3 Actions to Improve our Models and Ignite Hope
None of us want to stay locked down at home. We’re stuck between a rock and a hard place. We are unsure of the models. We are unsure of the actions we’re taking. We’re afraid of the outcomes on either side. All we know is that we’re trying to stop the economy from freefall, and we’re trying to keep our healthcare systems from collapsing. What can we do to ensure we’re on the right path and when to divert?
Well, we’ve taken action, but that doesn’t mean we can’t keep informing our models and our knowledge to achieve better outcomes the more we learn. The number one unknown is how many people already have or have had the disease and therefore have antibodies.
I buried this image in the last post, but I think it’s worth resurfacing here again.
The point of this was to create a visual “infection funnel.” I used data that was available for San Diego County (where I live) as a means to establish the “conversion” rates. As many of you who work in sales or marketing know, this is how we visualize the flow of prospects to sales and measure all of the actions in between. We are in need of organizing the “breakthroughs” we hear about in the media to a position of impact on this funnel. We can’t update the conversion rates (hospitalization rates, death rates) until we have a wider sampling of our population tested. We can’t understand how big the opportunity is (people who have not yet been infected) until we understand what percentage of people are already infected.
1 & 2, Testing & Testing
So we need to start with testing. Aggressive, widespread testing. This is the main piece of information we need to update our models. We can’t update those conversion rates until we know who’s had the disease and who has it now. We can get that from:
Infection Test Kits: COVID19 test kits used to identify whether you are currently ill. These are in production but woefully short on supply, distribution & cycle time for sample acquisition to test result.
Antibody Tests: If you have already had the disease, you have antibodies that were made to combat the virus. Antibody tests tell us if you possess the antibodies. These are emerging, but the moment they exist, we must mass produce, distribute and enable the local processes to test as many people as possible.
Cumulative Tests Done to Date in the U.S.
We’ve performed < 2 million tests (including on some tigers) on a population of 330 Million people.
That’s less than 0.6% of our population
In San Diego County that percentage is even smaller.
What if we invested immediately in 330MM tests and organized the state public services to set up drive through testing of as many citizens as possible? Instead of investing in ventilators, at the bottom of the infection funnel, can we co-opt manufacture of swabs, PPE, and test collection kits while also ramping up the labor and equipment on the test processing side? What if we spent our time, money and currently unemployed citizens attacking that problem? What could it look like and what would it do?
Local Fleet Service - I can see sending a fleet of service trucks doing mobile samples driving door to door and having people come to the vehicle, get their test and go back home.
Local Clearance Zones - As we’ve completed targeted areas, it would inform us of how many people were actually infected or were infected at a given time. This would tell us what the relative danger remaining is in our community and who specifically is “clear” and who isn’t.
Control - We won’t be able to just do this once. We’ll need to implement controls to ensure that we can combat resurgence of the virus as it happens in different regions e.g. Implement testing capabilities for all major travel modalities. Take a flight? Need to take a test before. Or produce an antibody certificate. I recall carrying an immunization card that went with my passport for entry to certain countries.
In the end we’d fall into one of three categories, infected, immune, or unexposed. Wouldn’t this be the fastest route to get our models more accurate and address each of the concerns?
A few home-kit companies started and faltered. The FDA put the kibosh on them, primarily because you can’t ensure that each home user is performing the swab correctly and that the sample maintains integrity during packaging and transport. So let’s just use the PCR test that we have in place and ramp up.
Let's say we test 50% of the population and it costs $200 per test between the cost of the kit, the labor to acquire, the shipping, and then the analysis. 150 Million people tested at $200 per person is roughly $30 Billion, a pittance compared to the $2T stimulus package we just delivered. Why are we asking manufacturers to make ventilators, so far down on the funnel above, when we should be making more test kits and ramping up facilities and services.
We could focus testing in zones and release people who are cleared in the “clear” zones. We could prioritize immune citizens first followed by those who are positive but will soon be clear of the illness. We’d need to leave the unexposed at home until we hit a certain tipping point within that zone.
Prioritizing Testing Zones
Testing everyone inside certain zones, could help with clearing work areas, returning to “normal” and progress.
We could start from established rings of commerce and work our way out. There are a number of ways to approach this and this is just one.
3. Pharmaceutical Treatments
Pharmaceutical interventions give us the promise of treating the illness earlier with the hopes of lessening its severity and minimizing its effect. Hydroxychloroquine with Azithromycin have been mentioned anecdotally and in very small samples. This doesn’t help us with immediately with our models. However, this might eventually affect the death rate and maybe even reduce the hospitalization. It has been unclear in the examples I’ve read to-date, if the medications are the cause of improvement, or simply used in conjunction with other medicines, and treatments. It’s a typical troubleshooting situation where we have a hard time attributing causation and instead are reacting to a perceived correlation. Reboot a computer and it fixes the problem, but if you don’t know what caused it, you may see it happen again.
The obvious benefit from these pharmaceuticals is the potential to alleviate pressure from our hospital system. If they cause an improvement in the ICU rate, the death rate, and maybe reduction in the length of stay inside the hospital they can be extremely crucial to our battle against the virus. These would certainly improve the bottlenecks that could occur with new patients coming into the hospital and could move treatment to the homes with the prescription. The best explanation I’ve read, drills deep into the way that Hydroxychloroquine and Azithromyin aid in expediting the speed and probability of recovery. It also suggests that ventilators are killing more people than they are helping. We are still learning.
Contact tracing
This has been a contributing factor in China, Korea, Singapore & Hong Kong’s progress with their cases. I’ve heard almost no discussion of contact tracing in the US at any level. If we can figure this out, we can isolate anyone and everyone attached to a positive patient, and target exam kits to those populations. It’s difficult to implement actions that track citizens without the public perception of totalitarianism (see a prior post and the video within it). The concerns are not unwarranted as they are frightening intrusions into our civil liberties. We may be backed into a corner, giving up civil liberties in a tradeoff against normalcy in our lives. In the meantime, we have to ask ourselves where we want to be in the next few months. As you might imagine, I’m least optimistic about contact tracing.
The National Psyche and Rallying the Nation
“I don’t want to be in a battle. But waiting on the edge of one I can’t escape is even worse.””
Many of these actions are daunting. But not more or less daunting than any number of things we have accomplished as humans throughout the ages. We stretched railroad tracks across the country , constructed the Great Pyramids, and recently learned of the heroic efforts of thousands of men and women who prevented Chernobyl from wiping out Europe.
Making tests available and local would allow everyone to know their current status. This alone would provide relief for each person who is tested. Shifting energy into service around collecting samples, shipping, tracking, and processing would create positive contributions and could employ a large number of people currently out of work. Knowing where we stand would also relieve a number of us to get back out and doing the work we need to get our economy to slow down its fall.
As we sit now, we are stuck waiting for the enemy to arrive at our doorsteps while it feels like the world is burning around us; we are helpless to act. Instead we could all be willingly and effectively engaged in the war on this virus, with actions that give us purpose and meaning and also inform our models, improve our certainty and get us all back to life and whatever the new normal will be. Hope is not a strategy, but a good strategy can create hope.
Sources
https://www.usatoday.com/story/news/2020/04/02/fda-oks-first-coronavirus-blood-test-track-immunity-test-vaccines/5116281002/
http://web.archive.org/web/20200405061401/https://medium.com/@agaiziunas/covid-19-had-us-all-fooled-but-now-we-might-have-finally-found-its-secret-91182386efcb