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United States Government Medicine

WSJ: Narrow Testing Guidelines By America's CDC 'Hid' the Growing US Epidemic (wsj.com) 311

Posted by EditorDavid from the in-plain-sight dept.
The Wall Street Journal reports that as the coronavirus pandemic began, America's Centers for Disease Control and Prevention "provided restrictive guidance on who should be tested."

They're basing that on archived pages on the CDC's own web site. "While agencies in other countries were advising and conducting widespread testing, the CDC, charged with setting the U.S. standard for who should be tested for the virus, kept its criteria limited." Once the CDC deferred testing evaluations to individual physicians and rolled out testing widely, early data show a surge in positive cases, so public-health officials expect a clearer picture of the epidemic's scale to emerge... Containing a virus requires identifying and isolating those who are infected, infectious-disease and public-health experts say. "If we would have had a true understanding of the extent of the disease several weeks ago, implementation of social-distancing measures could have prevented the escalation of the disease," said Neil Fishman, chief medical officer at the Hospital of the University of Pennsylvania and an infectious-disease specialist...

Initially, the CDC recommended only investigating those who had symptoms and had recently traveled to Wuhan, China, or made contact with someone who may have the virus. As the outbreak worsened, it expanded the criteria for travel history slowly, but maintained its recommendation that symptoms be present, despite some cases having mild or no symptoms.

Now, the CDC has turned over authority to physicians to determine who gets tested, but the testing rates vary widely by state.
America's response was also hampered by "a botched initial test batch," according to the article, which meant there were fewer tests available until the agency allowed private laboratories to develop tests.
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WSJ: Narrow Testing Guidelines By America's CDC 'Hid' the Growing US Epidemic More

WSJ: Narrow Testing Guidelines By America's CDC 'Hid' the Growing US Epidemic

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  • Hmm (Score:5, Insightful)

    by burtosis ( 1124179 ) on Sunday March 22, 2020 @10:42AM (#59859312)
    With the US and South Korea getting the first case at about the same time, I guess South Korea doing literally 1000x the early testing per capita really does get 1000x better results. We still aren’t even testing doctors and nurses on the front lines, who’d a thunk trying to cover up a pandemic would be a disaster?
    • Per capita, S Korea has had 50% more cases than the United States.

      It seems the only thing that works is quarantine. That is what Korea did to slow the spread of Coronavirus, and it is why New York has so many more cases than the Bay Area.
  • Testing everyone was simply not an option. Wasting tests would be negligent. We needed to deploy the tests we had in the most effective way possible. We're still in the same situation right now in many ways.

    • We could have had them.

    • We needed to deploy the tests we had in the most effective way possible. We're still in the same situation right now in many ways.

      Unfortunately, yes - due to supply chain issues as of a couple days ago. (For instance, one of the test makers was having trouble getting swabs.)

      Hopefully that has been fixed and they're ramped up, so wider-scale testing can start happening in the next few days, rather than late last week as had originally been expected. (I haven't seen anything about it being fixed yet,

      • Continuing (restarting) after thumb-post (I HATE trackpads)

        We needed to deploy the tests we had in the most effective way possible. We're still in the same situation right now in many ways.

        Unfortunately, yes - due to supply chain issues as of a couple days ago. (For instance, one of the test makers was having trouble getting swabs.)

        Hopefully that has been fixed and they're ramped up, so wider-scale testing can start happening in the next few days, rather than late last week as had originally been expected.

    • March 3rd, Pence offered a ray of hope saying they were shipping test kits that would allow1.5 million tests in the US. That didn’t quite pan out.

      In early February at the latest, a push for different tests being made and available rapidly and in quantity should have been done. The US should have tested over 2 million people by now.

      In early January, measures should have been taken to increase supply of ventilators and PPE. Kind of late to make that push in mid March, and there isn’t much evidenc

  • Still restricting tests (Score:4, Interesting)

    by MacColossus ( 932054 ) on Sunday March 22, 2020 @11:01AM (#59859346) Journal
    The area I live in wonâ(TM)t test even if you are symptomatic and have negative tests for strep or flu unless: You are over 60 and symptomatic Symptomatic and have a pre existing health condition. So numbers are still artificially low.

    • Unfortunately the US still doesn’t have enough testing kits, which is what is guiding the current criteria.

      I’m glad the President is taking this seriously now, but we should’ve been ramping up production in January or February rather than saying we had it under control and talking about it magically disappearing by April.

      • Re:Still restricting tests (Score:5, Informative)

        by dmr001 ( 103373 ) on Sunday March 22, 2020 @12:10PM (#59859596)
        In the area I'm working in (as a physician), as well as with people I know in New York City, testing is no longer constrained by test kit availability but by personal protective equipment needed by the people collecting the test. Recommended testing is a combination nasopharyngeal and oropharyngeal swab: we stick a long, thin wire Q-tip in through nose back about 4 inches, and then another one way back in your throat. We stopped nasopharyngeal washes (instead of swabs) in our area because this commonly resulted in patients gagging, coughing and aerosolizing a floating cloud of whatever they were infected with; this is less common with nasopharyngeal swabs but still a problem.

        We're no longer switching masks between patients but trying to reuse them as much as possible, because there aren't enough masks to go around. That will risk infecting both health care personnel, and probably to some extent patients. If you live in the Seattle area and have a sewing machine, my healthcare organization (for whom I do not speak in an official capacity) would love you to volunteer to make masks [providence.org]; we'l send you materials.

        To the grandparent who claimed that... > The CDC is just a bloated bureaucracy, like most government organizations in a count[r]y our size, and didn't get off its ass fast enough. They certainly weren't > destroying evidence or quarantining people in secret facilities or anything like that.

        I wonder what you mean by "bloated." The CDC was on this pandemic from the moment it appeared to be problematic, admittedly botched the initial tests results, and now has to spend a fair amount of time correcting the ongoing stream of misstatements of fact by the president who has been planning to cut its budget [snopes.com]. In my personal experience, people don't work at the CDC for the prospect of an easy government job. They tend to be dedicated clinicians and scientists who are interested in how to get the most bang for the buck, life-saving-wise, and happily travel to infected regions of the country and world to help keep you safe from a variety of horrible diseases. As an example of how CDC medical officers take advantage of government largess, enjoy these job postings [usajobs.gov] where for 25-50% of a typical low-end physician salary you can work for up to two years in places like Angola and Bangladesh.

        Sorry: I get a bit chapped when people with no likely first-hand knowledge slag my personal favorite heroic government bureaucracy.

        • Mod parent up

        • Sorry: I get a bit chapped when people with no likely first-hand knowledge slag my personal favorite heroic government bureaucracy.

          There are a lot of people here who read Ayn Rand as a teenager and never got over it. They now have "gubbermint evull" as an axiom and see everything through that lens.

  • Test Everyone! (Score:5, Interesting)

    by mspohr ( 589790 ) on Sunday March 22, 2020 @11:14AM (#59859392)

    Test and quarantine.
    Everyone needs to be tested and all positives quarantined.
    In Italy, they did an experiment on a town. They tested everyone and quarantined all positives (many of whom where not symptomatic). Retest 9 days later showed no new cases. Epidemic halted!
    In the USA, our great leader led us down the path of denial and now we are going to have a huge epidemic.

  • Test Kits (Score:4, Insightful)

    by JBMcB ( 73720 ) on Sunday March 22, 2020 @11:21AM (#59859424)

    The first test kits for the disease were faulty. The only reliable tests were at private facilities, which were extremely limited at the time. The CDC recommended only testing people at high risk for the disease, or who were known to be exposed to the disease, as they were highest risk, as the number of tests that could be done were limited.

    https://www.newyorker.com/news... [newyorker.com]

    • Re: (Score:2, Interesting)

      by burtosis ( 1124179 )
      Or, you know, the US could actually have collaborated with other countries and the WHO to get or copy already reliable tests. We could have seen the virus as a common enemy of all humans, but instead we just refused to deal with them in favor of going it on our own. This is a war and now we are lagging so far behind we don’t even have the tests to see if our own front line medical workers are infected and spewing virus around hospitals before showing symptoms, much less to try and contain this like

      • Did you read the article? The problem was with QC procedures in building the kits. The world *did* collaborate on creating the test. There was already a procedure in place to implement the whole thing.

        • Did you read the article? There was no cooperation on testing. The only thing communicated was the genetic code of the virus, no details or implementation. That’s akin to that friend explaining they have this idea for a million dollar app with no idea of how to code or what’s involved. The takeaway from the article is the CDC fully admits sending all test results through the CDC creates a bottleneck totally unsuited for a pandemic response. While PCR testing can be done in many locations, it

          • Re: (Score:2)

            by JBMcB ( 73720 )

            Did you read the article? There was no cooperation on testing.

            What are you talking about? You think we went from zero to available test kits in a couple of weeks without pre-planning and cooperation? Do you think every countries' health system, manufacturing sectors, regulations and supply chains are so similar that everyone can just build the exact same test kits? Do you think that adding more people to solving a problem will always speed up solving that problem?

            What *specifically* would more cooperation have done to fix the shortage of test kits, if the underlying

            • What specifically would I have done? Well first off yes, every country has nearly the same technology for PCR testing. Sharing methods, procedures, and at least some test kits for samples for starters. Second, this should have started back in January when the intel committee identified it as a global pandemic risk. Waiting until it blew up and having trump play it down saying it would magically go away and the cases drop to zero immediately was insane. Third, I’d have axed the whole one central t

  • There are mistakes all over the place, in the USA and elsewhere.

    Here in Ontario, Canada's most populous province, they are not testing someone unless they traveled or came in contact with someone who is positive. That may have worked two weeks ago, but is no longer the case. We are way past this: cases are popping up everywhere. In my not so large region (similar to a county in the USA) of ~ half a million, there are 15 cases [regionofwaterloo.ca]. However, three of them are 'community transmission' (i.e. public health officials

  • While agencies in other countries were advising and conducting widespread testing

    I wonder, which countries are those, where widespread testing for COVID-19 was (or even already is) possible [umn.edu] — regardless of official recommendations...

    But, hey, if only CDC had more funds — and were allowed to spend them on gun-violence [npr.org] — their recommendations would've been entirely different. #Impeach

  • You know, what constantly gets me is the line that the CDC apparently banned the development and deployment of private tests.

    I mean, isn't that the opposite of providing healthcare? The opposite of free(ish) market?

    I can understand a requirement to show that the test actually works before you go selling it to consumers, one still needs to block snake oil. But legit tests should be allowed regardless of CDC's desires, so long as the FDA has been satisfied that the test works well.

    • You know, what constantly gets me is the line that the CDC apparently banned the development and deployment of private tests.

      I have never read that the CDC to my knowledge bans "development". It generally does not deploy un-certified and unvalidated tests. In this case, any new test would have been subject to scrutiny as to whether it worked. False positives or false negatives could do a lot more harm.

  • They did not have the number of tests so were purposely testing those who were at highest risk.
    It actually makes good sense. The problem was that Trump et. al. were running around telling everybody that it was contained, when in fact, it was KNOWN that it was not.

  • There weren't even enough to test everyone who met the CDCs supposedly overly-restrictive testing guidelines. Measuring the scale of the epidemic was simply out of the question. Even today, we're well behind on testing.

    Under the circumstances, you have to triage use of the kits, and some people who obviously need them don't get them. There isn't a good reason to deny them, other than someone else needs it more.

    This is a classic examples of Benjamin Franklin's dictum, By failing to prepare, you are prepa

  • Comment removed (Score:4, Insightful)

    by account_deleted ( 4530225 ) on Sunday March 22, 2020 @01:01PM (#59859772)
    Comment removed based on user account deletion
  • It is essential to limit testing to those that are almost certain to be sick. Doing that, ensures that the death rate will look very scary and thereby ensure funding for research into a cure. If they would test everybody, then the death rate will be a small fraction of a percent and then the tax payers will ignore the whole thing and carry on with life as usual.

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