Over the past few weeks there has been a great deal of public messaging about the number of tests for the COVID-19 virus and the speed in processing the results. Questions from the public have revolved around why the local officials and emergency management folks are so insistent on these, why do they want so many, and what does it really mean to the official response.
As severe weather approaches, we believe it is imperative government leaders know about possible heavy rain or tornadic threats. As heavy rains fall, they need to know what ground saturation levels are, rainfall intensity predictions, and if there is a flood potential. As hurricanes approach, we look for predictions of winds, rain and storm surge. In any disaster or emergency, the first critical thing sought by the Emergency Management community is Tactical Intelligence (TI) in order to determine “how bad is bad”! Whether responding to a flood, tornado, hurricane, or earthquake our response efforts are driven by the information we have available. Do we need to sandbag, do we need to mobilize pumps, do we need to plow snow or fight icy streets? Knowledge is the power to affect change.
How Big is Big?
This why you hear state after state, city after city discuss the level of testing they are seeing in their area, and the responsive actions they are taking. Governors are faced with closing schools, bars, restaurants, and other public gathering places because they and their EM staff cannot answer that basic question of “how big is big.” Governors and mayors are faced with making major, life-altering decisions with information that as of March 20 averages 24-36 hours old. Instead of being able to be proactive in the response, all decisions being made are happening on data already in the past. In a situation like this where cases of illness are doubling in 24 hours, the plans are obsolete before they can be implemented.
Many involved in the current virus response believe that in order to get ahead of the virus a system of surveillance screening would be helpful. A system where large numbers of people are tested rapidly to determine a far more precise extent of the virus spread, enabling them to identify spread patterns and allowing them to take a more focused approach to intervention than a broad-brush approach currently being applied of closing down everything. As we have learned already, lagging symptoms and asymptomatic victims compound the difficulty in determining the extent with any certainty under the current symptomatic-only testing being conducted currently across most of the country.
When Will We Know the Spread?
In this testing protocol there may only be one person in a family tested, with an assumption all are affected, but without any definitive proof that could lead to quarantine and protection. New York City conducted epidemiological research into a cluster of cases in early March and found that one infected attorney had apparently infected more than 50 others through his work, church and social life. Of those 50, 17 were apparently infected within a two-day period. A 50:1 ratio of spread is a sobering thought to contemplate. Coupled with a data lag time of 1-2 days, the inability to keep current on data is one of the major frustrations for local and state officials.
As of this writing, deficits in test kits, test chemicals, and test swabs are still being reported in many parts of country, resulting in testing still being targeted to those who are symptomatic. In short, we still do not know how bad is bad. The question being asked in by medical and community leaders is simply, “when will we?”