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كيفية تسد أمريكا عجزها في اختبارات كوفيد-19؟

Jul 31, 2020 Simon Johnson

واشنطن العاصمة- لتتبع وجود فيروس سارس-كوف-2، الفيروس المسبب لـكوفيد-19، تعتمد الولايات المتحدة بصورة كبيرة على اختبارتفاعل البوليميريز المتسلسل لتشخيص الفيروسات الحية على نطاق واسع. وفي النسخة الأكثر شيوعًا من هذا النهج، ترسَل عينات- مسحات الأنف أو اللعاب- إلى المختبرات الكبيرة نسبيًا، بهدف إرجاع النتائج في غضون 24 إلى 48 ساعة. ولسوء الحظ، رغم أن بعض الاختبارات الأولوية تحرز تقدما سريعًا، إلا أنه عادةً ما يستغرق الأمر من 7 إلى 22 يومًا للحصول على نتائج في معظم أنحاء البلاد. وبالنسبة لفيروس سريع الحركة مثل سارس-كوف-2 الذي يمكن أن يتطور من الإصابة إلى النتيجة النهائية (الوفاة أو التعافي) في أقل من ثمانية أيام، فإن التأخر الكبير يعني أن اختبار تفاعل البوليميريز المتسلسل لتشخيص الفيروسات الحية هو مضيعة للوقت والمال. إذ بحلول موعد معرفة النتيجة، يكون الأوان قد فات للقيام بأي شيء آخر.

وبالنسبة ل"اختبار الترصد"، وهو جزء أساسي من استراتيجية منع تفشي المرض، يظهر عالمان غير متساويين إلى حد كبير. إذ ستدفع الشركات الكبرى والجامعات مبالغ طائلة لإخضاع جميع موظفيها للاختبار بوتيرة عالية (مرة أو مرتين في الأسبوع، مع نتائج سريعة)، بينما لن يخضع غيرهم أيا كان للاختبار بصورة فعالة (لأن النتائج التي سيتم الحصول عليها بعد أكثر من ثلاثة أيام لها قيمة ضعيفة) وهذا الترتيب ليس فقط غير عادل إلى حد كبير (بطرق ستصبح مرئية بصورة متزايدة)؛ بل سيساهم في عودة ظهور المرض بوتيرة متكررة في الأشهر المقبلة.

ويعد الكشف السريع عن تفشي كوفيد-19 حاليًا الأداة الرئيسية المتاحة للحفاظ على سلامة الأشخاص، والاحتفاظ بأي مستوى معقول من النشاط الاقتصادي (والوظائف). ويخضع حاليًا، في الولايات المتحدة، أكثر من 750000 شخص في المتوسط لاختبار الفيروسات الحية يوميًا. ولكن هذا بعيد من أن يكون كافياً في بلد يقطنه حوالي 330 مليون شخص، مع قوة عاملة تبلغ حوالي 165 مليون، وحوالي 57 مليون تلميذ في المدرسة، و20 مليون آخرين يحاولون الالتحاق بالجامعات.

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Simon Johnson

Writing for PS since 2007
140 Commentaries

Simon Johnson, a former chief economist at the International Monetary Fund, is a professor at MIT's Sloan School of Management and a co-chair of the COVID-19 Policy Alliance. He is the co-author, with Jonathan Gruber, of Jump-Starting America: How Breakthrough Science Can Revive Economic Growth and the American Dream and the co-author, with James Kwak, of 13 Bankers: The Wall Street Takeover and The Next Financial Meltdown.

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Paul Friesen Aug 11, 2020

The U.S. does not need some new whiz-bang-made-in-USA technology. It just needs to look beyond its borders for once at what other countries have done. Because most countries of the world - including some with a tiny fraction of the U.S. per capita income have already figured this out.

Here in Canada, life is returning to something pretty close to normal, with cases still going down. Most people I see wear masks in indoor public spaces. Cases are low enough that testing and tracing can keep up. Canada is not the best example to follow - New Zealand, Taiwan, China, South Korea, Ghana, or Cuba are all probably better. Even Italy, after a disastrous start, has turned things around nicely.

Americans just need to lose that self-centred attitude that only they know how to solve problems. On this one, they have much to learn from others.
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Gerald Silverberg Aug 3, 2020

While I cannot agree more that the testing regime in the US has broken down, this articles has some real issues:

1. Testing can only be used to contain the disease if it is coupled to scalable tracing and isolating. This has not even broken down in the US: in most states it is still non-existent.

2. An antibody test is not a substitute for the PCR test, since it can only detect past infections after two weeks, not currently infectious individuals. So what's really needed is a cheaper and faster replacement for the PCR test, not another antibody test, of which there are already many which are fast and cheap.

3. In the end this article appears to be just a promotion for the Ragon Institute's test. But have sensitivity and specificity been established for this test? It is not even listed on the FDA's webpage of emergency approval antibody tests: https://www.fda.gov/medical-devices/emergency-situations-medical-devices/eua-authorized-serology-test-performance.
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Elizabeth Pula Aug 2, 2020

https://www.vanityfair.com/news/2020/07/how-jared-kushners-secret-testing-plan-went-poof-into-thin-air?utm_source=pocket-newtab

That sure was a nice check of 2.5 millionUSD for tests that went no where. Although I'm sure some one got a bunch to pocket for more fun and games in Dubai and other points between.
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Michael Public Aug 2, 2020

Or just stop testing altogether, at least as far as individuals are concerned . The virus has seemingly won the battle the battle to spread generally across the US. Even if 2nd round lock-downs work, the virus will re-spread as soon as they are lifted because there is not sufficient herd immunity. The same is going to happen everywhere - in Europe it is currently re-spreading, and this will really take off when winter arrives. Random sample testing in major areas will give a good indication as to the general levels.
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Petey Bee Jul 31, 2020

Thanks for this timely article. There is substantial new test capacity due to come online starting around Sept (with manufacturing ramp-ups rushed out, via govt $$ dispensed around May). Giroir gave a bunch of interviews this month, throwing out a different planned test capacity number each time, but it seems we're looking at the 2-3 million per day ballpark at the time schools open. That would be best-case, no implementation delays. Perhaps it could be further enhanced with pooled testing, but a lot of the new capacity is tech with already imperfect sensitivity, so pooling has some real trade-offs there. Furthermore, with ~10% positive rates in the crisis states, the benefit of pooling falls off.

It seems to me that the simultaneous nationwide demand surge from "back-to-school" testing will consume all of the new capacity at once. And that is even before considering the likelihood of resurgent infections on college campuses creating repeat demand. The same among parents of high school kids, who are equally numerous. (the younger ones however are generally less susceptible).

The point about wealthy schools buying up the capacity, and starving out both state schools and the lower tier of health care, should be emphasized more. Not sure there is any political desire in either party to prevent this, even though the result would blow back on everyone regardless of wealth.

We're about a month away from a national scale live experiment, but the alternative of delaying school for another semester is equally unpalatable. Because of lead times in industry,
the test capacity that will be available in Sept is already baked in the cake, so to speak, so the immediate discussion should I think must be of policy coordination, not tech/manufacturing rollout.
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كيفية تسد أمريكا عجزها في اختبارات كوفيد-19؟

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