Bottlenecks

Long one today .. I’m guessing I am the bottleneck .. lots of things happening (and I’m still a day behind).

Regardless of whom is responsible for the virus, the response(s) or any of the other chatter .. It doesn’t matter at this point. Let’s face forward and get through this. We can do it.

On bottlenecks. First, it was testing kits. Then, beds .. then, ventilators. Then, PPE and Healthcare Staff.

• Happily, the Fed got engaged and converted convention centers to hospitals, sailed two hospital ships to hotspots, pushed companies to produce equipment and deployed military hero doctors to augment our healthcare heroes (oversimplified for brevity).
• The States rallied their resources, and after lots of contention, managed to reduce the spread, why responding, albeit in crisis mode.
• More happily .. the American people stayed home. It doesn’t matter who told us to do it (there were a lot of things being said by a lot of leaders) .. ultimately, we followed logic and common sense. We stayed put .. we got smart, if not for ourselves, for the ones we love. We stayed put and respected in-public guidelines for necessary trips.

Then, the curve shifted. Projected deaths (worst-case, of course), fell from 2.2 million to ~100,000 .. still a horrifying number, to be sure. Hospital admissions and intubations are all down. I covered off on this in “The Numbers are Good ..“. On that:

• We didn’t need all the beds. Excellent. Resources could be deployed elsewhere.
• We didn’t need all the ventilators. Even better: we can share with other countries who are not as well-equipped as we are.
• After managing in crisis mode, we were able to relieve the healthcare heroes with military hero doctors.

We still need testing kits .. while there are a lot of them out there, there are lots of variants, spread about in a lot of places. This still needs to be centrally-managed, as does how, and who can receive a test.

We still need ways to test everyone who needs a test .. I’ll detail below, but who “needs” a test needs to change dramatically. A quick summary (for more detail, please see “Testing, Testing, Testing“) .. some new, and some adjusted terms:

• Diagnostic: A point-in-time test that returns Positive / Negative for COVID-19. Typically administered to people with symptoms and critical asymptomatic individuals.
• Antibody: Detects antibodies in your system which will be present if you’ve had COVID-19, and may be immune to reinfection. Typically administered to people who have recovered, but could be expanded to individuals who think they’ve had a mild case at a point in the past.
• Sentinel: Broader test methodology that administers Diagnostic tests to asymptomatic individuals. This test looks for positive results that will identify groups for Contact Tracing to uncover more positive results. This will help to identify the spread.
• Contact Tracing: This methodology retraces the steps of a person who tested positive to determine with whom they interacted. Tracing helps to determine who may need to receive a Diagnostic test. This tracing will reveal suspect clusters that may be geography, social, workplace, school and so on.

Then, the test flow:

• Take the test .. requires a swab of nose or throat, saliva or blood (depending on the test).
• Process the test .. requires a lab.
• Lab processing requires reagents (chemicals that facilitate detection), as well as other materials.
• Get results.
• Act on the results (typically quarantine).

Again, lots of variants of these tests from different manufacturers .. variants on processing capabilities and capacities in various labs, but overall, tests can be processed.

So .. who should be tested (besides EVERYONE)? The science suggests:

• Folks with symptoms should be tested using the Diagnostic test.
• Folks without symptoms should be tested with the Diagnostic test as Sentinels. If positive, invoke Contact Tracing. Note that asymptomatic people are reservoirs for the virus .. they store it and spread it, and evidence is suggesting they are at their peak contagious levels before they show symptoms.
• Folks who have gotten over it should be tested with the antibody test.

Some good testing news: “Hundreds of Detroit cops back from COVID-19 quarantine” .. because they were tested. These are officers and firefighters who were quarantined because they were exposed .. We need this in all 50 States and territories straight away.

But now, bottlenecks remain:

• Is the test kit you need available in your area?
• If it is can you get it?
• Can the test be processed in a practical amount of time?

Kits and capacity. But even if the kits exist, the capacity to process the tests at an industrial level simply isn’t there. Yes: you can get a test, but you may not be able to get it processed.

For now. We’ll get this sorted with the proper levels of management and coordination between The States and The Fed.

Stay connected. Stay safe. Stay home.