COVID-19: Our Salvation Lies in Testing
by Raywat Deonandan, PhD
Epidemiologist & Associate Professor
University of Ottawa
(I add my credentials to these COVID-19 blog posts in case they get shared. I want readers to know that my opinion is supposedly an educated and informed one)
This blog post has since been expanded into a feature article for India Currents magazine under the title, “COVID-19 Testing Is Our Salvation“
We are now several days into widespread social distancing in Canada, though it feels like weeks. Cases of COVID-19 continue to mount, as expected, and we watch Italy and Spain for signs of when our society might be cast into crisis and chaos. Health care workers, the heroes of our time (and of all times, really), gird themselves for a possible flood of respiratory distress cases. Physicians and nurses of all specialties are being asked to update their ventilator training in anticipation of being called to the front lines for service. Yet many fear that they will not have sufficient weapons for this fight, such as masks and ventilators.
At this time, it’s important to remember that COVID19 has a case-fatality rate of about 2.3%, meaning that most people will survive this. In the words of Larry Brilliant, “this is not a zombie apocalypse. It’s not a mass extinction event.” What is it, then? This is, and always has been, a health systems crisis more than simply a health crisis.
In a health crisis, we await salvation from a lucky mutation, a change in seasons (that will likely have no effect on this virus), a vaccine, or a cure. But in a health systems crisis, we can manufacture our own salvation through proper preparation, investment, leadership, and resource management.
In the early phase of a pandemic, it is possible to identify infected individuals, trace their contacts and quarantine them. Once there is community spread, the focus shifts to isolating populations and hardening the hospitals against the onslaught. We are clearly in this second half now.
At present, Canada’s 57,000 beds are not challenged by the number of serious COVID cases. But in anticipation, health systems managers are struggling to procure PPE (personal protective equipment), ventilators, and even sufficient front-line staff. But there is another way, and both Singapore and South Korea have shown us the first steps on that path.
With an extreme national lockdown that only permits movement of emergency personnel and essential services, lasting a couple of months or more, the number of new cases can be kept to a slow simmer. This is because it would take longer for new infections to occur, while allowing time for existing infections to resolve. The more severe the isolation, the longer it would take for a new case to emerge. The epidemic then recedes to a small number of active cases and a non-newsworthy number of hospitalizations.
However, a return to normalcy at that point would result in a reassertion of the epidemic and another need for isolation, probably in weeks or months. Our current path, if successful, would see rolling waves of isolation and pseudo-normalcy for as long as it takes for the deus ex machina arrival of the vaccine to save us.
But this post-lockdown scenario resembles the early phase of the pandemic, with a few cases and contacts. That, then, is the time to apply the force of a newly resourced awesome preventative public health system. The secret weapon is something that exists now, that we can manufacture or purchase: tests, and lots of them.
The deployment of rapid, frequent, public testing at a national scale would allow society to return to productive normalcy while keeping the disease to a simmering annoyance.
A Herculean investment in the flotilla of new testing options now available, including rapid 15-minute in situ and at-home testing would give us the epidemiological data to control the outbreak. With sufficient human resources support, every case could be quickly identified and isolated, their contacts immediately traced and tested, as well.
This would require a commitment to a strong and well-maintained public health infrastructure. But such an investment would be a pittance compared to the costs of either the expansion of our hospitals to accommodate throngs of dying patients or the economic cost of many more months of isolation.
Health care system crises like the COVID19 pandemic are not elemental disasters delivered by the gods, but rather are manageable aspects of 21st century globalized life. They can be overcome with good leadership, investment, and planning.