Both South Korea and the United States (US) confirmed the first case of COVID-19 on the same day. Yet, as of April 14, the total number of cases in the U.S. skyrocketed to 608,988 cases while South Korea has reported 10,564 total cases. As a researcher, this piqued my interest. What has led to this stark difference? What can we learn moving forward?
SARS-CoV-2 is sneakier than other known viruses, spreading from one host to another for several days before triggering any symptoms. To curb such an enemy, we need a test that can be used to identify infected people, isolate them, and trace those they’ve had contact with. That is what countries like South Korea, Singapore, and Hong Kong did while the US lagged until it was too late.
Diagnostics serve as the first line of defense in any pandemic response. A crack in the frontlines has largely allowed the virus to spread unchecked and demanded strict social distancing measures to reduce spread and transmission. Past experiences from previous pandemics have taught us that coming up with a potential vaccine or a cure might take a year, if not longer. This delay calls for us to step up our testing infrastructure.
The viral diagnostic tests follow a two-pronged approach. The first approach identifies the RNA (the blueprint that helps it to reproduce) present in viral particles, in a nose or throat swab collected from infected individuals.
Another testing methodology, serological tests, detect antibodies (your body’s warriors against infections) that are produced in the blood to fight the virus. This provides us with the number of cases that might have gone undetected due to increased immunity. Gaining these insights might be crucial to manage the pandemic and to forecast its course. Prompt accessibility of these tests to the public is the next big goal in the fight against the virus. In Colorado, efforts in San Miguel County to provide access to free blood tests for everyone have been delayed due to shortage in Personal Protective Equipment (PPE) and staff processing the tests at the lab.
As a Coloradan, I feel proud as the state has been quick to respond to the pandemic by opening up drive-through testing facilities, a strategy that allows for easy access to testing and prevents exposure to other patients in waiting rooms. However, proper implementation of this plan was hindered by the limited number of supplies provided by the federal government.
To alleviate the issue, the Colorado Department of Public Health and Environment (CDPHE), is currently following a tiered system of testing criteria recommended by the CDC, where preferences are given to frontline workers, high-risk individuals, and severe cases that need immediate hospitalization.
Given the measures such as a stay-at-home order, COVID-19 cases in Colorado are expected to peak in May. Having a system to decrease the load on health care facilities, including ICU beds and ventilators, are critical factors that define our path ahead.
“It might be harder for Colorado to bounce back economically due to the TABOR (Taxpayer Bill of Rights) act which restricts the amount of tax the state can retain and spend,” state Rep. Yadira Caraveo told me in a recent interview.
In light of the fact that economic comeback might be harder, efficient diagnostics infrastructure becomes even more critical.
Considering Colorado hasn’t peaked yet, we have still to face the worst scenarios from a shortage of ICU beds to doctors having to make the call on who gets on the precious ventilator. What can we do? Can we learn from others who have peaked and what has helped them to contain the virus?
We can adapt measures followed by states like Washington and California calling on certified labs to train skilled volunteers to perform testing. In addition, contact-tracing apps have been developed in the U.S. (Safe Paths and COVID Watch) to aid with diagnosis. As these crowdsourcing apps largely depend on community-driven anonymized data, we can actively contribute by registering ourselves. Alternatively, countries such as Singapore (TraceTogether) and South Korea are implementing the contact-tracing approach through location data released by state health officials.
Past pandemics/epidemics have taught us that the infection occurs in multiple cycles. We need better planning and preparation for the next wave. Initiatives such as a mass-screening program implemented through point-of-care testing will be essential to break the next chain of transmission. Further, an earnest attempt to improve policies that govern pandemic preparedness and health care emergencies needs to be made. This might include, but is not limited to, increasing American manufacturing (reducing the dependence on supplies from other nations once travel is restricted), stockpiling of PPE at the state level in addition to a Strategic National Stockpile, and facilitating open communications between researchers, epidemiologists and policymakers to move towards evidence-based strategies.
To even think about returning to normalcy, we would have to build stronger testing facilities first.
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