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US testing and surveillance failures have led to political, economic, and medical disaster

2020-05-06

em coronavirus from NIAID– CC license

What happened to cause 1.25 million cases and 73,000+ deaths from the novel coronavirus in the US as of this morning?  There were nearly 3.8 million cases and over 260,000 deaths recorded worldwide at the same time.  So the US, with 4 percent of the world’s population, has nearly a third of the cases– and that’s just the ones we can confirm.  What went wrong?

There are a few things that we can be fairly certain did NOT occur.  The first is the conspiracy theory that the virus was accidentally released from a high-security laboratory in Wuhan.  According to the researchers working there, this virus was not being studied so it could not have been released; it simply wasn’t there to get out.  Other, similar viruses were the subject of intense study, but none of them were released.

We can also be certain that the virus was not deliberately engineered or released.  There is simply no logical motive for Chinese military scientists to create a virus with such a bizarre combination of features– asymptomatic in a large percentage of cases, highly transmissible, and indistinguishable from influenza clinically.  What military use would this virus have?  Then there is the impact that this had within China.  It was devastating– to the very country which would have created it.  Simply not credible.

Another theory, that the virus originated in a “wet market” in Wuhan, is more likely, but still uncertain.  One factor arguing against this is that only 27 of the more than 40 initially diagnosed patients had some connection to the market.  The situation in France, where a case dating to December 27, 2019 was just announced, might be similar to the situation in Wuhan.  In that case, it is probable that this virus was circulating there for weeks before it was found when a minority of the patients infected showed up at a hospital with severe disease.

The ultimate origin of this novel coronavirus, patient Zero, will probably never be found.  Most likely, there were several people who were infected in the initial jump from animal to man, and most of them had no symptoms at all.  The virus is so contagious that they didn’t have to be bitten to be infected.  Their contact could have been so trivial that they won’t remember it at all.  This makes pinning down the origin next to impossible.

Whatever the origin, once the virus began to circulate internationally, the responsibility for containing it rests with each country affected.  After all, the action taken by the US to close its borders to China, Europe, Mexico, and finally, Canada, should have prevented us from being exposed to the rest of the world (I’m not saying that’s true, I’m just saying that’s what some people claim).

China has done its authoritarian best to control the spread within its own country.  The escape to other countries, through international travel by US citizens, makes surveillance a vital measure to reduce its impact on the US.  What did we do inside the US to control the virus?

The United States made several crucial mistakes in the early stages.  The first mistake was in refusing to use the test that the World Health Organization had developed during the initial months.  Using this test allowed other countries to see that the virus was spreading rapidly.  We simply wanted our own test– there was no other excuse.   The test we developed had near-fatal flaws and its use was highly restricted.  Not having any test at all made it impossible to see how quickly people here were getting infected.

The second mistake, which followed inevitably from the first, was the failure to do contact tracing or isolation of those exposed.  Not having a test made it impossible to identify who was infected or see who was exposed, which meant we couldn’t trace their contacts.

Without testing, the only way to find out we had a problem (besides clinical diagnosis by exclusion) was to look at how many more people were dying than usual.  This type of surveillance is always six to eight weeks behind, because that’s how long it takes to collect and collate death certificates.

We know that the overall death rate has increased dramatically.  The average daily death rate last year was about 8,000 people (it’s higher in January: 8,300 — than in June: 7,150) and about 1,150 people died on April 29 (that we know of) due to the virus.  We won’t know for some months how many people died each day this month.  We can only guess that the overall death rate is increased because people are dying from coronavirus.

These two errors, lack of testing and lack of contact tracing, caused us to be blinded to the pandemic’s nature in its early stages.  Not knowing that the virus was spreading rapidly made it possible for our leaders to pretend that nothing was wrong.

What’s worse, our testing is still limited to roughly 150,000 people a day and we found over 24,000 new cases (that’s about 16%).  We need enough tests so that less than 16% of the tests turn out positive– it should be less than 5%, especially given that testing is only 70-80% sensitive.

This lack of tests and thus lack of known cases made it politically attractive for Republicans to claim that the whole thing was a Democratic “hoax”– which lead to the situation in which we find ourselves today.  Large segments of our country (fortunately not a majority) are still claiming that the whole thing is made up, that our death toll is grossly exaggerated, and so on.  They will wake up too late, to a savagely dented country.

We are headed for a national depression.  When the Republicans realize how badly they are going to lose, they will stop any attempts to spend money for stimulus or relief.  They will pivot towards fiscal conservatism and then lay the blame on the Democrats for the slow economic recovery that will result.

They will even blame the Democrats for the deficit brought on by the stimulus spending that they voted for in the first place.  They will use the deficit to push cuts to social spending and restrictions on Medicare, Medicaid, and Social Security, just as they did in 2009-2013.  Do you remember when the Republicans caused a government shutdown to force the Democrats to accept an austerity budget?

This is the same playbook that worked so well at the outset of the Obama administration.  It will work again this time if the Republicans realize that they are bound to lose this election by a landslide, and throw the brakes on spending as early as this summer.  Poor people will suffer even more, and the uneducated and unintelligent among them will believe One America News Network, which will say the Democrats did it.

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