Tags: Coronavirus | coronavirus

Test-Trace-Isolate: A New Red Herring?

wooden signposts reading test trace isolate
(Jon Anders Wiken/Dreamstime)

By Monday, 18 May 2020 09:30 AM Current | Bio | Archive

The experts originally justified the nationwide lockdown on the grounds that we had to "flatten the curve": that is, to slow the spread of the virus in order to protect our health system from collapsing under the weight of a spike in hospitalizations. By the end of March, it was clear that we had dodged that bullet.

Even in New York City, where the virus hit the hardest, the hospital system never collapsed. In fact, our hospitals' greatest stress in recent months has been serious under-use, as patients are dissuaded from seeking non-emergency care. Nonetheless, we did not immediately re-open our society. Instead, the authorities pivoted to an entirely new justification for the lockdown.

The new argument is that we must stay locked down until our testing capacity is "great enough." Officials claim that we cannot "safely" re-open until we can test a large enough segment of our population. But how much is enough? What is the targeted testing rate, and, more importantly, what is the justification for that target? If we test 2% of the population a month, is that enough? Or should it be 100% a day? On what basis can we decide?

Testing alone cannot stop or even slow the epidemic. If testing is going to make a difference, it has to be combined with contact tracing and social isolation of identified carriers. If we can successfully identify the vast majority of those carrying the virus and successfully isolate those people from the rest of the population, we can extinguish the epidemic. But those are two very big ifs, especially given the fact that carriers of COVID are often asymptomatic.

The Safra Center of Ethics at Harvard recently estimated that we would need at least 30 million tests a day to sustain an effective test-trace-isolate strategy. In the worst-case scenario, we would need 100 million tests per day. They argue that we continue the lockdown until our testing capacity has reached this astronomical level. The Safra Center is half-right; it is hard to see how we could have any confidence that we have identified all of the asymptomatic carriers without such a massive effort. But this immediately raises the question: Is such a proposal realistic?

The current test runs about $150 per use. If we run 30 million tests per day for four months, that would come to over half a trillion dollars. Then we have to add to this the cost of tracing contacts and maintaining records. And this is the best-case scenario. At 100 million tests a day, we could be looking at many trillions of dollars.

But even if we had infinite financial resources to spend on this, could it be done? Can our biomedical industries manufacture 3 trillion tests in a matter of months? Could we find the millions of trained technicians and researchers needed both to conduct 30 million tests a day and to identify the contacts of those testing positive? It's hard to believe that we could. Consider how much difficulty we have every 10 years in finding and counting all the residents of the country for our census. Imagine that we had to complete an almost perfect census twice a week for months!

How many active infections are there in the United States? The IHME at the University of Washington estimates that there are about between 50,000 and 350,000 cases in the U.S. as of May 17. Recent results from serology testing conducted by Stanford University researchers in Santa Clara and Los Angeles counties suggest that the infection rates might be 15 to 50 times greater, which would give us numbers between 750,000 and 17 million cases. The traditional rule of thumb is that contact tracing and isolation is feasible only when no more than one person in a million is a carrier. For our country, that would be only 330 cases. We are over that level by a factor of at least 2,000!

Can we reach the magic level of one case per million by extending our lockdown policy? The IHME, which supports that strategy, predicts that we will still have between 8,000 and 40,000 cases on August 1, even assuming that we maintain current policies without widespread defection. Even the optimistic estimate is too many by 2,400%. It would take years of sheltering in place to reach the magic number of 300.

How many other individuals would have to be quarantined in order to contain the virus, even assuming that we could (in a matter of days) identify all active cases? Could we enforce a perfect quarantine of tens of millions?

The test-trace-isolate strategy lives in the realm of fantasy, not reality. Why then do we hear so much about it? The cynical answer is that the supposed need for testing is an excuse, a "noble lie" (to use Plato's phrase), useful in keeping a potentially fractious populace patiently enduring an indefinite prolongation of the lockdown.

Rob Koons is a professor of philosophy specializing in logic, metaphysics, philosophical theology, and political thought. He is the author and editor of six books, including "The Atlas of Reality: A Comprehensive Guide to Metaphysics" (with Tim Pickavance, Wiley-Blackwell, 2017). He has been active in conservative circles, both nationally and in Texas, including the Intercollegiate Studies Institute, the National Association of Scholars, the Texas Public Policy Foundation, the Philadelphia Society, and the Austin Institute for the Study of Family and Culture. Read Rob Koon's Reports — More Here.

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Even if we had infinite financial resources to spend on this, could it be done? Can our biomedical industries manufacture 3 trillion tests in a matter of months?
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2020-30-18
Monday, 18 May 2020 09:30 AM
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