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Testing and Masks Can Help Only So Much

Dr. Greg Gulbransen hands a test for the coronavirus after taking a nasal swab from a toddler at his pediatric practice in Oyster Bay, N.Y., April 13, 2020. (Lucas Jackson/Reuters)

May the Fourth be with you. On the menu today: a chat with a top hospital scientific director about the potentials and limitations of testing and masks, the Department of Homeland Security confirms some more of our suspicions about the Chinese government, some elected leaders experience a surprise outbreak of humility, and relishing ESPN’s two-hour mental vacations to the 1990s.

What Testing and Masks Can and Can’t Do for Us

I recently had a chance to pick the brain of a scientific director from one of the top ten hospitals in the United States, who has been briefing powerful decision makers since the coronavirus epidemic began.

This director didn’t want to be quoted by name, lest his assessments cause headaches for his institution. I asked him what the biggest misperceptions about the ongoing pandemic are, and he offered some important points for those who think that America needs to be locked into this semi-shut-down status quo until a nationwide frequent testing regime is in place.

“Politicians and other decision makers like university presidents — who are just politicians of another stripe — are a highly risk-averse species,” this scientific director told me. “If they can avoid making a tough decision, they will, and as long as they think that if we test enough people, we can identify and quarantine everyone who is infected and make the problem go away.”

As he sees it, there are two problems with tests that are largely being overlooked. “One is that they’re only as good as the sample being collected. The technology is as close to perfect as you’re going to get in a diagnostic test. But if you don’t sample where the virus is, the test result will be a false negative. A recent scientific paper that has not yet been peer-reviewed concluded that the real-life sensitivity of tests where persons were collecting their own samples was down around 60 percent, which is pretty much unacceptable when testing for a contagious disease. It turns out, and this is no surprise, that you can’t rely on people to stick a swab far enough up their nose or down their throat to get a useful specimen.”

He added, “the second problem is that the test is only a one-time snapshot, and it doesn’t mean that a person isn’t going to be contagious tomorrow, or even later today. That has serious policy implications and may be the only way to get people to understand that we can’t bring the risk down to zero.”

From where I sit, demanding “We need more testing!” has turned into a comfortable dodge for elected officials and opinion leaders. As laid out last week, just about every company capable of producing tests is looking at ways to expand and speed up production of tests; by the end of the month, America’s producers think they’ll be making 1.6 million to 2 million per day. The Defense Production Act has already been invoked to ensure that Puritan Medical Products in Maine “will quickly establish a new manufacturing facility capable of doubling its current monthly output of 20 million to 40 million swabs.”

The federal government does not have a magic button to press to increase production to 5 million new tests a day. The rate of production is limited by the access to supplies, raw materials, reagents, manufacturing equipment, and trained workers. Before the outbreak, we had more than 157 million Americans in the workforce. Even if we could produce 5 million tests a day, that unreachable-for-a-while threshold would mean testing every American once a month. Clearly, we want to test some Americans more than others; medical personnel working on patients and those working in nursing homes are a higher priority than someone living in an area with few cases, or those working at home and minimizing their contact with others.

This medical director also has doubts that masks will be as effective as some lawmakers hope.

“Go out to the supermarket or the hardware store or wherever else people are being instructed to wear a mask or other facial covering, and you’ll see about half of them have pulled the mask down off their nose because it’s uncomfortable to breathe,” he said. “That totally defeats the purpose. There are people spending stupid amounts of money to buy N95s, and then wear them with big gaps around their mouth because they don’t take the time to learn how to use them properly — and they keep using them, even after they’re physically broken down and can’t seal properly. If I wanted to be one of those Karen scolds, I could get my [thrills] all day lecturing those folks, but since this is the epidemiologic equivalent of TSA Security Theater, and the typical American puts personal comfort and convenience first, it’s not worth doing. Then again, I’m not one of those persons who gets their [thrills] bossing others around.”

For what it’s worth — which is not much — my perspective is for most of the public, imperfect or partial protection is better than no protection. Imagine that you came across a burning building and hear someone crying for help inside. Because you’re a brave and noble person, you choose to run inside to rescue that person. As you’re about to run in, someone hands you a bandana and says, “use this, so you don’t collapse from smoke inhalation!” But another person says, “No, the smoke particles are too fine! The bandana won’t do much good!” Even if the bandana only improves your odds a little, you’re going to wear it, because you want every little advantage you can get. If wearing a mask lessens the chance you’ll get the virus, why not?

DHS: Boy, China Imported a Lot of Medical Equipment in January

The Associated Press reports on a Department of Homeland Security analysis paper, concluding the Chinese government downplayed the severity of the outbreak so that they could buy up medical supplies:

Not classified but marked “for official use only,” the DHS analysis states that, while downplaying the severity of the coronavirus, China increased imports and decreased exports of medical supplies. It attempted to cover up doing so by “denying there were export restrictions and obfuscating and delaying provision of its trade data,” the analysis states.

The report also says China held off informing the World Health Organization that the coronavirus “was a contagion” for much of January so it could order medical supplies from abroad — and that its imports of face masks and surgical gowns and gloves increased sharply.

Those conclusions are based on the 95 percent probability that China’s changes in imports and export behavior were not within normal range, according to the report.

 As much as I have enjoyed researching and exploring the possibility of a lab accident being the trigger that fired off this pandemic, that question is unlikely to ever be answered satisfactorily and is somewhat moot. Once Chinese authorities knew they had a contagious virus, they did everything possible to protect themselves and nothing to protect the rest of the world — with 430,000 air passengers traveling from China to the United States from New Year’s Eve to April 4.

Our Humbled Leaders

I’m not sure where the “never apologize” philosophy came from — probably someone deeply insecure, who sees admission of any fault or weakness as fatal — but we are seeing some surprising humility from certain leaders.

Dr. Anne Schuchat, the number two official at the U.S. Centers for Disease Control and Prevention, told the Associated Press, “The extensive travel from Europe, once Europe was having outbreaks, really accelerated our importations and the rapid spread. I think the timing of our travel alerts should have been earlier.

Ohio governor Mike DeWine said this week that his state’s order requiring the wearing of masks in public “was just a bridge too far. People were not going to accept the government telling them what to do.

And Vice President Mike Pence said he realized he made a mistake not wearing a mask while visiting the Mayo Clinic: “I didn’t think it was necessary, but I should have worn a mask at the Mayo Clinic and I wore it when I visited the ventilator plant in Indiana” two days later, Pence said at a Fox News virtual town hall on Sunday, nodding sheepishly.

This is uncharted territory. People are going to make mistakes. Most of these decisions involve competing values, and in many cases, there may be no “good” answer, just “less bad” ones. The most important thing is to keep steering ourselves closest to the best answer.

ADDENDA: Like Matthew Continetti, I’ve been enjoying the ESPN documentary series The Last Dance — surprised how much I enjoyed it, since I’m not a huge NBA or Chicago Bulls fan. Watching last night, I realized how much of the series is about the era, not just the greatest player of all time or the team. A news report from Michael Jordan’s rookie season noted he was “more popular than a Cabbage Patch Doll.” The era of these Bulls was when the ’80s turned into the 1990s — and Continetti puts his finger on why two-hour vacations in those past decade seem like such a balm at this time:

The end of History was short-lived. After 9/11, Krauthammer took to calling the 1990s not an end but a “holiday from history.” What a pleasant holiday it was. And how large a part Michael Jordan played in it. I can’t be the only child of the Reagan years for whom memories of Stormin’ Norman Schwarzkopf, Bill Clinton and Gennifer Flowers, and H. Ross Perot are intermixed with recollections of Bulls Starter Jackets, pairs of Air Jordan sneakers, All-Star Weekend, and NBA Inside Stuff with Ahmad Rashad on Saturday mornings. To watch The Last Dance is to revisit America before the fall of the World Trade Center, before Afghanistan and Iraq, before the global financial crisis, Syria, Ukraine, and the rise of China. It was a stronger, more self-confident place. And a naive and superficial one.

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