a presumed post-quarantine, relaxed-but-still-vigilant mode, to test apparent new cases in the workplace and to trace their contacts. We really need to do both; the former to determine where the hot-spots are and the latter to keep a second “surge” suppressed.

    I think the point you are making, perhaps inadvertently, is that, for the former purpose the State’s testing regime is barely getting beyond the “scattershot” stage of testing only those with the most urgent need for it. We need a coordinated State effort to conduct a broad randomized, standardized sampling of the entire populace in order to know where the problems are and to allocate resources properly. And for the latter, post-quarantine purpose, getting people back to work is going to remain a balancing act with too much covid contact quickly spiraling into too many new cases; how can we manage those contacts without spot testing of those working in hot spots or exposed to more isolated new cases? We may not have the widespread testing we need now but we sure as hell need it to go forward towards any kind of partial normalcy.

    1. Good point about workplace testing, presumably conducted by the employers themselves.

      Maybe that’s one of the recommendations Northam’s working group will come up with. But where does that 10,000-a-day number come up with? It strikes me as a number plucked out of thin air.

    2. Reed Fawell 3rd Avatar
      Reed Fawell 3rd

      Or in the alternative, the real danger and difference earlier presumed by “experts” to be inherent in this Coved-19 crisis will pass and fade (or prove largely to be our own invented illusion), long before Virginia’s growing flock of experts will have a clue as to what has happened, and is happening in front of their noses. There open letter I put up here on BR is evidence of that myopia overwhelming these experts.

      And, in addition, those experts being short of cash and/or hungering for power and control, will continue their wild goose chase as long as they can, as Virginia’s economy collapses around them. This scenario appears more likely with each passing day.

  3. LarrytheG Avatar

    There are a lot different views on testing in terms of how to do it and to combine it with contact tracing.

    Contact tracing is nothing new. It’s the way the health departments have operated for decades with infectious diseases like Tuberculosis. As soon as someone tests positive – it kicks off contact tracing to find others.

    The folks who wonder if this is useful – well I don’t know… it’s the standard procedure for tracking infectious disease.

    Without testing, we’re basically saying that we have no way to deal with the disease – just keep track of hospitalizations, so we know when it’s trending down..

    I cannot imagine a less intelligent way to deal with infectious disease.

    If we did that with something like tuberculosis or aids, etc – i.e. just keep track of how many people got infected and ended up hospitalized… as our approach…

    Add that to some views that testing is just “too much” .. that we just can’t do it… it’s not practical…. again… that defaults back to the premise that we cannot really do anything other than track how many have gotten infected and hospitalized… died.. recovered… etc.

    and that, in turn, goes back to whether social distancing is effective or not – or if we have any way of actually determining if it is effective or not and what we’d do if relaxing restrictions actually resulted in more infections… How would we know if we waited until more hospitalizations?

  4. LGABRIEL Avatar

    James is asking the right questions . There seems to be at least 2 possibilities of how the 10,000 number was derived. 1) It was a good round number calculated to buy himself more time so he would have cover for not relaxing restrictions that no longer make sense. 2) It was an actual, probably rounded up, number derived from some model. If so that model by necessity contains a lot of strategy and assumptions about how the testing will be done and the purposes of the testing. It would have to have built into it whether it would be done in a randomiized manner, as a component of contact tracing, or some combination. These assumptions in the model are not trivial. They must be well understood by the testing community, the medical profession, and the public at large to make this strategy work. The Governor owes it to the citizens to be totally open, honest, and transparent. I doubt if he will if he is doing it for reason number 1. There is absolutely no reason not to if for reason 2.

    1. LarrytheG Avatar

      No he is not because testing is something that almost every epidemiologists on the planet is advocating so what is the point of saying that Northam has to justify it, especially if he says he’s following the guidance of the professionals?

      What I get out of this is that some people – lay people – who do not understand testing are questioning it.

      And what I ask is – “do you not believe the science” ?

      do you not believe the epidemiologists?

      If you do not – then admit it and don’t be playing “gotcha” games with the Gov.

      so do you not believe what the epidemiologists are recommending?

  5. Steve Haner Avatar
    Steve Haner

    Fauci has been talking about testing 2% of a state’s population per month, which for Virginia would be about 170K tests, or 5,700 per day. Where the 10K per day came from is anybody’s guess. I’m still hearing that to get tested you need to have (or claim to have) symptoms or exposure to a known positive. They are relenting on the required doctor’s order, but that still leaves the vast majority ineligible unless willing to pay out of pocket. And a negative test one day doesn’t mean you aren’t exposed the next.

    The lock down will end when more and more simply ignore it. I don’t see this regime lifting it, not in this state.

    A random running sample of the total population might tell you whether the disease is spreading and how fast, but I don’t think that is what they can or will do. A month ago hospitals, nursing homes and prisons could not test their patients, staff or inmates. Now it seems they can and that’s good progress. Perhaps even grocery chains and public transit can now test their staff. But I’m with Jim, nobody has explained exactly how more testing means it is (or is not) safe to reopen the economy. By the time the Larry’s of the world are satisfied, the economy will be dead.

    1. LarrytheG Avatar

      I think fixating over testing numbers is largely irrelevant. The correct answer is that we need a LOT – maybe MORE than 10,000… It’s basically a place-holder for a LOT!

      And yes – you point out that to this point – we are not even talking about testing asymptomatic restaurant workers going back to work as prophylactic even though that is EXACTLY what they are doing for front line workers, the military, prisons, nursing homes and now meat packers.

      Most employers are going to want to test their workers to protect their larger workforces. This is what many employers are asking for and it’s what many schools K-12 and Higher Ed are saying they’ll need to do to protect both students and teachers.

      What is the point of relaxing the restrictions if we do not test?

      The counter argument to testing seems to be to relax the restrictions and see what happens to hospitalizations.

      Is that really what we are saying? Just loosen the restrictions and see what happens?

      1. Steve Haner Avatar
        Steve Haner

        Larry, 1Q GDP was down 5% and 2Q GDP might be down 40%. At this point, the cure is clearly worse than the disease. The real case fatality rate is higher than flu, but way lower than the epidemiology “experts” were screaming about six weeks ago. The restrictions should ONLY apply to the vulnerable population. As noted before, 79% of all deaths (worldwide, I bet, not just in the US of A) are 65 or older, 91% 55 or older. Poverty kills, too.

        My old employer NNS has been operating reasonably well without being able to test 23,000 shipbuilders. Why can they operate but not some other company, Larry? Why should the big boxes stay open and continue killing the mom and pops?

        This was sold to us as “keep the hospitals from being overcrowded” which is now done. If they can start doing chin lifts, tummy tucks and installing stents in patients who don’t need them, I can go get a haircut. This is ridiculous now.

        1. LarrytheG Avatar

          Steve – that’s your view. Is it the view of scientists? Do you not believe the scientists about the need to test?

          It’s not only the elderly, it’s people with health conditions and it’s also some younger people who are getting strokes.

          Not going to put words in your mouth, so I’ll as if this statement is wrong – that you basically are saying that testing is not the issue and that we just need to open up and whoever dies, will die and the economy will recover?

          or .. if that is wrong, how about re-wording it to be your view?

        2. LarrytheG Avatar

          re: ” My old employer NNS has been operating reasonably well without being able to test 23,000 shipbuilders. Why can they operate but not some other company, Larry? Why should the big boxes stay open and continue killing the mom and pops?”

          Are you sure that NNS is not testing? What ARE they doing, nothing? But good point… need to know more… especially since Ford, Chevy and Dodge are closed and that seems to be a similar industry.

          in terms of the big boxes killing the mom & pops… As far as I know all grocery stores are allowed to be open , no? The demise of Mom/Pop is pre-ordained prior to COVID19 – it’s just accelerating the trend.

          Don’t you find it ironic that WalMart/Lowes/Home Depot are killing it and yet our economy is going to hell in a handbasket over mom/pop who have the lowest paid workers most of who do not have health insurance…

          This was sold to us as “keep the hospitals from being overcrowded” which is now done. If they can start doing chin lifts, tummy tucks and installing stents in patients who don’t need them, I can go get a haircut. This is ridiculous now.

          wait… health care profitability/economic well-being is dependent on non-emergency , discretionary services?

          Again, how does this make any sense?

          The most important, essential things are still in place and working yet discretionary spending for things that are not necessities is why our economy is on it’s butt?

          Finally, as far as I can tell, we’re NOT going back to the way the economy worked before. Almost every single thing will have to be re-invented to deal with social distancing. Is that going to be costly?

  6. Reed Fawell 3rd Avatar
    Reed Fawell 3rd

    “The real case fatality rate is higher than flu, but way lower than the epidemiology “experts” were screaming about six weeks ago.”

    Some now think Coved-19 death rate might be same as flu. More on this later.

    “The lock down will end when more and more simply ignore it. I don’t see this regime lifting it, not in this state.”

    Lock downs cannot go on much lower. Daily carnage now is spreading far and wide. Layoffs going up up the food and education chain, including way up telecommuting chain. For example, collapse of hotel visitors knocks out whole network of collateral sub businesses supporting hotel industry, including highly innovative high techs on cusp of success serving them, just as customers abruptly drop away. This brings on cumulative collapses across whole industries, now.

    Plus, now there are growing signs that earlier predicted Coved-19 virus threat is deflating and diluting as quickly now as the economic threat is conflating, spirally out and up, right now hourly.

    Regarding Northam, he pathologically sets high bars and strict standards. Then, just as pathologically, he fails grossly to effectively arm and lead his state to meet his own standard and demands. Testing, as example. It’s tragic, what is unfolding. It’s as if Nero and his elite allies fiddle as Rome burns. Clueless, they do not understand how business and commerce work, nor do they respect it.

  7. TooManyTaxes Avatar

    What can be done if both workers and customers wear gloves and masks? Can some businesses be opened but the number of customers limited? Giant and Costco are doing that. People are generally following face covering and social distancing limits in the businesses that are open.

    I read where the Fairfax Chamber of Commerce predicts 25% of all small businesses in the County are going under and that was a couple of weeks ago. That’s a helluva big toll on ordinary people even if some cling to their religion and guns and are deplorable.

  8. LGABRIEL Avatar

    You seemed to accuse Steve of not believing in testing, but I read both of his posts and I did see him saying anything close to that. Both he and James’s point is that everyone needs to understand the testing protocol on which the Governor’s number is based. Citing “science” or “scientists” is not enough. Science presupposes totally revealing all data and methodology used in their experiments. This transparency has not been evident at the state or national level. Should we all just sit back and take the word of experts even when they don’t publish their data? Is it too complicated for the citizens who are responsible for the conduct of their government officials? Certainly among the millions of Virginians there are those who do understand modelling, statistics, and many other disciplines involved in the underpinnings of the Governor’s testing strategy. Enough name-calling and innuendo. Let’s get back to what a testing strategy and implementation should look like. We have not seen step 1 as of today.

    1. LarrytheG Avatar

      @LGABRIEL – actually, I did ask them both what they thought the purpose and value of testing is because both are questioning testing and Steve is NOW making the argument that the economy is more important than the virus impacts (I think, he can correct if I’m wrong).

      Both of them appear to me to not think that testing is imperative to getting back to work.

      In terms of experts – when the vast majority of them are pretty much in agreement – who are you going to go to – to question their veracity?

      If scientists were split – yes… even from the top Feds – policy and experts, they are saying that testing is imperative.

      The Defense Dept thinks it is. Other companies think it is.

      Without testing, what do we have in terms of knowing how to proceed with lowering restrictions?

      The Governors testing strategy is pretty much what the science is saying and very similar to most other states including California and New York. Why are we putting the onus on Northam for him to justify what is, in fact, a standard approach among virtually all parties?

      I DO understand there are difference in strategies but these are small bore things compared to the overall strategy to test the population in as many ways as we can to help us know if the infection rates are changing when we start loosening restrictions. Without that information, we are essentially flying blind and despite the folks who say “damn the torpedoes” we risk even worse damage to the economy if the virus runs wild… yeah, we can speculate as to whether than might be a certainty or just a “cry wolf” warning from science..

      In the end, either you do accept the science or , you really are lost because everybody and their dog outside of science has their own opinion… and it’s all based on little more than beliefs – not science.

  9. There was a report: “Poverty by Race in Richmond City,” by University of Richmond, Bonner Center for Civic Engagement that compared the racial breakdown of the impoverished. https://scholarship.richmond.edu/cgi/viewcontent.cgi?article=1029&context=poverty

    It compared 2000 and 2015 population numbers.
    Black 73%
    White 19%
    Hispanic 4%
    Asian 2%
    Other 3%

    Black 64%
    White 22%
    Hispanic 9%
    Asian 2%
    Other 3%

    The proportion may have changed since then, but it’s something to look at for now in comparing the COVID-19 numbers by race. I merged Hispanic, Asian and Other into one category to match the VDH stats.
    Merging Hispanic, Asian, Other into one category:

    2015 Population % compared to VDH’S 323 COVID Cases in Richmond City.
    Black — 64% of 323 = 206. VDH 189 cases, 45 hospitalized, 13 deaths
    White – 22% of 323 = 71…..70 cases, 8 hosp, 1 death
    Other – 14% of 323 = 45 ….21 cases 7 hosp, 0 deaths
    Not reported……………………43 cases, 2 hosp, 0 death

    Without the race of the not reported, we don’t get a full picture, but enough to show the rate of disease is probably close to what would be expected based on population. But it’s also an indicator that comorbidities with the virus in the black community can be deadly, and hospitals need to be proactive in testing for hyperinflammatory reactions.

    We don’t know the breakdown between nursing home and general population deaths, whether patients remained in nursing homes vs being transferred to hospitals, or whether nursing homes tested for cytokine storm syndrome (CSS) and treated the severest cases accordingly. If not, there’s no mystery as to the higher death rate.

    Even if recognized, there will be a higher death rate of those with the overwhelming systemic reactions, but at least they’ll have a chance of survival over those with unrecognized CSS.

    If more testing does prevent or at least delay infections, it will give the most vulnerable a better chance of surviving until a treatment like remdesivir is confirmed.

  10. Steve Haner Avatar
    Steve Haner

    Larry, all the “scientists” are employed and getting paid. What the #$@& do they care? I’m saying follow the data and focus protection on the vulnerable. That’s not most people.

    1. LarrytheG Avatar

      Totally true but what’s your point? Do you believe the science or not?

      What “data” do you trust more than science?

      When you say: ” I’m saying follow the data and focus protection on the vulnerable.” is that what the scientists are advising?

      Do I detect that your view is changing?

      My view is that if you do that (focus on the vulnerable), the rest of society is going to live in fear that they or a member of their family will get it.

      1. Steve Haner Avatar
        Steve Haner

        The fearful can stay fearful. The rest can go back to work.

        1. djrippert Avatar

          Exactly right. Here’s my prescription for the fearful – go to your bedroom, take the sheets off the bed, hide under the bed, cover yourself with the sheets, close your eyes tightly, do NOT use your cell phone since 5G towers are a known accelerator of the virus, do not leave your house for any reason.

          That will take 75% of the liberals out of circulation.

          1. LarrytheG Avatar

            hmmm.. must be that all the old folks are diseased younger folks are “liberals”… sounds about right, eh?

            Can you provide a single CREDIBLE source that advocates what you are advocating with the bed sheet idea? Any states? Any localities? Any scientists? Any Feds? who?

            How about all those anti Vaxxers? or the “freedom” protestors?

  11. LarrytheG Avatar

    Okay, got it.. testing is not really that relevant?

    Is this how you started on this or has it changed as
    the damage to the economy has increased?

    1. Steve Haner Avatar
      Steve Haner

      I doubt anybody has been watching the (publicly available) data more closely than I have, and I search widely. What the data tells me is 1) most people exposed don’t get sick, 2) most who do get sick recover, and 3) those who don’t recover are usually old and/or suffering from preexisting conditions. Those are mainly obesity or smoking related (hypertension, coronary artery disease, diabetes, COPD) and in most cases those people know who they are. I bet the intake people in ER spot them and segregate them immediately. If you are under 55 and have none of those, sure, you might still die, but this is a dangerous pandemic only for that narrow subset of people. The data also indicates that warm humid air impedes transmission and vitamin D levels matter. Me, I’m still drinking my tonic water with quinine 🙂 and ingesting zinc, with known anti-viral qualities (not proven for this.)

      You push back and fall for the Appeal to Authority argument but you have no idea what we will learn with 10,000 tests a day that we don’t already know. Unless those tests are targeted at protecting the vulnerable populations, I don’t see the point either. But Northam promised to bring his charts tomorrow.

  12. LarrytheG Avatar

    FIRST, THANK YOU for your forthright response!

    re: “appeal to authority” = belief in science? or tell me different

    would you not see a use for testing for employer workforces?

    Finally, out of 330 million, how many do you think are in the “vulnerable” category and how do those folks do things like visit doctor/dentists, hospitals ER, elective surgery, have repairs done , and many of the other things that most do in their normal lives?

    Can you name ANY “authority” – science or political or other that is advising this approach?

  13. djrippert Avatar

    Why is testing important in a reopened world?

    1. You feel sick so you get tested.
    2. You test positive.
    3. You list those with whom you have been in contact (or your phone lists those who have phones that have been near your phone)
    4. You get quarantined and placed under close observation.
    5. Those who you have been near get tested.
    6. Any people from #5 (above) who test positive get quarantined and their contacts get tested.

    Broad based testing lets society reopen on the way to herd immunity without overwhelming the medical system.

    Or … we can all take the sheets off our beds, crawl underneath the bed, pull the sheets over our heads and close our eyes tightly as we wait for the COVID19 boogeyman to go away.

    1. LarrytheG Avatar

      Is it possible that the folks that think widespread testing is the way to re-open the country are …. GASP… Liberals who do NOT want to hide under their beds – and thats a way to go forward instead?

      forked tongue issue?

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