Matthew J. Edlund M.D.

The Power of Rest

COVID-19: An American Badge of Honor?

Being number one in deaths is not good news.

Posted May 22, 2020

WHO
WHO model of Sars Cov 2
Source: WHO

Recently, President Donald Trump declared having achieved more COVID-19 tests and cases than any other country provides America “a badge of honor.”

In my view, the statement demonstrates an administration conceptually incapable of doing what’s needed to saves lives: using verified testing to trace, track, and quarantine.

Meaningful Numbers

Both the American and British governments have put out the message that more COVID-19 tests mean less suffering and unnecessary death. In Britain, this led to a campaign of getting 100,000 tests done in a day, leaving the country without needed reagents for future results.

So let's look at who tests the most per million people (via Worldometer for 5.22.20):

  • Iceland: 170,748
  • United Arab Emirates: 162,087
  • Bahrain: 154,713
  • U.S.A.: 40,749

By their statistics, the BBC reported 16 countries with higher testing rates than the U.S.

But what do these numbers mean? In the U.S., there are now at least 48 different swab tests and 120 antibody tests. Many are inaccurate. Though they test for present (swab) and past (serologic-antibody tests) infection, the two tests are often conflated in national statistics, making for a public health mess.

The same patients also get very different test results—another clinical and public health tragedy. The Abbott ID NOW test the president uses to prove that he is not infectious was found by an NYU verifying study to get false negatives 32 to 48 percent of the time.

Many countries like Taiwan and South Korea try to use one test their national labs made to provide reliable figures. US testing is a free-for-all. There’s no national coordination. We don’t know what much of our testing statistics signify.

But the most important part of testing is how you use it.

Testing, Tracking, and Quarantine

Here are four countries and their Worldometer 5.22.20 overall death rates per million from COVID-19:

  • Vietnam, 97 million people: 0
  • Taiwan, 24 million people: .3
  • Sri Lanka, 21.5 million people: .4
  • The U.S., 328 million people: 291 and rising

Here are their testing rates per million:

  • Vietnam: 2828
  • Taiwan: 2954
  • Sri Lanka: 2295
  • U.S.: 40,749

Why does Taiwan, which never fully locked down, have a death rate one-thousandth that of the US? 

Why has Vietnam had no official COVID-19 deaths?

They were prepared. They tested, traced, tracked, and quarantined, coordinating everything nationally. They knew if they shut down the virus quickly, they could “crush the curve.” So they did it, and keep doing it. That’s what works. 

We have no nationally coordinated testing, tracing, and tracking program—except for the White House. 

Following infections of people close to the president and vice-president, West Wing workers can be tested daily, the president and vice-president more often.

Not doing standard epidemiologic tracking and quarantine is rather like going to the doctor with pneumonia symptoms to get an x-ray. But you don’t get a standard x-ray. Perhaps you image one lung. Or you make sure only your doctor gets the results—no one else. To stop epidemics you verifiably test people, trace their contacts, get them quarantined. That’s how countries have records preventing COVID-19 deaths at least a thousand times better than ours.

In the past, our national CDC was the leader in showing other countries what to do. Not anymore.

What Happened to CDC?

The CDC was until recently regarded as the best epidemic intelligence service in the world. According to Laurie Garrett and others, CDC has been systematically gutted. The process started at the beginning of the Trump administration when its international epidemiology training and support were defunded despite protests from the Defense Department, which wanted to protect our troops overseas. 

When COVID-19 hit, the CDC warned people like University of Washington researcher Rachel Chu not to find out who was sick and dying, or they would lose their grants or go to jail. The real, unofficial message—we can’t have an epidemic if we prevent people from studying it. The CDC then refused WHO COVID-19 testing kits, demanding to use its own. The tests it made were hopelessly contaminated and useless. When the time came to obtain needed reagents to make new tests, we were last on the international lists.

Lots of people died.

Now when people around the world call the CDC, no one calls back. Look at CDC’s finally released guidelines for reopening, and you find necessary metrics don’t appear. Look for guidance on religious services, which helped spark the epidemics in South Korea, Iran, and New York among others, and there’s nothing.

In less than four years, we’ve rendered ineffective the best epidemic fighting organization in the world, a true badge of honor.

Bottom Line

To save lives, you need to nationally coordinate programs to trace, track, and quarantine. Leaving everything to the states and cities won’t work. Many local public health departments, like CDC, were defunded or rendered toothless over the last four years. Plus, Americans like to move. They cross state borders. They visit other countries.

To save our lives, we need someone else to step up. It could be the Gates Foundation, Bloomberg, others. They’re making some attempts, but it’s not enough.

As the country fitfully reopens, we need to do what’s necessary to keep people safe.  

Try to help. 

Plenty of people have volunteered to help trace and track. But in my view, we need national coordination, now.