Ending Covid-19 in a month only requires one thing: presidential leadership
So far, 117,000 Americans have died from Covid-19. the CDC predicts Covid-19 deaths to 1,000 per day over the next month. At this rate, the number of Covid bodies will be nearly a quarter of a million by election day.
President Trump declared himself a war president, hinting that he was going to lead us to victory. Nothing could be further from the truth. Here is his after action report: No national testing policy. A lower number of tests per capita than 27 countries. No nationwide contract search system. No national smartphone application to facilitate contact tracing. No mandatory masking policy, let alone enforced. No mandatory social distancing policy, let alone imposed. No nationwide randomized testing to determine disease prevalence. No requirement that states follow CDC reopening guidelines. No restrictions on large gatherings. And a The-Buck-Stops-There strategy that threw the Covid problem on states, forced states to compete with each other, and ended up treating residents of other states like outcasts.
The president’s worst rating – an F – is in testing. Yes, the president has helped increase our capacity. But he and the FDA have completely failed to mobilize thousands of academic and commercial research labs across the country. Much worse, neither the president nor the FDA seem to understand the fundamental purpose of Covid testing. It is not, primarily, to identify whether a person with symptoms of Covid has the disease. The treatment of these people is not very dependent on the result of their Covid-19 test (although the protection of their healthcare workers and roommates does).
The fundamental purpose of Covid testing is to isolate infected people and thus contain and eliminate the virus. This requires testing the “healthy”, not just the sick.
Right now we have more than enough capacity to test sick people (those with symptoms). Indeed, we have excess capacity. What we are missing is a federal plan to test the “healthy” and, in doing so, give the “healthy” a huge incentive to get tested. Currently, healthy people have little or no incentive to get tested.
But testing the “healthy” and visibly identifying them is essential, not only to defeat this scourge, but to resuscitate the economy for real, and not, as now, to pretend. Yes, the states are officially reopening. But the fear of infection keeps customers away. My dentist told me that half of his patients are canceling their appointments. My hair salon, usually packed, was empty except for me. The local laundry is closed for more hours than it is open. He’s tired of no one showing up. Even our favorite grocery store is sorely lacking in customers. Everyone I know is saying they won’t fly until there is a vaccine or some other definitive way to end this scourge, of which new cases appear, once again, to be on the rise.
There is, indeed, a way to end the plague and do it almost overnight. March 27, I had a fight in Forbes that we had to test every American every day. We quarantined the positives or sent them to the hospital. As for the negatives, we would give them a hospital bracelet – decorated in the color of the day – to show that they had tested negative. This would give employers reassurance that they could safely rehire those wearing the bracelet, give employees the reassurance that they could return to work safely with other bracelet wearers, and give restaurant patrons and buyers visual confirmation that they were mingling with virus-free people. Yes, there would be false negatives. But repeated testing would quickly eliminate this problem. New entrants to the country? No problem. They would be tested when they reached our shores and would be either with a bracelet or quarantined the same day.
Suppose this plan is achievable and is adopted today. Tomorrow only people with bracelets will go to work because employers would be subject to legal liability for endangering other workers by non-bracelets. According to the same argument, only those who wear bracelets would be allowed to go to school, go shopping, go to restaurants, etc. Signs saying “No bracelet, no entry” would appear across the country overnight. Therefore, every household would suddenly rush to the front row to be tested. And with every household tested daily, the virus would be almost completely contained within a day and fully contained within two weeks. With nowhere to spread, the virus would die. That’s what it takes to win this war rather than tweeting about winning this war.
My column identified universal and repeated testing as the only obvious and foolproof strategy, barring a vaccine to beat Covid and, indeed, any similar scourge that pops up down the road. Yet I also knew that performing 330 million tests per day was impossible. Yet knowing where you are going is the key to finding your way. The next day, much of the puzzle arrived in my inbox in the form of an email from two prominent economists – one French and one Belgian – about group testing (also called pools or batch).
I wrote in Forbes March 29 on this ingenious method of drastically saving the number of tests, which dates from the work of economist Robert Dorfman during World War II. The two European economists – Olivier Gossner and Christian Gollier – wrote about it in the Washington post March 31. Also, March 31, my brother, Michael, who is provost at Cornell, joined me to discuss the vital importance of group testing in The hill.
May 3, I called Drs. Fauci and Birx, in another Forbes column, to support a protocol for nationwide group testing of each household each week. The protocol was developed by Cornell operations research professor Peter Frazier and his colleagues. The protocol showed that we could kill Covid-19 in a month using just 6 million tests per week. This fits well with the combined capacity of diagnostic, academic and commercial research laboratories. ABC NEWS covered the work of Frazier and the group test proposal on May 13.
In short, running 330 million individual tests every day isn’t necessary. Running six million group tests once a week achieves the same result.
This is my fifth column on this subject. He is motivated by two things. The first is a fresh one Harvard-MIT joint study on group testing. This shows that we can pool 47 actual negative Covid test samples with an actual positive sample and reliably come back with a positive test result. Undoubtedly, even larger groups are achievable. But this study shows that the PCR group tests for Covid-19 are scientifically valid. And a group size of 47 is very close to the group size of 62 assumed in the Frazier protocol.
Second, I want to explain how nationwide group testing of all households each week could work on a practical and voluntary basis.
Imagine the president announcing that any household can a) request by email, phone, text, or online that a household sample collection kit be mailed to them. The kit would include swabs for each member of the household, all to be placed in a single container with a preservative solution, b) mail the collection kit free of charge to the laboratory indicated on the attached envelope, and c) receive bracelets, good for one week, for each member of the household if the household test is negative. (Group testing in the lab would combine samples from around 50 households, but would do so in more than one pooled test via a 2 or 3-dimensional grid method so that in the end, the group test method identifies each positive household.)
What would this free testing service do? The answer is voluntary compliance. Healthy households would like to be tested for bracelets that would allow them to return to work and join other bracelet wearers in restaurants, shops, cinemas, etc. For their part, commercial establishments would instantly demand that their employees and customers have bracelets (just as many now need masks).
Those who do not like the idea of providing a sample would be free to refuse to do so. But they would find they would have a hard time navigating the world of bracelet wearers. As for households with positive test results, they would be quarantined for two weeks, receive food and medicine deliveries from local authorities, and then submit another household sample for retesting. Of course, anyone in need of medical care would receive it as it is now. Each member of a positive household would be tested individually and participate in the search for contracts.
Yes, some household members may refuse to include a swab sample in their household container and ask others to swab themselves twice for them. This will increase the risk of false negatives circulating in society. But Dr. Frazier’s protocol assumes a conservative (very high) false negative rate of 30%. Therefore, its protocol is robust to cheating some households. This is because group testing can be far from perfect on many dimensions and R0, the number of people infected by an infected person, can remain well below 1.
The biggest concern is building additional robotic test machines and programming them to perform the cluster tests. It will take some effort, but nothing like producing a B-24 bomber in 63 minutes like our country did in WWII.
The only thing stopping our War President from winning the Covid War (and possibly being re-elected) is the President. He just has to pick up that group test ball and run with it. To begin with, he needs to get Congress to authorize federal payment for all Covid-19 tests. Second, he must organize the sending of the sample collection kits to the households, organize the group tests and supervise the transmission of the bracelets. Third, it has to make sure that a sufficient number of testing machines with the right robotic capacity for mixing samples are produced and essentially overnight. The rest will take care of itself. Everyone will participate voluntarily, wristbands will automatically be required to enter anywhere, whether in the factory or the classroom, and our great national nightmare will be over. The hero will be President Trump who finally receives and deeply deserves what he so desperately desires: the admiration and thanks of all Americans.