The story of COVID-19 revolves around testing, tracing, and isolation

I have an interest in the intersection of governance and public health, as demonstrated by how different countries have addressed COVID-19 testing.

Countries such as Taiwan, South Korea, and Hong Kong have been highly capable in coronavirus testing, tracing, and isolation. Others have not done as well.

I’ve found that Twitter is a helpful resource for keeping track of information about how different jurisdictions are responding to COVID-19. Examples of information sources I’ve learned about through Twitter include Stat, Nature, Undark, and Narwhal.

Figuring out who’s who requires a bit of discernment. For example, some university-affiliated bodies in North America presenting health policy recommendations are politically middle of the road and some are anything but. That’s what I’m talking about, when I refer to discernment.

Previous posts refer to variability in COVID-19 testing

Some previous posts have focused on testing; for example:

March 18, 2020 Intensive testing has vastly reduced infections in South Korean, Taiwan, and Singapore; in Canada the focus is now on minimizing the quickness of the ‘forest fire’ as it burns, yet testing still remains a key requirement

March 19, 2020 Intensive testing for COVID-19 is recommended by WHO; in Canada, public health messaging appears to emphasize restrictions on testing

April 5, 2020 South Korea and Germany are doing extensive COVID-19 testing; Province of Ontario has not been doing much testing at all

Testing missteps in New York City

An April 25, 2020 CBC article is entitled: “How hidden cases, testing blunders and political missteps doomed NYC’s COVID-19 response: Researchers say dozens of cases from Europe went undetected, seeding the outbreak that’s ravaged the city.”

An excerpt reads:

Experts say a lack of available testing, poor screening at the city’s international airports and a dense urban area combined to bring New York to its knees, forcing millions into isolation and pushing hospitals to the brink.

With more than 15,000 probable and confirmed deaths due to COVID-19, New York City has the fifth highest recorded death toll in the world, behind only Italy, Spain, France and the U.K.

Early disadvantage

That such a high number of probable cases went undetected early on put New York at a disadvantage compared to cities on the West Coast, which had fewer initial cases and locked down sooner, said George Rutherford, the head of infectious disease and global epidemiology at the University of California, San Francisco.

“When New York started off, they had 200-plus chains of transmission going on, whereas out here in the West, we had six, seven, eight, something like that,” he said.

A second excerpt features Dr. Eric Cioe-Pena, director of global health for Northwell Health, a non-profit network that runs hospitals and research and testing facilities in New York state:

A failure of testing

Cioe-Pena said the initial lack of testing infrastructure meant health officials were unable to keep on top of the spread, contributing to New York’s inability to control the outbreak.

Early stumbles by the U.S. Centers for Disease Control and Prevention meant states and municipal officials didn’t have access to large numbers of tests, so they were limited to testing only the sickest patients, and it would take days to get results back.

“It was already too late for us to scale up testing. We had already missed the boat on that,” Cioe-Pena said.

Associated Press article provides in-depth look at Lombardy; BBC article says Zoom is tiring

An April 26, 2020 Associated Press article is entitled: “Many failures combined to unleash death on Italy’s Lombardy.”

The article refers to a perfect storm of events and circumstances that led to the enormous loss of life in Lombardy. At previous posts I’ve highlighted Lombardy at the time that COVID-19 was just beginning its exponential growth in Europe. The above-noted article rounds out the picture in depth with extensive detail.

An April 22, 2020 BBC article is entitled: “The reason Zoom calls drain your energy.”

An excerpt reads:

Silence is another challenge, he adds. “Silence creates a natural rhythm in a real-life conversation. However, when it happens in a video call, you became anxious about the technology.” It also makes people uncomfortable. One 2014 study by German academics showed that delays on phone or conferencing systems shaped our views of people negatively: even delays of 1.2 seconds made people perceive the responder as less friendly or focused.

An added factor, says Shuffler, is that if we are physically on camera, we are very aware of being watched. “When you’re on a video conference, you know everybody’s looking at you; you are on stage, so there comes the social pressure and feeling like you need to perform. Being performative is nerve-wracking and more stressful.” It’s also very hard for people not to look at their own face if they can see it on screen, or not to be conscious of how they behave in front of the camera.

Anthony Fauci: Testing and tracing procedures have to be in place first

To return to testing, an April 14, 2020 Associated Press article is entitled: “‘We’re not there yet’ on key steps to reopen economy.”

An excerpt reads:

Dr. Anthony Fauci, the government’s top infectious disease expert, said Tuesday [April 14, 2020] the U.S. does not yet have the critical testing and tracing procedures needed to begin reopening the nation’s economy, adding a dose of caution to increasingly optimistic projections from the White House.

“We have to have something in place that is efficient and that we can rely on, and we’re not there yet,” Fauci said in an interview with The Associated Press.

The alternative to having testing in place is a second wave of deaths. Which fact brings to mind an April 25, 2020 Associated Press article entitled: “Many states fall short of mandate to track virus exposure.”

Testing is also addressed in an April 25, 2020 Reuters article entitled: “After ’21 days of hell’ New York governor expands virus testing.”

Asymptomatic coronavirus infection

An April 25, 2020 Reuters article is entitled: “Prison testing finds huge asymptomatic population.”

The subheading reads:

As mass coronavirus testing expands in prisons, large numbers of inmates are showing no symptoms. In four state prison systems – Arkansas, North Carolina, Ohio and Virginia – 96% of 3,277 inmates who tested positive for the coronavirus were asymptomatic, according to interviews with officials and records reviewed by Reuters. That’s out of 4,693 tests that included results on symptoms.”

An April 26, 2020 Toronto Star article is entitled: “COVID-19’s silent spread: Evidence mounting that many infections are going undetected.”

An excerpt reads:

In Iceland, nearly half of people with COVID-19 had no symptoms when they were swabbed for a scientific study. In the United States, preliminary results from a new antibody survey suggests as many as one in five New Yorkers may have been exposed to the novel coronavirus. And in the waters off the coast of Guam, more than 850 sailors on a navy warship have been infected in a massive outbreak — with roughly half reporting no symptoms when they were tested.

In the early days of COVID, experts were skeptical of initial reports of asymptomatic cases, which weren’t thought to play a significant role in spreading the disease. But four months on, there is mounting evidence that “silent spreaders” are a major driver of the pandemic, with top scientists now speculating they could comprise between 25 and 50 per cent of all cases.

Path out of lockdown in Quebec: Test, test, test

An April 25, 2020 Montreal Gazette article is entitled: “The path out of lockdown in Quebec: ‘Test, test, test’ is the key.”

An excerpt reads:

As the Quebec government prepares to announce its plan next week to gradually reopen the province, experts agree there’s one aspect that will be needed, regardless of what approach is taken: widespread testing.

“Test, test, test,” Dr. Horacio Arruda, Quebec’s director of public health, has repeated from the beginning of the pandemic.

Nature article refers to research on vastly different containment measures

An April 27, 2020 Nature article is entitled: “Whose coronavirus strategy worked best? Scientists hunt most effective policies: Researchers sift through data to compare nations’ vastly different containment measures.”

An excerpt reads:

Hong Kong seems to have given the world a lesson in how to effectively curb COVID-19. With a population of 7.5 million, it has reported just 4 deaths. Researchers studying Hong Kong’s approach have already found that swift surveillance, quarantine and social-distancing measures, such as the use of face masks and school closures, helped to cut coronavirus transmission — measured by the average number of people each infected person infects, or R — to close to the critical level of 1 by early February. But the paper, published [1] this month, couldn’t tease apart the effects of the various measures and behavioural changes happening at the same time.

Working out the effectiveness of the unprecedented measures implemented worldwide to limit the spread of the coronavirus is now one of scientists’ most pressing questions. Researchers hope that, ultimately, they will be able to accurately predict how adding and removing control measures affects transmission rates and infection numbers. This information will be essential to governments as they design strategies to return life to normal, while keeping transmission low to prevent second waves of infection. “This is not about the next epidemic. It’s about ‘what do we do now’?” says Rosalind Eggo, a mathematical modeller at the London School of Hygiene and Tropical Medicine (LSHTM).

Much remains to be learned about the new coronavirus

An April 26, 2020 New York Magazine article is entitled: “We Still Don’t Know How the Coronavirus Is Killing Us.”

An excerpt reads:

In an acute column published April 13, the New York Times’ Charlie Warzel listed 48 basic questions that remain unanswered about the coronavirus and what must be done to protect ourselves against it, from how deadly it is to how many people caught it and shrugged it off to how long immunity to the disease lasts after infection (if any time at all). “Despite the relentless, heroic work of doctors and scientists around the world,” he wrote, “there’s so much we don’t know.” The 48 questions he listed, he was careful to point out, did not represent a comprehensive list. And those are just the coronavirus’s “known unknowns.”

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