What’s Wrong with Trump’s Response to Covid?

Forbes

So far, 117,000 Americans have died of Covid-19. The CDC projects Covid-19 deaths at 1,000 per day over the next month. At this rate, the Covid body count will be almost a quarter of a million by Election Day.

President Trump declared himself the War President, suggesting he was going to lead us to victory. Nothing could be further from the truth. Here’s his after action report: No national testing policy. A lower number of tests per capita than 27 countries. No nationwide contract-tracing system. No national smartphone App to assist contact tracing. No obligatory, let alone enforced, masking policy. No obligatory, let alone enforced social distancing policy. No nationwide random 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’s dumped the Covid problem on the states, forced the states to compete against one another, and ended up with each state treating residents of other states as pariahs.

The president’s worst grade — an F — is in testing. Yes, the president has helped ramp up our capacity. But he and the FDA have completely failed to mobilize thousands of academic and commercial research labs around the country. Far worse, neither the president nor the FDA appear to understand the fundamental purpose of Covid testing. It’s not, primarily, to identify whether someone with Covid symptoms has the disease. The treatment of such people doesn’t much depend on their Covid-19 test result (although protecting their healthcare workers and housemates does).

GETTY

The fundamental purpose of Covid testing is to isolate the infected and thereby contain and terminate the virus. This requires testing the “healthy,” not just the sick.

Right now we have more than enough capacity to test the sick (those with symptoms). Indeed, we have excess capacity. What we lack is a federal plan to test the “healthy” and, in the process, give the “healthy” an enormous incentive to get tested. Right now the healthy have little if any incentive to get tested.

But testing the “healthy” and visibly identifying them is critical, not just to beat this plague, but to resurrect the economy for real, not, as now, for pretend. Yes, the states are formally reopening. But fear of infection is keeping customers very far at bay. My dentist told me that half his patients are cancelling their appointments. My barbershop, usually packed, was empty except for me. The local dry cleaner is closed more hours than he’s open. He’s tired of no one showing up. Even our favorite grocery store is sorely lacking customers. Everyone I know says they won’t fly until there’s a vaccine or some other definitive way to end this plague, whose new cases appear, once again, on the rise.

There is, indeed, a way to end the plague and do so almost overnight. On March 27, I argued in Forbes that we needed to test every American every day. We’d quarantine the positives or send them to a hospital. As for the negatives, we’d give them a hospital bracelet — decorated with the color of the day — to show they had tested negative. This would give employers the assurance they could safely rehire those wearing the bracelet, give employees assurance they could safely return to work along with other bracelet wearers, and give restaurant patrons and shoppers visual confirmation that they were mingling with people who were virus-free. Yes, there would be false negatives. But repeat testing would quickly eliminate that problem. New entrants to the country? No problem. They’d be tested as they reached our shores and either braceleted or quarantined the same day.

Suppose this plan were feasible and were enacted today. Tomorrow only braceleted people would be going to work because employers would be subject to legal liability for placing other workers at risk by the un-braceleted. By the same argument, only those with bracelets would be permitted to attend school, go shopping, frequent restaurants, etc. Signs stating, “No bracelet, no entrance” would pop up across the country overnight. Consequently, every household would suddenly rush to the front of the line to be tested. And with every household tested on a daily basis, the virus would be almost totally contained in one day and entirely contained in two weeks. With nowhere to spread, the virus would die. That’s what it takes to actually win this war as opposed to tweeting about winning this war.

My column identified universal, repeat testing as the obvious and only foolproof strategy short of a vaccine to beat Covid and, indeed, any similar plague that surfaces down the road. Yet, I also knew that fielding 330 million tests a day was impossible. Still, knowing where you’re going is the key to finding your way. The next day, a huge part of the puzzle arrived in my inbox in the form of an email from two prominent economists — one French and one Belgian — about group (also called pooled or batch) testing.

I wrote in Forbes on March 29 about this ingenious method of dramatically economizing on the number of tests, which dates to work by economist Robert Dorfman during World War II. The two European economists — Olivier Gossner and Christian Gollier — wrote about it in the Washington Post on March 31. Also, on March 31, my brother, Michael, who is Provost at Cornell, joined me in discussing the vital importance of group testing in The Hill.

On May 3, I called out Drs. Fauci and Birx, in yet 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 colleagues. The protocol showed that we could kill Covid-19 in one month using just 6 million tests per week. This is well within the combined capacity of diagnostic, academic, and commercial research labs. ABC NEWS covered Frazier’s work and the group testing 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 topic. It’s prompted by two things. The first is a just-released joint Harvard-MIT study of group testing. It shows that we can pool 47 actual negative Covid test samples with one actual positive sample and reliably come back with a positive test result. No doubt even larger group sizes are feasible. But this study shows that PCR group testing of Covid-19 is scientifically valid. And a group size of 47 is very close to the 62 group size assumed in Frazier’s protocol.

Second, I want to spell out how nationwide group testing of all households each week could work on a practical and voluntary basis.

Imagine the President’s 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 household member, all to be placed in a single container with a preservative solution, b) mail, free of charge, the collection kit to the lab indicated on the enclosed envelope, and c) receive bracelets, good for a week, for each household member if the household tests negative. (Group testing at the lab would combine the samples of roughly 50 households, but do so in more than one pooled test via a 2 or 3 dimensional grid method so that, in the end, the group testing method identifies each positive household.)

What would this free testing service produce? The answer is voluntary compliance. Healthy households would wish to be tested to get bracelets that would let them go back to work and join other bracelet wearers in restaurants, shops, movie theaters, etc. For their part, business establishments would instantly require their workers and customers have bracelets (just as many now require masks).

Those who don’t like the idea of providing a sample would be free to refuse to do so. But they would find they’d have a hard time navigating in the world of bracelet wearers. As for those households with positive test results, they would be quarantined for two weeks, receive food and medication deliveries from local authorities, and then submit another household sample for retesting. Of course, anyone needing medical attention would receive it as is now the case. Each member of a positive household would be individually tested and participate in contract tracing.

Yes, some household members might refuse to include a swab sample in their household’s container and ask others to swab themselves twice in their stead. This will increase the chance of false negatives circulating in society. But Dr. Frazier’s protocol assumes a conservative (very high) 30 percent false negative rate. Hence, his protocol, is robust to cheating by some households. Indeed, group testing can be far from perfect on many dimensions and R0, the number of the people an infected person infects, can stay well below 1.

The bigger concern is building additional robotic testing machines and programming them to do the pooled testing. This will take some effort, but nothing akin to producing a B-24 bomber in 63 minutes as our country accomplished in World War II.

The only thing preventing our war President from winning the Covid war (and likely getting re-elected) is the president. He simply needs to pick up this group-testing ball and run with it. For starters, he needs to get Congress to authorize federal payment for all Covid-19 testing. Second, he needs to organize mailing sample collection kits to households, arrange for the group testing, and oversee the transmission of bracelets. Third, he needs to ensure enough testing machines with the right robotic sample-mixing capability are produced and done so essentially overnight. The rest will take care of itself. Everyone will voluntarily participate, bracelets will automatically be required for entrance everywhere, be it the factory floor or the university classroom, and our great national nightmare will be over. The hero will be President Trump who will finally receive and deeply deserve what he so desperately craves — the admiration and thanks of all Americans.