6 ms·

US admits 'failing' on testing, says Fauci

179 points by hhs 7y ago

Reedx 7y ago
Sounds like he's being too honest. Expect him to be replaced imminently. Seriously, how are we so bad at this? We knew it was coming and South Korea has been testing 10k/day since Feb, so it's clearly doable. We've done <10k total! What in the world is going on with the tests?
- pgrote 7y ago
  >What in the world is going on with the tests? It appears the main driver has been lack of chemicals and in the beginning, the cdc required tests to be sent to them. The states can now test on their own. https://www.vox.com/science-and-health/2020/3/12/21175034/coronavirus-covid-19-testing-usa https://www.vox.com/science-and-health/2020/3/12/21175034/co...
  - beamatronic 7y ago
    There was a technical issue, and a policy issue.
    - belltaco 7y ago
      There was literally a policy not to allow states to use testing from other countries. And also to restrict testing a lot, early on. Even India started aggressively testing many travelers long before.
  - ssully 7y ago
    Even so, I will echo the OPs main point of the USA had a head start and did nothing with it. These shortages and policies could have been reviewed and resolved back in January or even February.
drevil-v2 7y ago
It’s so hard to trust the media to report on anything without trying to inflame the “orange man bad” narrative. In Australia almost no one with some or most of the symptoms is being tested. General Practitioners are basically telling people to fuck off, self isolate and call the hospital if symptoms worsen. https://apple.news/ASvoRONOWS9ijWX4RrGmiTQ https://apple.news/ASvoRONOWS9ijWX4RrGmiTQ “Currently we are not testing everyone, and whilst this may change in the future, at the moment this isn’t feasible. The pressure on labs would be mammoth and the yield is likely low,” Similar stories from colleagues in Europe.
- ajross 7y ago
  At what point does it become OK to point out that the "orange man" is, in fact, bad? Fox news and republican leaders spent weeks (weeks that we can't get back) trying to tell people that this wasn't a problem, that they shouldn't prepare, and that this was all a partisan argument against the president. And that was all wrong. It's real, it's happening, and we've lost critical time. That's bad, right? And it's bad in a distinctly partisan way, because the "other side" didn't say or do that stuff, and was broadly correct in its pronouncements. Can we say that? When can we say that? Or is any amount of wrongdoing or incompetence allowed as long as you get a whole political party to do it at once?
  - jfengel 7y ago
    Especially since the article isn't about him. It mentions him twice, once citing the travel ban, another time quoting him as saying that we have good testing infrastructure (but noting that he did not elaborate). It does not describe him as "bad" or say anything directly negative. The article is about a high-level bureaucrat who says only "we". The OP's comment is, unfortunately, indicative. The OP reads it as negative, and the reality is negative, but his primary concern is about the assignment of blame. In particular, assuring that it does not fall on him, and trying to shift it anywhere else. Meantime, the person actually cited in the article is trying to get something done -- which starts by admitting the there is a thing that needs to be done.
    - 7y ago
ajross 7y ago
Realistically there is no "US" any more. Fauci is speaking for the NIAID, and arguably for the scientific community within the CDC/NIH/HHS. The white house certainly wouldn't be on board with this message, but as we saw last night even the white house is inconsistent with its own policies in important ways. But yes: we messed up. We weren't prepared to begin with, we rolled back a bunch of existing preparedness work, when the disease arrived we turtled instead of testing, and then we refused to scale the testing capability for critical weeks. At this point it's too late. Better testing is still needed to inform the hard public health decisions that will have to be made, but it's no longer able to contain outbreaks that have grown orders of magnitude too large.
- MiroF 7y ago
  Absolutely. Was talking with a friend who was confused about why schools in remote areas are being shut down - testing needs to be done just so people realize that it's not just Washington or New York, this is pretty much everywhere or imminently about to be everywhere in the United States.
  - chrisco255 7y ago
    Anyone want guess at how difficult it is to ramp up testing to a population of 320 million for a disease that didn't exist 4 months ago?
    - ajross 7y ago
      Very difficult, which is why work should have started, ahem, four months ago. Now we are, indeed, hopelessly behind.
      - chrisco255 7y ago
        They did start working on it 4 months ago. The CDC has been on the case since then. Mind you, China was not cooperating with us and wouldn't allow our experts into the country while it was getting bad there. They are ramping up rapidly and we'll see that over the next few days.
pgrote 7y ago
Admitting and identifying the problem is the first step. The Cleveland Clinic just came out with an 8 hour test and hopefully this will help the situation if they share the process. https://www.vox.com/science-and-health/2020/3/12/21175034/coronavirus-covid-19-testing-usa https://www.vox.com/science-and-health/2020/3/12/21175034/co...
- thearn4 7y ago
  I live in Cleveland, and it sounds like they're considering the drive-thru testing approach as a possibility. Hoping this ramps up this month.
- throw7337 7y ago
  There is nothing secret about RNA testing. Any decent lab can synthetise its own markers from a file downloaded from internet. It is like genetic research is illegal in US or what.
  - tlb 7y ago
    Offering a diagnostic test without FDA approval is illegal, for good reason (there would be companies far worse than Theranos) but clearly in an emergency regulators need to adapt.
    - wbl 7y ago
      That's not true for tests developed in the lab they are used in.
      - vmh1928 7y ago
        In Arizona, Mayo Clinic, Sonora Quest Laboratories, and the Translational Genomics Research Institute in Flagstaff are rolling out their own tests. Official test kits from the CDC are in woefully short supply, under 200 right now, and only being used for people showing significant symptoms. According to a news article the new tests will use a technique similar to the CDC test known as reverse transcription polymerase chain reaction, otherwise shortened to RT-PCR
chvid 7y ago
I thought this polymerase chain reaction test was something you could do at any university hospital?
- scrumbledober 7y ago
  we did PCR in my highschool biochem lab...
  - gitgudnubs 7y ago
    I've done it with an oven.
- jfarlow 7y ago
  From a technical perspective, it is a simple test. Hard part is chain of custody and sample integrity - controls, etc.
  - heyitsguay 7y ago
    Are there any differences for Covid-19 samples versus any of the other samples such labs would be routinely testing though?
    - chromatin 7y ago
      Yes, it is RNA virus so it is an extra step that is not necessary in many other PCR based clinical tests.
      - heyitsguay 7y ago
        Sure, I meant for the non-technical aspects that the previous poster mentioned - chain of custody, sample integrity.
        jfarlow 7y ago
        So the process used in this testing is so common that research labs and any biochemistry lab in any college or high-school can run the test. But they probably shouldn't because they have no practice nor experience providing a diagnosis to a human - much less the strict statistical controls to interpret their results reliably. A clinical lab that is used to running these kinds of (very common) protocols will see no difference in this protocol from others they commonly run (from a chain of custody, sample integrity, etc. perspective), just with a slight change to their reagents to specifically test for COVID. Their handling should be no different.
snapetom 7y ago
I have a hard time faulting the CDC for the response overall, but I just don't understand why they decided to make their own test at the beginning. Was it bravado? Did they think the 70% accuracy of the WHO test wasn't good enough? If they didn't make their own test, they wouldn't have fubarred the manufacturing, which would have given us more tests. One of the CDC's main goals, if not the main goal in this, is to spread out the panic. Given this goal, the fact that we're in flu season, and the lack of test kits, I can understand the stringent testing criteria. They choose the best option in a bad situation, and I think they've done a pretty good job. However, it seems like a lot of problems could have been avoided if they just used the WHO tests.
- surge 7y ago
  The test accuracy of the WHO test as far as I understood it was good if someone was already experiencing symptoms once viral load was high enough. The bigger issue was false negatives, people would get released from quarantine measures, then spread it (like the cruise ship). They recommended anyone within contact to self quarantine until symptoms had reached a point they could get a definitive test. At this point testing early and coming up negative doesn't mean anything, you should still stay quarantined and continuously get retested, since a lot of people who tested negative were found to have had it the whole time when symptoms present and were given the all clear before. In summary, the testing early doesn't change the decision tree, which is stay quarantined for 14 days, until symptoms present or not, so little point was seen to testing until then. Problem is now, we can't track it, so everyone ideally should self quarantine or limit as much as possible social interaction and get tested if they have good reason to believe they've been exposed. Early testing will catch a lot of people but not all, so it will slow the spread, so at this point the decision tree changes and we need to start testing more, if nothing else to get a sample to extrapolate the true spread of this thing.
  - snapetom 7y ago
    > In summary, the testing early doesn't change the decision tree, which is stay quarantined for 14 days, until symptoms present or not, so little point was seen to testing until then. That makes a ton of sense. Thank you!
holri 7y ago
Austria alone (8 Mio people) made to date more than 5000 tests, the US 11000....
- elygre 7y ago
  Norway (5-ish million) did more than 10000.
esthermun 7y ago
He can do the mea culpa later. Lets fix this asap!
astrophysician 7y ago
What is the true/false negative/positive rate for these tests? I can't find that online and I have tried. If FPR is 10% and we test 100,000,000 people in the US but only 100,000 have the disease right now, then assuming a TPR of 100% (and a FNR of 0%) we will have 10,100,000 positive results = 101 x the number of people with COVID? How is that useful? Disclaimer: I am maybe an idiot.

179 points by hhs 7y ago

Sounds like he's being too honest. Expect him to be replaced imminently. Seriously, how are we so bad at this? We knew it was coming and South Korea has been testing 10k/day since Feb, so it's clearly doable. We've done <10k total! What in the world is going on with the tests?

pgrote 7y ago
>What in the world is going on with the tests? It appears the main driver has been lack of chemicals and in the beginning, the cdc required tests to be sent to them. The states can now test on their own. https://www.vox.com/science-and-health/2020/3/12/21175034/coronavirus-covid-19-testing-usa https://www.vox.com/science-and-health/2020/3/12/21175034/co...
- beamatronic 7y ago
  There was a technical issue, and a policy issue.
  - belltaco 7y ago
    There was literally a policy not to allow states to use testing from other countries. And also to restrict testing a lot, early on. Even India started aggressively testing many travelers long before.
- ssully 7y ago
  Even so, I will echo the OPs main point of the USA had a head start and did nothing with it. These shortages and policies could have been reviewed and resolved back in January or even February.

drevil-v2 7y ago

It’s so hard to trust the media to report on anything without trying to inflame the “orange man bad” narrative. In Australia almost no one with some or most of the symptoms is being tested. General Practitioners are basically telling people to fuck off, self isolate and call the hospital if symptoms worsen. https://apple.news/ASvoRONOWS9ijWX4RrGmiTQ https://apple.news/ASvoRONOWS9ijWX4RrGmiTQ “Currently we are not testing everyone, and whilst this may change in the future, at the moment this isn’t feasible. The pressure on labs would be mammoth and the yield is likely low,” Similar stories from colleagues in Europe.

ajross 7y ago
At what point does it become OK to point out that the "orange man" is, in fact, bad? Fox news and republican leaders spent weeks (weeks that we can't get back) trying to tell people that this wasn't a problem, that they shouldn't prepare, and that this was all a partisan argument against the president. And that was all wrong. It's real, it's happening, and we've lost critical time. That's bad, right? And it's bad in a distinctly partisan way, because the "other side" didn't say or do that stuff, and was broadly correct in its pronouncements. Can we say that? When can we say that? Or is any amount of wrongdoing or incompetence allowed as long as you get a whole political party to do it at once?
- jfengel 7y ago
  Especially since the article isn't about him. It mentions him twice, once citing the travel ban, another time quoting him as saying that we have good testing infrastructure (but noting that he did not elaborate). It does not describe him as "bad" or say anything directly negative. The article is about a high-level bureaucrat who says only "we". The OP's comment is, unfortunately, indicative. The OP reads it as negative, and the reality is negative, but his primary concern is about the assignment of blame. In particular, assuring that it does not fall on him, and trying to shift it anywhere else. Meantime, the person actually cited in the article is trying to get something done -- which starts by admitting the there is a thing that needs to be done.
  - 7y ago

ajross 7y ago

Realistically there is no "US" any more. Fauci is speaking for the NIAID, and arguably for the scientific community within the CDC/NIH/HHS. The white house certainly wouldn't be on board with this message, but as we saw last night even the white house is inconsistent with its own policies in important ways. But yes: we messed up. We weren't prepared to begin with, we rolled back a bunch of existing preparedness work, when the disease arrived we turtled instead of testing, and then we refused to scale the testing capability for critical weeks. At this point it's too late. Better testing is still needed to inform the hard public health decisions that will have to be made, but it's no longer able to contain outbreaks that have grown orders of magnitude too large.

MiroF 7y ago
Absolutely. Was talking with a friend who was confused about why schools in remote areas are being shut down - testing needs to be done just so people realize that it's not just Washington or New York, this is pretty much everywhere or imminently about to be everywhere in the United States.
- chrisco255 7y ago
  Anyone want guess at how difficult it is to ramp up testing to a population of 320 million for a disease that didn't exist 4 months ago?
  - ajross 7y ago
    Very difficult, which is why work should have started, ahem, four months ago. Now we are, indeed, hopelessly behind.
    - chrisco255 7y ago
      They did start working on it 4 months ago. The CDC has been on the case since then. Mind you, China was not cooperating with us and wouldn't allow our experts into the country while it was getting bad there. They are ramping up rapidly and we'll see that over the next few days.

pgrote 7y ago

Admitting and identifying the problem is the first step. The Cleveland Clinic just came out with an 8 hour test and hopefully this will help the situation if they share the process. https://www.vox.com/science-and-health/2020/3/12/21175034/coronavirus-covid-19-testing-usa https://www.vox.com/science-and-health/2020/3/12/21175034/co...

thearn4 7y ago
I live in Cleveland, and it sounds like they're considering the drive-thru testing approach as a possibility. Hoping this ramps up this month.
throw7337 7y ago
There is nothing secret about RNA testing. Any decent lab can synthetise its own markers from a file downloaded from internet. It is like genetic research is illegal in US or what.
- tlb 7y ago
  Offering a diagnostic test without FDA approval is illegal, for good reason (there would be companies far worse than Theranos) but clearly in an emergency regulators need to adapt.
  - wbl 7y ago
    That's not true for tests developed in the lab they are used in.
    - vmh1928 7y ago
      In Arizona, Mayo Clinic, Sonora Quest Laboratories, and the Translational Genomics Research Institute in Flagstaff are rolling out their own tests. Official test kits from the CDC are in woefully short supply, under 200 right now, and only being used for people showing significant symptoms. According to a news article the new tests will use a technique similar to the CDC test known as reverse transcription polymerase chain reaction, otherwise shortened to RT-PCR

chvid 7y ago

I thought this polymerase chain reaction test was something you could do at any university hospital?

scrumbledober 7y ago
we did PCR in my highschool biochem lab...
- gitgudnubs 7y ago
  I've done it with an oven.
jfarlow 7y ago
From a technical perspective, it is a simple test. Hard part is chain of custody and sample integrity - controls, etc.
- heyitsguay 7y ago
  Are there any differences for Covid-19 samples versus any of the other samples such labs would be routinely testing though?
  - chromatin 7y ago
    Yes, it is RNA virus so it is an extra step that is not necessary in many other PCR based clinical tests.
    - heyitsguay 7y ago
      Sure, I meant for the non-technical aspects that the previous poster mentioned - chain of custody, sample integrity.
      - jfarlow 7y ago
        So the process used in this testing is so common that research labs and any biochemistry lab in any college or high-school can run the test. But they probably shouldn't because they have no practice nor experience providing a diagnosis to a human - much less the strict statistical controls to interpret their results reliably. A clinical lab that is used to running these kinds of (very common) protocols will see no difference in this protocol from others they commonly run (from a chain of custody, sample integrity, etc. perspective), just with a slight change to their reagents to specifically test for COVID. Their handling should be no different.

snapetom 7y ago

I have a hard time faulting the CDC for the response overall, but I just don't understand why they decided to make their own test at the beginning. Was it bravado? Did they think the 70% accuracy of the WHO test wasn't good enough? If they didn't make their own test, they wouldn't have fubarred the manufacturing, which would have given us more tests. One of the CDC's main goals, if not the main goal in this, is to spread out the panic. Given this goal, the fact that we're in flu season, and the lack of test kits, I can understand the stringent testing criteria. They choose the best option in a bad situation, and I think they've done a pretty good job. However, it seems like a lot of problems could have been avoided if they just used the WHO tests.

surge 7y ago
The test accuracy of the WHO test as far as I understood it was good if someone was already experiencing symptoms once viral load was high enough. The bigger issue was false negatives, people would get released from quarantine measures, then spread it (like the cruise ship). They recommended anyone within contact to self quarantine until symptoms had reached a point they could get a definitive test. At this point testing early and coming up negative doesn't mean anything, you should still stay quarantined and continuously get retested, since a lot of people who tested negative were found to have had it the whole time when symptoms present and were given the all clear before. In summary, the testing early doesn't change the decision tree, which is stay quarantined for 14 days, until symptoms present or not, so little point was seen to testing until then. Problem is now, we can't track it, so everyone ideally should self quarantine or limit as much as possible social interaction and get tested if they have good reason to believe they've been exposed. Early testing will catch a lot of people but not all, so it will slow the spread, so at this point the decision tree changes and we need to start testing more, if nothing else to get a sample to extrapolate the true spread of this thing.
- snapetom 7y ago
  > In summary, the testing early doesn't change the decision tree, which is stay quarantined for 14 days, until symptoms present or not, so little point was seen to testing until then. That makes a ton of sense. Thank you!

holri 7y ago

Austria alone (8 Mio people) made to date more than 5000 tests, the US 11000....

elygre 7y ago
Norway (5-ish million) did more than 10000.

esthermun 7y ago

He can do the mea culpa later. Lets fix this asap!

astrophysician 7y ago

What is the true/false negative/positive rate for these tests? I can't find that online and I have tried. If FPR is 10% and we test 100,000,000 people in the US but only 100,000 have the disease right now, then assuming a TPR of 100% (and a FNR of 0%) we will have 10,100,000 positive results = 101 x the number of people with COVID? How is that useful? Disclaimer: I am maybe an idiot.