Coronavirus testing has been a major bottleneck in determining how many people have the virus, a serious issue when it comes to assessing health care and public policy needs.
The United States, while having ramped up testing, is nowhere near where we need to be — something that ought to concern us, given the fact that a tight testing regime would necessarily be a precondition for reopening the country in a widespread manner
That said, educated guessing isn’t the answer.
I mention this only because this seems to be a very en vogue way to calculate how the novel coronavirus is spreading.
The Centers for Disease Control and Prevention, for instance, faced widespread criticism for guidelines in late March that told hospitals to list COVID-19 as the cause of death even if it was only an assumption the patient had it or it was a contributing factor.
This goes further than death certificates, though. In Ohio, for instance, at least one county is now counting people as having COVID-19 even if they haven’t been tested as long as the health department determines they have the symptoms for it.
“Health departments across Ohio now will include people who show symptoms of having contracting the coronavirus but who have not been tested, said Michael Dohn, medical director, Public Health – Dayton & Montgomery County,” WHIO-TV reported last week.
“The change in how patients will be counted doesn’t mean things are worse, he said, but it means health care professionals will get a better count of who is sick and has COVID-19, whether confirmed by a test or not.”
#JUST IN: Health departments across Ohio will now count who has tested positive for #COVID-19 as well as people suspected of having #coronavirus but who have not been tested, county health medical director Dr. Michael Dohn said. https://t.co/GGJ2DaZafY pic.twitter.com/TfQ1949aCi
— WHIO-TV (@whiotv) April 9, 2020
Very little is known about coronavirus right now, and this is the sort of well-intentioned policy that doesn’t help.
It’s just one Ohio county, but this is still another example of how a guessing game could turn the numbers on the disease into a case of garbage in, garbage out.
We’re told that COVID-19 has a wide range of presentations — from asymptomatic and mild to serious and deadly, from respiratory to gastrointestinal, from strange symptoms like losing your sense of smell and taste to more traditional ones like difficulty breathing.
But these aren’t necessarily different from other infections. In fact, many people describe their coronavirus cases in language that’s incredibly similar to the cold and the seasonal flu.
At least at present, COVID-19 is multiples of times more deadly than the seasonal flu, however, which is why you’re probably reading this from a home you haven’t left for any other reason than obtaining medication or food.
We don’t know how deadly this is, though.
As of Friday, Montgomery County has had 161 coronavirus cases and four deaths. This likely goes up due to the new guidance.
But do those numbers necessarily get us to a better understanding of how many people have the disease?
There’s no question we’ve dramatically undercounted the number of people who have coronavirus. According to a German study, we’ve only identified 1.6 percent of cases via testing in the United States. (The number worldwide is no better, coming in at 6 percent.)
However, this also means the virus is less deadly than we might have originally thought. If we’re only catching 1.6 percent of cases via testing, this means most people are able to recover at home or are asymptomatic.
Meanwhile, counting people who present with symptoms similar to coronavirus presents a hammer/nail-like situation for medical professionals.
If someone is in bed with a bad cold or flu, the tendency — given the fact all practitioners are (quite rightly) in an all-coronavirus, all-the-time mindset — will be to say that individual has COVID-19.
What’s more, Montgomery County could be a bellwether. Even with increases in testing capacity and the fluctuating set of symptoms coronavirus causes, it’s easier on face to say someone with a serious infection has COVID-19 without them being tested. Over the next few weeks, this might not be an unpopular policy — and it’ll tell us nothing about the disease.
These are numbers we’re using to determine where scarce resources are being distributed to, where restrictions need to be tightened and, perhaps above all, when the country can get back to some semblance of normalcy.
Those of us who bring up that last factor are always accused of heartlessness and putting dollars above public health. The numbers are dire, however, particularly when you consider the fact that economists at the Federal Reserve Bank’s St. Louis region have predicted job losses of 47 million, according to Forbes.
That’s a 32 percent unemployment rate.
The longer this goes on, the longer those people are going to be unemployed and the sooner this becomes a depression with no end in sight.
For technocrats, this can all be solved one way or another once we lock down this existential threat, but if we don’t have accurate numbers about that threat through actual testing — with actual testing, both for the disease and antibodies, not guessing — we can’t be entirely sure what we’re dealing with.
Nothing is served by lumping people who don’t have coronavirus in with the pool that does. It distorts numbers for a disease where numbers are the key to fighting it.
Even as a last-ditch approach to the problem, this doesn’t pass muster.
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