COVID Update April 20: The next narrative will be one of the states vs the federal government & who has responsibility for testing.
The Hill, governors, WH, testing cos. I got a little of everyone’s opinion.
30 minutes or so if you’re interested in following. 1/
The Hill, governors, WH, testing cos. I got a little of everyone’s opinion.
30 minutes or so if you’re interested in following. 1/
Will also cover the overall state of things, the Senate bill, the disability community & other learnings of the day. 2/
OVERALL: NY is slowly flattening but things are precarious.
States that haven’t been touched will without significant social distancing & containment. So they will have later peaks. Why? No human has natural immunity.
We are flattening the curve not stopping it. 3/
States that haven’t been touched will without significant social distancing & containment. So they will have later peaks. Why? No human has natural immunity.
We are flattening the curve not stopping it. 3/
We don’t know this virus but at this point it’s safe to say that an invisible spec making its way into your nostril or throat can pass from unknowing to unknowing person. @EricTopol current best estimate is 40% never know they have it (without testing all of us). 4/
That spec when it finds the right party may be able to not only can destroy lungs, but other organ systems— kidneys, heart, brain & gut. 5/
So much we don’t know. I talked to a young doctor who has been wrestling with her own COVID-19 today. She describes feeling her immune system was utterly befuddled at what to do, cried from pain & confusion for first time since she was a child. (She is almost recovered now.) 6/
With all this deaths/case are all over the map which we know is a function of testing.
What we do know is that deaths/population start to converge. The variance depends on containment efforts. 7/
What we do know is that deaths/population start to converge. The variance depends on containment efforts. 7/
But the countries that have beat the system will only beat it if they keep the virus out or keep it from spreading before a vaccine. 8/
If this were the flu— you got symptoms, you stayed home— even if it were deadly, it would be easier to manage.
Since it’s not— if we want to open the economy, testing is the only way to get there. 9/
Since it’s not— if we want to open the economy, testing is the only way to get there. 9/
So on to the testing story. We’re not ready to open up if enough testing to contain new outbreaks is one metric. And the WH said it was.
So today I’m going after “why and what happens next.” 10/
So today I’m going after “why and what happens next.” 10/
Pre-COVID tests were not built for scale. Takes a lot of labor, supplies, some big machines— but measured in hundreds not thousands/day.
If you had your cholesterol taken, you didn’t much care if it took a few days. 11/
If you had your cholesterol taken, you didn’t much care if it took a few days. 11/
The FDA also approved things they thought worked best— the exact best swab with the exact right chemicals that fit the exact right machine was what the FDA approved.
If Roche sold the razor it wanted to sell the razor blades (their cartridges & reagents). 12/
If Roche sold the razor it wanted to sell the razor blades (their cartridges & reagents). 12/
(Brodie and I are outside as he has business to attend to. It’s a pretty beautiful world right now.)
We’ve ramped up testing quickly to about 1 million tests/week. And then we stopped increasing.
Easy phone calls to spot many easy to see culprits:
1. Not understand & overpromising from the WH
2. Over promising from the major commercial labs
3. Load balancing (will explain) 14/
Easy phone calls to spot many easy to see culprits:
1. Not understand & overpromising from the WH
2. Over promising from the major commercial labs
3. Load balancing (will explain) 14/
4. Limited number of the big machines
5. The uncertain reimbursement from insurers slowing down labs
6. Not allowing interchangeable parts
7. 2 negative tests needed after a positive 15/
5. The uncertain reimbursement from insurers slowing down labs
6. Not allowing interchangeable parts
7. 2 negative tests needed after a positive 15/
8. Confusion on ordering— no public way of accessing tests
9. Testing swabs mostly from Italy
10. Some private labs catering to paying customers
11. Some being exported still
12. New demand from DoD May be about to pull hundreds of 1000s of tests 16/
9. Testing swabs mostly from Italy
10. Some private labs catering to paying customers
11. Some being exported still
12. New demand from DoD May be about to pull hundreds of 1000s of tests 16/
13. Processes labor intensive
14. Access and distribution points not set up/missing ordering process/EMR integration
15. Many new EUA tests of dubious quality
16. Several governors/states haven’t figured out how to buy 17/
14. Access and distribution points not set up/missing ordering process/EMR integration
15. Many new EUA tests of dubious quality
16. Several governors/states haven’t figured out how to buy 17/
(Some of you are very impatient you know). 18/
I’m talking about you with your funny GIFs making @somuchweirdness laugh hysterically.
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