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Summarizing COVID-19 Testing Worldwide - Our Perspective

E :  

(That big yellow "E :" means this is in English). Just for you ...

 

Countries do COVID-19 Testing. Counts of such tests can be found here, by country.

They do it differently.

The "It" in the sentence above being what I'll call, Actual Testing Philosophy and Practice.

I'll give one example of that P & P, at the bottom of this article, from one country: Belgium.

 

Do differences in testing impact on final outcomes of this disease COVID-19, or not ?

Probably too early to answer that one, but let's see how testing numbers translate today through reported values for Confirmed Cases, Deaths, Recovered and Actively Sick. Clearly, without any numbers to examine, testing decisions impact on costs.

 

Let's first give you this which you have probably come across:

 

Tests Performed per Million Pop - 14 March 2020

Above,  most countries, are grouped on the left. Then there are the outliers, high and low.

 

Can we get an average for that?

It should be called a mean, and here it is :

 

Mean (All) - 14 March, 2020

We have included in this value above, ALL values.

 

Let's throw out some outliers.

 

South Korea, Italy especially, Germany that doesn't report its tests, Russia that took off like a Sputnik with almost no actual cases. That distribution now looks like this.

Already a more normal looking distribution.

Now we have a sample of 16 instead of 20.

Tests by Country (outliers excluded- - 14 March, 2020

And the mean and standard deviation calculate to this number of tests done per million population:

 

Mean (no outliers) - 14 March, 2020

 

Is that a good number?

 

Is that the number that :

  • countries should shoot for ? (for example in Belgium, population  11,589,623 estimated this day, x 342 / 1 million  =  3,964 tests done to date. The actual number: 5,734 tests done in Belgium).
  • experts should recommend ?
  • the governments should use to find funding for all the lab reagents, new testing stations, etc. ?
  • should be used to evaluate results of medical care, mortality data, etc. ? Outliers there translates into difficulties for patients.
  • Maybe there are some outliers here too. Maybe we should just present data for one country. Ours.
  • ? you have a suggestion ?  Don't hesitate to share it with our able staff at info@coronastavelot.com

 

Here is the translation of these actual values above, through the clinical picture : Confirmed Cases (Epidemiology),  Active Cases (Medical Care), Deaths ("What went wrong?"), and those who have Recovered (living in a world with a quite different Economy at the present time).

 

Here's a little gallery of graphs to show this: 

(Outliers excluded) 

 

 

Q: "Did you see it ?"

A: "Uh, ... see what ?"

 

  • There is no evidence of a uniform Actual Testing Philosophy and Practice around the world.
    • Some countries are driven by the simple presence of an Confirmed Case.
    • Others seem driven by number of Deaths. Even small numbers of Deaths (scaredy cats, scaredy cats!)

 

Each country sampled seems to be on a steep and different learning curve than some of the others.

And that's excusable.

But it won't work for long.

 

Here in this gallery, we throw the outliers back in ...

Did you notice ? It gets even crazier. 

 

But none of these variables gathered above, correlates highly with the actual prevalence of COVID-19, reported for this Sample of 20 countries. 

 

Who is telling "management" of a country to do something that makes not much sense?

  • "No testing will be needed. I can assure you."
  • "Start doing some testing now. I can assure you it's the right thing."
  • "Test only Doctors and Nurses. If they die it's all over, I can assure you."
  • "Test just those with health insurance. This is going to get very expensive, I can assure you."
  • "We've got to test everybody, and we're already way behind, I can assure you."
  • "Stop all testing now. It makes no difference in outcome and you'll save a budle. I can assure you!"

 

My God ! It's the Experts !

 

"Abe, things have changed."

Since Abe Lincoln died his messy death, the guys at the top, have stopped saying, while whittling on a stick: "We will do this because I know that it's the right thing to do." They depend on their experts. These days they've started bringing them along and placing them right behind their position at the podium at Press Conferences. If Abe had done that, he might not have been assassinated.

 

If you don't control the method for what you are doing, in rolling out the product that your making (in this case, testing for COVID-19), what changes will you make if one seems to be needed ?

 

"How would you know?"

 

Let's quickly look at an example.

 

Here is a nice summary of why testing is even needed at all ...

"Why Testing for COVID-19 is important  (Source)

 

  • We want to know the total number of people infected with COVID-19. To know this, it is necessary to have widespread testing.
  • When testing is too low we do not have a clear picture of what's going on.
  • Testing is crucial to understand the prevalence of the disease, to provide timely treatment to those infected, to understand how the disease evolves, and to ensure that we take measures to stop the disease spreading.
  • This last point is very important: Testing is crucial to lower the rate of infection. When infected people do not know that they are infected, they might not stay at home – thereby running the risk of infecting others. It's vital that efforts are increased in this regard.
  • Unfortunately, there are two important reasons why testing is still low in many countries affected by COVID-19. 
  • First, some people who are infected with COVID-19 have mild symptoms and therefore do not go to get checked (we explain the symptoms here); and second, in some places there is not enough testing capacity."  

 

OK. Let's just acept those explanations as Good Testing Philosophy and Practice.

 

Here is one example, of where the approach is different.

This announced March 13 by Public Health in Belgium. It's in French so I translated it.

 

"Who are we testing for COVID-19?

Since March 12, new directives have come into force regarding the tests of persons with COVID-19

In short:
• Only people with severe respiratory disorders who need to be hospitalized will still be tested for COVID-19.
• People with respiratory tract infections who do not require hospitalization are no longer tested by either the general practitioner or hospitals. It is assumed that they have COVID-19. The general practitioner asked them to apply home isolation.
• Exception: the nursing staff (for example, doctors and nurses) necessary for treatment will be tested as a priority in the event of respiratory problems, so that they can be brought back quickly to treatment in the event of a negative test.
Procedure
• Anyone with a respiratory tract infection should stay at home and contact their family doctor by phone.
• The general practitioner decides by telephone whether the person can remain convalescent at home or must go to the hospital.
• Where possible, general practitioners organize "triage stations" where patients can first undergo a clinical examination before being referred to the emergency room.
• Those who can stay at home should stay in home isolation for at least 7 days and definitely stay at home if they have symptoms. In the context of home isolation, the person also tries to isolate himself as much as possible from family members. The person will not be tested, unless it is a caregiver necessary for the care of patients or vulnerable persons.
• Anyone who has to go to the hospital will be examined there clinically. If hospitalization is necessary, the person will be tested on COVID-19 so that treatment can be adapted.
Contacts of potential patients
• People who are not sick go to work or school (with special attention to hygiene measures and maintaining social distance when possible). There is no home isolation for those who do not complain of being sick.
• If you have breathing problems, stay at home and contact your general practitioner.
• Vulnerable groups avoid places where large numbers of people gather. People with chronic illnesses or with less resistance seek the advice of their treating physician if they can return to work / school.
• Contacts of (potential) patients are no longer the subject of research and contact by doctors specializing in infectious diseases.
Why prioritize and limit tests in this way?
There are several reasons for this adjustment:

• As the COVID-19 epidemic spreads, it becomes increasingly difficult to determine who should be tested. Initially, we were able to clearly delimit this criterion to people with a certain history of travel or contact with an infected person + symptoms, but as more and more regions in the world are infected and there are also more of local infections in our own country, this criterion becomes untenable.
• We also need to check the testing capacity. With signals indicating that test reagents are depleted in laboratories, it is becoming more and more important to prioritize tests and stop doing large-scale tests.
• As the flu decreases in our country, the likelihood that someone with a respiratory infection will develop COVID-19 becomes more and more likely.
• We can follow the evolution of the epidemic in other ways: to follow the COVID-19 epidemic, Sciensano now uses the same surveillance method as for the influenza epidemic. Sciensano now also receives daily hospital data from hospitals.

 

I won't even a comment here, on why this is clearly a risky change in policy.

 

But the point here was: local expert opinion in each country, has lead to vastly different implementations of testing for COVID-19.

 

The goal varies from country to country, and certainly for very good reasons.

I thought there was only one goal. To diagnose a disease called COVID-19.

 

And of course, it's not just Belgium.

 

Testing Philosophies vary. One example : "Here's what I think. If you think human life is sacred, you test, because humans are valuable, and life is meaningful. If you think humans are inept, life is cumbersome and trouble, you would let them rot."

 

Testing practices vary around the world, always influenced by Policy: I think that's what we just showed.

 

Practicing compassion

... involves doing for someone else, something that he or she can no longer do alone.

 

So the people in Laboratory Medicine and decision makers in Government need a large dose of compassionate action right now. Sounds trite, but yes, we are all in this together. They have enough work. Too much. They don't need more put downs, nor embarassing questions from the Press.

 

What was done in China and elsewhere to identify and manage individuals with COVID-19, has of course been in the news for a month. It was frequently commented on to give the impression that China was putting its citizens with COVID-19 in what could be labelled concentration camps. 


That level of "severity" makes people respond quickly with "... well, but this isn't China."
And that is true.

 

But differences in management of COVID-19 there and here (or where you are), help define critical differences between societies. 


We are different.

But even within that difference, can we implement procedures that will save lives?

That's ultimately the goal in all this, to save lives.

And the current increases in cases outside of China, as presented today on this site, suggests that we had better do that soon.


"Oh, you know, ... the people here will never accept all that."
Well they better.

 

Experts in China are now looking out on the world, quite puzzled, and in disbelief.

They are asking: "What are they waiting for?!"

Their inability to understand our delay, has most certainly, some deep societal components.

 

Listen to the linked presentation by an expert who writes for the New York times. An interview on MSNBC. Donald McNeil, Science and Health reporter.. It may help clarify for you, the required response to this pandemic, right where you are. Again it's media stuff, so its tone is unmistakeable.

 

"A bit alarmist, but realistic" said an acquaintance who lives in New York.

 

It doesn't have to be 'just like China'.

But it should carefully collect all the good parts of the Chinese experience, and speedily share and apply them. There, 70 to 80% of all transmission of COVID-19 occurred in families. How does that fit suggested "things to do if you feel sick" where you are?

 

Testing for COVID-19 which I tried to touch on in this article, is just one part of "getting it together."

 

 

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14/03/2020
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