April 21, 2020

China Virus Testing Woes

Lack of nationwide sample testing for both cases of active COVID-19 and antibodies has hindered the country’s ability to move forward.

“We need more testing” has become the most popular refrain invoked by political leaders when pressed on when Americans can expect an end to the ongoing shelter-in-place orders. Governors from Maryland to Michigan and Ohio to Virginia continue to complain that the lack of tests, testing supplies, or testing facilities is preventing them from feasibly moving forward on relaxing their lockdown directives.

They’re not entirely wrong, but their focus is misplaced. For the most part, tests have been administered to those experiencing possible symptoms of the China Virus. What the country currently lacks is broad, nationwide sample testing for both active cases of COVID-19 and antibodies, with the aim of determining the overall infection rate. Without this data, political leaders are largely left in the dark guessing as to what the best course of action is.

While the U.S. has conducted a higher total number of COVID-19 tests than any other country, the lack of broad sample testing has hindered our ability to determine the actual national impact of the virus on the population — at least what is publicly known. It may very well be that sampling is already underway, but the CDC may not want to release the results of those samples if they don’t support the current shelter-in-place guidelines. If people learned that this virus is not nearly as dangerous as they have been led to believe, it would undermine efforts to get people to abide by restrictions.

There are, however, some positive developments, specifically regarding antibody testing. Again, that data is needed for gaining a fuller picture of just how broad the infection rate actually is, and therefore a better picture of the virus’s fatality rate. A recent Standard study on antibody testing in Santa Clara County, California, has provided data suggesting that the infection rate may be much more widespread — upwards of 50 to 80 times higher — than current numbers indicate.

This is potentially really good news. The study’s author, Dr. Eran Bendavid, explains, “If our estimates of 48,000-81,000 infections represent the cumulative total on April 1, and we project deaths to April 22 (a 3 week lag from time of infection to death), we estimate about 100 deaths in the county. A hundred deaths out of 48,000-81,000 infections corresponds to an infection fatality rate of 0.12-0.2%.” In short, this would mean a fatality rate significantly lower than current data estimates have projected — one on par with annual influenza.

Furthermore, another study covering Los Angeles County was released on Monday. “Based on results of the first round of testing, the research team estimates that approximately 4.1% of the county’s adult population has antibody to the virus,” the study’s researchers said. “Adjusting this estimate for statistical margin of error implies about 2.8% to 5.6% of the county’s adult population has antibody to the virus, which translates to approximately 221,000 to 442,000 adults in the county who have had the infection. That estimate is 28 to 55 times higher than the 7,994 confirmed cases of COVID-19 reported to the county by the time of the study in early April.” New York is also expanding its own antibody sample tests.

Finally, once this data is collected, we can begin to ascertain the answer to the real question of acceptable tradeoffs. Should the economy be opened up more quickly and fully with a better understanding of the real infection and fatality rates? Early antibody testing indicates that the answer may be yes. But until that nationwide sample testing is done, the debate will largely remain academic.

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