Initially the epidemic got out of control in America from a series of missteps in the federal agencies responsible for efficiently controlling infectious diseases. The Center for Disease Control and Prevention (CDC) was tasked with creating a diagnostic test for the disease, and thereafter the Food and Drug Administration (FDA) to certify the CDC test and finally to certify production in quantities to be produced by giant commercial companies to sell and distribute for the nation’s needs. Here is what did happen. The CDC obtained the genetic sequencing for the novel coronavirus on Jan 10 and on Jan 28 CDC claimed to have produced an effective test – this was a stunningly short time. On Jan 30, the Secretary of Health and Human Services announced emergency procedures over all public health activities – CDC, FDA and state and private institutions were included. On Feb 5 the test kit distributed to a Manhattan lab failed to work, and upon retesting with distilled water gave a false-positive response. Immediately all CDC test kits were worthless, and by the previously issued emergency order, private labs and universities, et al were prohibited from using tests they had produced. There was huge uproar among them demanding answers from the CDC and FDA. The “silence from the CDC and FDA was deafening”. The FDA said it was prohibited from approving tests made by giant test producers supplying tests to the rest of the world. On Mar 12 the FDA gave approval for two giant manufacturers to make and deliver test products. The FDA could have sought emergency relief to do this in January instead of March.
I use New York City as an example of problems following the CDC/FDA issues above. As long as there was a pinched supply of tests, there was going to be an over-abundance of persons whose only diagnosis was the symptoms of the disease. The deluge of infected persons occurs predominantly in urban centers, and commonly within families. This finding was previously known to US public health officials. Why was contact tracking not implemented to cut off the rate of Covid-19 growth, even if only in densely populated cities? There appear to be two reasons; one, health care facilities were unable to keep up with exponential increases in infections and remediating the hospital problem was a higher priority. Second, even if the hospital issue were solved, politicians would still have been leery of the general public response to contact tracking. Would the public cooperate with health workers contacting them and asking personal questions that might appear to be supporting a “round-up” of friends and neighbors? Contact tracking requires skilled persons to do this work and skillful politicians to introduce and back the procedure for public support. For example, now that the NY City hospital collapse has been controlled, Michael Blumberg’s volunteering to head the effort was easily accepted by the governor and mayor. Former mayor Blumberg is wise enough to know to use laid-off school nurses, social workers, medical school students, and such who will be most effective getting results. His personal charge predicts success.
No state or the federal government has immediately available database systems necessary to collect and analyze the data for its demographic and geographic information. The database needs to be accessed by epidemiologists to direct contact trackers to where the need is greatest, avoiding otherwise hit-or-miss results. Ideally, everyone that is contacted should be offered testing for the virus, and if positive, for quarantine to be arranged and carried out effectively. Not coincidentally, infectious disease experts are predicting the virus will reappear in a “second wave” later this year. By establishing systems now, the second wave may not be a repeat performance.
The most successful Asian countries that experienced spread of novel coronavirus instituted contact tracking immediately and used technology in smart phones adapted to blue-tooth providing proximity of known Covid-19 carriers’ phones. This huge invasion of privacy among Asian countries never resulted in any pushback. That is not expected to be the reception smart-phone tracking in America will receive. There are many institutions who will publicly complain about such implementation in the US, which could make future vaccination dust-ups look amateurish.
Publiustoo.com April 29, 2020