“You go to war with the army you have, not the army you might want or wish to have at a later time.”
― Donald Rumsfeld
We are living in this strange space because we do not want the number of elderly with severe coronavirus cases to outrun our inventory of respirators and intensive care hospital beds. And we don’t want our doctors and nurses to themselves be put on sick leave.
So we isolate ourselves and our loved ones because a mayor or governor says we should.
Everybody brings their educational background and past experiences to the pandemic. Public health is on centerstage like only a few other times in the past century. The public health system is always juggling about one hundred priorities during normal times, including foodborne illness.
It is the one we brought to the dance. Or as Secretary of Defense Rumsfield says, the one we’ve gone to war against this novel virus. I prefer ours to the others that are out there. Ours can miss and mislead us. I’ve been plenty critical of the premier federal agencies like the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA) and USDA. Their shortcomings are mostly over transparency, sometimes failing to disclosure entirely something the public has every right and need to know.
But when viewing the pandemic outbreak through the prism of all the foodborne outbreaks we’ve followed in the last ten years, some issues do come into better focus.
Take testing. It has long involved the working relationship between some 2,700 state and local health departments as the CDC.
If two or more states are experiencing a Salmonella outbreak, the CDC takes over the investigation. If you are ill with Salmonella symptoms, you go to your doctor or local public health department.
A doctor says you have Salmonella, and you are interviewed or asked to fill out a food diary. You are asked if you’d be willing to send a “sample” to a state lab or maybe directly to CDC. The follow-through is always a good idea because it’s how you become a “confirmed case.”
But you’ve got your Salmonella diagnosis and you are being treated, so you might slip down the road without leaving that “sample.” The test is of secondary importance to extinguishing the outbreak, which is Job 1 for the public health system and something that usually occurs with great efficiency.
Confirming the diagnosis through testing and collecting demographic information from victims are local health department duties that are in turn passed up to the CDC. The agency’s number crunchers can take it from there, putting credible estimates on the size of the outbreak.
Federal courts, meanwhile, have accepted much higher counts from CDC than just confirmed cases. CDC has declared outbreaks based solely on the work of their statisticians. In 2010, the agency forced the largest recall of shell eggs in history after noticing Salmonella enteritidis (SE) levels were spiking from normal background levels. That testing was never intended to be linked to a specific person, but the whole population.
For this pandemic outbreak, CDC messed up. Only now does it seem to be surging enough testing capacity out there to turnaround testing that hospitals and clinics said was “highly deficient”.
Testing for this coronavirus is all about making the original diagnosis. You may be suffering symptoms that appear 2-to-14 days after exposure, but does that mean the mild fever, cough, and shortness of breath you have is COVID-19?
Testing as the diagnosis isn’t new. HIV testing as part of the bad old days of the AIDS crisis.
Hospitals and clinics want enough testing of those with symptoms to help allocate reasons to the outbreak, and thousands of Americans with symptoms have reported getting the medical run around trying to get tested.
The government reported over the weekend that more than 195,000 Americans have now been tested, most in recent days and 90 percent of those were negative. Still, the confirmed COVID-19 case count in the United States was reported over the weekend at around 22,000.
CDC also collects one data point that usually tells where a foodborne outbreak is going. That’s the reported onset of illness. In my experience, the onset of illness data is more predictive than just about anything else. New illness reports are sometimes like looking out the back window of a car.
In other words, we could at the moment be looking at history as tests confirm pre-existing illnesses who will report the onset of illness dates from the past. What we are looking for are dates in the present and future with reduced or totally without an onset of illness report.
A string of dates without any onset of illness reports will be a cause for celebration.
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