From the beginning the US has had major problems with testing. First we rejected tests from other counties to develop our own, and those tests turned out to be defective. And then, once we got tests that were actually acceptable, we’ve had tons of trouble getting the components necessary for the tests, from swabs to chemical components. Here it is five months into the pandemic and we’re still hindered by not enough testing. And there are huge issues still with both false positives and false negatives, calling the accuracy of what little testing we’ve done into question.
Nothing we do seems to be improving testing (hell, lately it seems we might be making things worse by combining testing data from both active cases and antibody testing) even though that’s supposed to be the golden ticket that’s going to allow us to get a handle on things. We were supposed to shut down to get testing up to speed, but so far we’ve just squandered that time.
But I don’t see much in the news about other countries’ testing other than counties x and y are doing more testing than we are while countries w and z are doing less testing.
So what’s the testing situation like in other countries? Are all the problems we’re having getting accurate testing accomplished in numbers that will help uniquely American problems? And if not, why does the US media not really acknowledge that the problems are widespread?
Well, China has had some issues. Many of the test kits they sold…sorry, that they gave to assist other countries…were defective in big ways. When they got them back, there are persistent rumors they have been used widely in the current series of tests ongoing, even though China has ‘beaten Covid-19’ and all. Many other countries have had a lot of issues with Chinese test kits. Another persistent issue has been the fact that many of the chemicals and other materials for the test kits is manufactured in China, so there have been a lot of issues getting those to really ramp up production. I think testing has and continues to be a major challenge on the scales that are needed. Sort of like the PPE problem which, interestingly enough, has similar roots.
In Australia, some of the Chinese antibody tests have been rejected and are disputed: if there aren’t many antibodies to test for, or if the antibodies are mostly the wrong kind, then antibody tests may not turn out to be fit for purpose.
PCR testing was slow to start, there was some shortage of test kits, but that was mostly OK in Aus because there weren’t many people that needed testing. There was some media noise from people who believed that the only reason we had low infection rates was because we were only testing people who were sick or exposed, but they were wrong.
We were rate-limited for some time, we couldn’t ramp up testing to forcibly test everybody as some people wanted, I think that was mostly due to a shortage of test machines rather than test reagents. We’ve received more test machines (probably from China?), and the demand for universal compulsory testing has diminished, but I think we may still be testing at our maximum possible rate.
One of the problems is that PCR testing takes something like 12 hours, and the best they can offer is 24 hour turnaround, and some people aren’t getting their call backs (to tell them they are clear), for a week or more. That’s an issue if your employer won’t let you go back to work until you have documentation.
I think most countries have been facing the same issues with shortages of tests and the ensuing political rows.
Those that did not already had test development, manufacturing and the necessary labs in place.
Germany, seems to have had all it ducks lined up in row.
In the UK it has been sad litany of grand objectives, missed targets and political obfuscation. The reality is that they did too little, too late and had insufficient testing capacity and resorted to the worldwide scramble for testing kits.
This podcast from the BBC radio programme More or Less takes a look at some of the statistics peddled by politicians regarding Covid-19 testing. When is a test not a test? The UK government seems to take a very generous approach to their definition of a virus test which seems to match the impressive numbers they were claiming.
It also takes a look at the German experience handling the pandemic. They did not hesitate to act decisively and they dodged a few bullets. Other governments denied, dithered, procrastinated and failed to recognise the seriousness of the threat. That poor leadership and the failure to get organised, cost many lives. Timing is everything when a pandemic is silently spreading a virus around the world.
Well here in Slovenia at least that was done more or less correctly. A week after first case (march 4th) tests peaked on average at 500 /day / per M and stayed there through the whole pandemic to this day (4th day in a row with no new cases). There were some problems at first with protocol, who, how and when should be tested, but that was quickly resolved. 1 entry point per 100000 peeps was made functional in a matter of days. Usually some improv drive through container at hospital parking lots.
Sufficient amount of proper lab swab tests were acquired from Germany a month or so before first case. 65 EUR per piece. That is also selling price for self-payers who need it for papers for traveling abroad. Not sure why tests didn’t go up from there as on most other countries. Some said there was shortage of lab crews. Anybody knows what kind of knowledge you need to do the test?
Main problem here were masks and other protection equipment. Someone forgot to fill the national reserves. That is now highly politicized issue here.
What people still don’t sufficiently understand is that the early problems with testing in the US were not technical in nature but were entirely regulatory. Any competent university lab, if given a genetic sequence, can whip up a test in a week. PCR machines are bog standard, commonplace equipment. The FDA actively forbid anyone else from creating their own tests because they wanted the single, CDC designed test to be standardized across the country. When the first batch of CDC tests failed, they kept on trying to make the original CDC tests work while miring private companies in paperwork.
Literally if everyone in the FDA and CDC went into a coma on Jan 1st, we would be in a better situation with testing than we are today.
One mistake the UK government made was to rely on government owned labs run by the agency Public Health England for too long before leveraging hospital, university and private labs capable of processing the tests. They instead decided to build a few large centralised high capacity test labs and then had to find trained staff.
They managed their limited capacity by restricting virus testing to hospital patients and staff. The residents and staff of care homes for the elderly were not tested and the infection took hold and spread.
This was a serious mistake.
Countries that had test lab capacity already available before the pandemic spread did not have this problem.
The figures for the number of virus tests, as published by the government in their briefings, seem a very liberal interpretation of what a test actually means.
Mobile testing stations have been set up, but the referring system had people traveling long distances across country to use them and some ran out of tests quickly.
Hopefully they will get it together in time to deal a second wave of infection that may start once lockdown restrictions are relaxed in the coming weeks.
— and when I look at the details, it starts to look like the 1,000 test per day machines are going to require a high level of care and maintenance, and the people are going to have to be very disciplined to handle infectious agents and to avoid cross-contamination.
Speaking of which, labs in Aus are deliberately mixing samples, so that they can clear a set of samples “all at once”. If, by some rare chance, they actually find an infected sample group, they have to reprocess each sample from that group to find which one is really infected. This works because by far the majority of samples in Aus are not infected. It multiplies throughput and saves on reagents.
I think the default response to emergencies by public institutions is to hold onto their turf, even when they clearly are having difficulties because of capacity issues or regulatory log jams.
It is job of politicians to cut through all of these obstacles and marshal the resources needed to address the problem.
At the moment I am listening to a podcast the BBC called Spitfire which examines how the UK went about reorganising aircraft production during the Battle of Britain. It was a race against time to build enough Spitfires to see off the Luftwaffe and prevent invasion. He got people who knew about manufacturing to take charge and leverage all the states resources to get planes in to air.
Here we have another national emergency. But did Johnson get someone who knew what they were doing to kick backsides and get things moving? There is no evidence of that. He is surrounded by people whose skill is political manouervering to wrangle his own fractious party machine. The government let the relevant public body Public Health England move their own pace and thereby lose valuable time building up capacity in labs they controlled. Without enough testing kits available, this allowed the virus to spread. The result: one of the worst infection rates in Europe.
It is a similar story with PPE. They NHS does not have a centralised procurement system and it withdrew from an EU wide scheme, because, you know…Brexit and all that. This proved to be a serious shortages, leading health workers becoming infected.
Same with care homes for the elderly. These are not controlled by the NHS and there has been a long standing issue of patients bouncing between care homes and hospitals. This has resulted in untested patients being returned to care homes where the staff lacked PPE again allowing the infection to spread. Social care has been a long standing issue in the UK that every government has tried to avoid dealing with and these are the consequences.
National emergencies expose long standing structural weaknesses in public organisations and that is when executive leadership is tested to sort out the issues.
So far I can see that they have made mistake after mistake and they cover it up by pointing at scientists as their best buddy advisors and claim progress with dodgy statistical reports. At virus test in the UK is apparently counted by the government when it gets sent out in the post, not when it is used and the results returned without error.
I work for a university and part of the reopening strategy is to use the newly approved pooled sample testing. As it was explained to us, one of the primary benefits is that it requires less reagents and other materials (other than swabs) to be used when all 4 samples are negative. When there’s a positive, they have to test the samples individually, though hopefully that’s not going to happen all that often given our current low case rate in New Hampshire.
Given the on-going supply issues and the on-going under-testing, why did it take the FDA until July 18th to approve pool testing?
My province, Ontario, is currently testing 25,000 per day. It was a few weeks ago they opened it up so anyone can get tested. (It’s free!) You don’t need to have any symptoms.
They want to know how many undiagnosed are out there. They said to keep testing gives them valuable info about spread.
