with Paulina Firozi
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The Trump administration is weighing a new testing strategy as coronavirus cases mount: testing groups of people together.
Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told me in an interview last night that health officials are having “intense discussions” about what’s known as “pool testing.” The idea is that by testing samples from many people all together, officials could test more people with fewer resources. And those who are infected could be more quickly found and isolated.
Pool testing would allow officials to cast a much broader net to find cases faster.
It would represent a dramatic shift from how coronavirus testing is currently being carried out in the United States – but one that may be sorely needed as virus hot spots worsen and new ones appear.
“Something’s not working,” Fauci said of the current approach. “I mean, you can do all the diagramming you want, but something is not working.”
The approach works this way: Samples from, say, 20 people are combined into a single pool. One coronavirus test is used on the entire pool. If the test comes back negative, researchers know they can move on to another pool of samples. If it comes back positive, only then would each individual be tested.
“What you need to do is find the penetration of infected people in your society,” Fauci said. “And the only way you know that is by casting a broad net.”
Criteria for who can get a test still varies among states, depending on their resources and testing capacity. But if group testing would allow more people to get tested, there could be a better chance of finding the asymptomatic people who may be quietly spreading the disease.
The U.S. set a record for infections reported in a single day for the second day in a row.
States reported nearly 38,500 new cases. Texas, Alabama, Missouri and Nevada reported daily highs, per my colleagues. The death toll also spiked, to about 2,500, as New Jersey added 1,854 probable deaths. Even California, which was the first state to lock down and one of the last ones to reopen, is setting daily records this week for new cases.
President Trump’s mantra lately has been has been that cases only appear to be going up because of increased testing.
That’s not true, as I explained in this Health 202. The president reiterated that take yesterday:
The number of ChinaVirus cases goes up, because of GREAT TESTING, while the number of deaths (mortality rate), goes way down. The Fake News doesn’t like telling you that!— Donald J. Trump (@realDonaldTrump) June 25, 2020
White House aides told Politico’s Nancy Cook that there will be no change in the White House’s strategy to fight the pandemic. A senior administration official told her the “vast majority” of the country isn’t experiencing an increase in cases.
Yet Fauci told me the mounting crisis means the nation needs a paradigm shift in its disease-fighting approach.
Fauci is reconsidering whether the traditional tools for fighting infectious diseases – identify, isolate and contact trace – are even effective against the novel coronavirus, given how easily asymptomatic people can spread it.
Throughout the spring and early summer, Fauci and other officials had stressed that this triple-pronged approach was key to containing the virus and allowing Americans to return to something resembling normal life. But that’s only true, Fauci told me, if almost all the people who spread the virus exhibit symptoms.
But research suggests up to 40 percent of those infected with coronavirus may be asymptomatic. It’s like someone threw a monkey wrench into the normal system of containing viruses, Fauci said.
“We now know the level of virus in an asymptomatic person is about the same as the level of virus in somebody who has symptoms,” Fauci said. “So it’s like, oh my goodness, how do you address that?”
Pool testing could work because the vast majority of Americans probably haven’t been infected.
Scientific American recently described group testing this way:
“Group testing is a numbers game. Let’s say you are examining 100 people, and one of them is positive. Normally you would do 100 diagnostic tests, searching for genetic material from the virus in each individual. But with group testing, you can divide those 100 people into five groups of 20. That gives you five pools with 20 samples, and you use one test per pool. If the first four sample pools test negative, you have eliminated 80 people with four tests. If the last pool tests positive, you retest each sample in that last pool individually to identify the one with the disease. In the end, you did 25 tests instead of 100.”
The approach wouldn’t work as well if many people were infected, because then most group tests would come back positive and then people would have to be tested individually anyway.
But Robert Redfield, director of the Centers for Disease Control, estimated yesterday that 92 to 95 percent of the population is still susceptible.
Yet Redfield also said the number of infected Americans is likely 10 times higher than the 2.3 million confirmed cases, The Post’s Lena H. Sun and Joel Achenbach report. “Our best estimate right now is that for every case that’s reported, there actually are 10 other infections," Redfield said on a call with reporters.
Under that methodology, there would be at least 23 million cases in the U.S. “Redfield said the larger estimate is based on blood samples collected from around the country that look for the presence of antibodies to the virus,” Lena and Joel write. “For every confirmed case of covid-19, 10 more people had antibodies, he said.”
Labs already have the capacity to pool tests, Fauci said.
Shifting to this style of testing would require cooperation from health departments, labs and private manufacturers, all of whom are playing a role in carrying out around 15 million tests a month currently.
Researchers in Israel and Germany are also looking into this testing strategy to fight coronavirus.
Ahh, oof and ouch
AHH: The Trump administration is asking the Supreme Court to overturn all of the Affordable Care Act.
The briefs, due to to the court yesterday, reiterated arguments the Department of Justice and states have now made for months in a protracted court battle over the 2010 health-care law. The administration is fully taking the side of Republican states seeking to get it overturned, while California and other Democrat-led states are defending the law.
Oral arguments could come before the November election, giving Democrats a prime opportunity to contrast their approach on health-care to that of Trump and Republicans.
“In the brief, Solicitor General Noel J. Francisco argues that all of the ACA should be struck down because one of its core provisions, the individual mandate, is unconstitutional, rendering the rest of the law invalid as well,” The Post's Tim Elfrink and Meagan Flynn report.
“Francisco argues that the individual mandate provision became unconstitutional when Congress reduced penalties to zero in 2017. Without any remaining tax penalty, Francisco argued, the provision could no longer be considered a constitutional use of Congress’s taxing power — the reason the Supreme Court upheld it in a previous challenge.”
Democrats, who made the administration's refusal to defend the ACA a key part of their 2018 campaign strategy, stressed yesterday that ending health coverage for millions of Americans would be particularly disastrous during the pandemic.
Former vice president Joe Biden, the presumptive Democratic nominee, said during a campaign trip in Pennsylvania yesterday that it would amount to a double whammy for covid-19 survivors. He suggested insurers would view covid-19 as a preexisting condition, and without the ACA's protections, would be free to deny survivors coverage (it's not clear that would be the case).
“Those survivors, having struggled and won the fight of their lives, would have their peace of mind stolen away at the moment they need it most,” Biden said. “They would live their lives caught in a vise between Donald Trump’s twin legacies: his failure to protect the American people from the coronavirus, and his heartless crusade to take health-care protections away from American families.”
White House spokesman Judd Deere dismissed concerns that dismantling Obamacare could worsen the pandemic crisis. “A global pandemic does not change what Americans know: Obamacare has been an unlawful failure and further illustrates the need to focus on patient care," he told Tim and Meagan.
OOF: Public health experts warn Arizona has lost control of the pandemic.
“Arizona has emerged as an epicenter of the early summer coronavirus crisis as the outbreak has expanded, flaring across new parts of the country and, notably, infecting more young people,” according to The Post's Isaac Stanley-Becker and Chelsea Janes, along with Jeremy Duda.
Disease trackers at Children's Hospital of Philadelphia warn that Maricopa County, which includes Phoenix, is now “eclipsing the New York City boroughs even on their worst days” as it records as many as 2,000 cases a day.
“Arizona is facing more per capita cases than recorded by any country in Europe or even by hard-hit Brazil," they write. “This week, Arizona reported not just a record single-day increase in new cases — with Tuesday’s tally reaching 3,591 — but also record use of inpatient beds and ventilators for suspected and confirmed cases. Public health experts warn that hospitals could be stretched so thin they may have to begin triaging patients by mid-July.”
“But physicians, public health experts, advocates and local officials say the crisis was predictable in Arizona, where local ordinances requiring masks were forbidden until Gov. Doug Ducey (R) reversed course last week,” they add. “State leaders did not take the necessary precautions or model safe behavior, these observers maintain, even in the face of compelling evidence and repeated pleas from authoritative voices.”
“We have failed on so many levels,” said Dana Marie Kennedy, the Arizona director of AARP.
OUCH: Nearly one-third of behavioral health providers haven't yet received coronavirus relief funding.
That's according to Chuck Ingoglia, president of the National Council for Behavioral Health, writing on the results of a member survey. Of those who did receive funding, 39 percent got less than $50,000 and 44 percent of members say they only have enough funding to remain open for up to six months, he wrote in a blog post.
Health providers serving low-income people had to wait weeks to receive relief funding supplied by Congress, as the Department of Health and Human Services tried to distribute it through a complicated process (we wrote about that here). Behavioral health centers have particularly suffered under the delay, Ingoglia wrote.
“Lawmakers understood the value of providing resources to hospitals and other health care institutions quickly when the pandemic began, but they have failed to grasp the value of quickly extending that same assistance to behavioral health clinics,” he wrote.
“We can already quantify the impact of this failure: a spike in suicide rates, increase in drug and alcohol use, relapses due to isolation, a rise in depression, anxiety, post-traumatic stress disorder and more all brought on by the covid-19 pandemic.”