An ongoing dialogue on HIV/AIDS, infectious diseases,
March 8th, 2020
As Testing Ramps Up, Diagnoses of Coronavirus Disease in the U.S. Will Soon Increase Substantially — How Will We Respond?
Brace yourself. As coronavirus disease (COVID-19) occurs at multiple locations around the United States, the number of confirmed cases here is about to increase big time.
There are two reasons:
- New infections
- More testing
Believe it or not, despite statements by certain politicians, COVID-19 tests still cannot be ordered by any clinician who believes it should be done. In many parts of the country — including, as of today, Massachusetts — a local health department continues to be the only place to get the test. These state labs have limited resources, and hence must offer the test only to those who have a clear exposure, or have a severe respiratory illness without other obvious cause.
That’s about to change. Two of the largest commercial labs in the country, LabCorp and Quest, announced that they have tests ready to go.
Plus, multiple academic medical centers plan to modify their existing molecular diagnostic assays by adding the coronavirus genetic sequence as a target. This will enable testing to be done rapidly “in house” at hospitals that see the highest volume of critically ill and immunocompromised patients.
And not a moment too soon. By all objective measures, our testing has been woefully inadequate, meaning that the reported number of diagnosed COVID-19 cases are the proverbial tip of the iceberg — an iceberg of the pre-climate change magnitude.
Consider — today’s report shows 484 cases reported with 20 deaths. Remember that these tests were done mostly on the sickest people. That’s why our mortality rate is so high at 4.1%.
By contrast, consider South Korea, which already has widespread disease and an aggressive testing policy (they have apparently done over 140,000 tests). They have diagnosed 7,314 COVID-19 cases, with 50 deaths, for an estimated mortality rate of 0.6%.
If we apply that 0.6% mortality rate to the 20 deaths we’ve had here, this would mean there are already around 3,000 cases in the United States. We just haven’t been testing enough to find them.
(Apologies to epidemiologists for the crude estimates. Hey, math is hard.)
There are several ways we could — as clinicians, scientists, media, public — react to this surge of cases that will inevitably dominate the headlines in the coming weeks.
On the negative side is panic, which will bring with it further hoarding behavior, conspiracy theories, and unproductive accusations. On this last one, I’d like to emphasize what I posted here about the people I know who work at CDC and the department of public health — they are not to blame:
Agree. The people I know who have worked at @CDCgov and at @MassDPH have been hard-working, mission-driven, and science-based individuals who want to do the right thing. They must be given the resources they need. https://t.co/iukkqLkRMb
— Paul Sax (@PaulSaxMD) March 7, 2020
Another terrible reaction will be to suppress the information.“I like the numbers being where they are” is not an effective mitigation strategy — a strategy which will be critical to prevent the overburdening our healthcare system (see figure).
What I’m hoping for?
Let’s welcome the accurate data, even though the numbers will sound scary. It’s time for expansive tests for COVID-19, even introducing them as soon as possible on our multiplex respiratory virus testing platforms.
Such information will give us a much better sense of the spectrum of the illness here, as well as the risk factors both for COVID-19 acquisition and severe disease. It will also allow us to institute more sensible infection control policies, to allocate resources where the disease is most prevalent, and to construct viable strategies to turn the tide against the epidemic.
When Knowledge is Power confronts Ignorance is Bliss during a public health emergency, give us the first one every time.