Why we need test-and-trace to get back to work

April 28, 2020 12:01 am

Health care workers screen a patient for COVID-19 at a drive-through coronavirus testing site on March 18, 2020 in Arlington, Virginia. Fewer patients are relying on PCR tests, preferring at-home antigen tests whose results aren’t typically reported back to the state. (Photo by Drew Angerer/Getty Images)

By Jon Sealy

When this crisis is over and history is written, I hope an independent commission is able to uncover all the facts of how we got to this nationwide state of quasi-lockdown. There is plenty of blame to go around, but what strikes me most, as a communications professional, is how many communications gaps we continue to see in this crisis.

The virus is “just the flu” one day and a once-in-a-lifetime pandemic the next. Masks aren’t helpful, or maybe they are. We’re staying home for two weeks, or is it a month, or three months? Today, the most pressing communication Virginians are not receiving from the state government is: What happens after June 10, when Gov. Ralph Northam’s stay-at-home order ends?

The virus arrived in the United States in January and picked up steam in February, causing a three-month shutdown. If we go back to work in June, it stands to reason that the virus could pick up steam in July and come August we’ll be right back here, stuck at home and hoping we flatten the curve enough to preserve our health-care infrastructure.

Is this going to be life until a vaccine arrives in 2021? Is there a plan to keep the virus contained after Virginia re-opens? Or are we looking at successive waves of shutdown?

Failure to Contain, Failure to Test

Speed is one reason we are where we are. As a communications consultant, I hear a common adage that getting a big organization to do anything is like steering an aircraft carrier. Over the past few months, a lot of aircraft carriers really needed to act like speed boats. The Trump Administration and the media were slow to acknowledge the threat of the virus, the CDC was slow to develop an accurate test, the FDA was slow to approve various testing protocols and private industries were slow to mobilize to provide testing and medical personal protective equipment.

The first strategy of managing the outbreak was containment — tracing all the cases from Wuhan, monitoring contacts and making sure positive cases were in quarantine. In late February, however, the CDC acknowledged “community spread.” Positive cases were popping up and no one knew how they were infected.

At that point, my company’s corporate clients — acting before getting any real government guidance — all started asking for communications recommendations for their employees. What did they need to know about the coronavirus? Did the CDC have any advice? Did companies need to start doing temperature checks at the door? What was about to happen in this country?

Nationally, the strategy shifted from containment to mitigation via social distancing, handwashing and other measures. In the absence of federal leadership, states largely have been forced to solve many issues on their own and Virginia has thus far lacked a nimble, centralized, coordinated response to up-scale testing and tracing measures.

Today, I suspect most of us understand the need for more testing. People with symptoms such as a cough or fever have been screened and advised to stay home without testing. Generally, only the most severe cases have been able to receive a test, so we have absolutely no idea how widespread the virus is, which has therefore made containment impossible.

The good news is that the testing situation in Virginia may soon be resolved. More and more labs and hospitals are coming online with high-scale testing, both the rapid screening option from Abbott Labs as well as the DNA-based PCR testing that involve the nasal swab. Soon enough, it seems safe to say that everyone who has symptoms will be able to get a test without screening.

But this isn’t enough to get us out of this crisis. Ample evidence has emerged to suggest people who are infected can spread the virus before they develop symptoms, so even if we test every single Virginian with a cough or fever, asymptomatic (or pre-symptomatic) people could be walking around spreading the virus. Until we can locate and test these asymptomatic spreaders, the virus will not be contained and we will not be free to get back to business as usual.

We need test-and-trace

On March 29, Scott Gottlieb, former commissioner of the FDA, released a plan via the American Enterprise Institute outlining our best way out of this crisis. Until a vaccine or therapeutic treatment is developed, we must contain the virus through “test-and-trace.” 

“Test-and-trace” means we must test not only people who have symptoms, but also anyone who has been in contact with someone who has tested positive. If I wake up with a fever and get a positive test, everyone I have been in contact with must also get a test. Many of my contacts likely would be asymptomatic spreaders and would need to be isolated.

This bears repeating: To contain the virus, we must test every single positive case in Virginia and then we must test every contact of those cases so that asymptomatic spreaders can be prevented from spreading the virus.

We may soon have enough testing available in the region to handle such a scale (think tens of thousands of tests every day in the commonwealth) but I worry no one in government is thinking big enough about a contact-tracing approach — or at least, they aren’t communicating clearly about the strategy.

In the last week, Gov. Northam has mentioned contact-tracing, but has yet to give an indication of the scale and approach he is considering. We cannot afford to wait. If we re-open without a test-and-trace infrastructure in place, community spread will pick right back up and we will be forced to contend with shutting back down or giving up on containment.

What would test-and-trace look like? One approach would be to hire a small army of contact-tracers who can catalog and follow up on every single case. These contact-tracers would make sure that if you receive a positive test, they will follow up with all of your contacts to make sure they get a test. Every single case of COVID-19 in the commonwealth would be catalogued.

Technology may help with this process. We could install an app on our smartphones, so that if I receive a positive test, my phone will send an alert to any other phones that have been within six feet of me in the past week. Smart phone tracing might work, but it would require a difficult conversation around civil liberties that no one has initiated seriously.

Finally, a perfect solution would be an instant at-home test, such as a device you could breathe into before leaving the house. If you’re shedding the virus, you stay home, and maybe an alert goes to the health department. I don’t know if such a test is in development, but it would need funding and a fast-track approval from the FDA before it would be effective.

Virginia’s opportunity

Any of these solutions would be a tall order — a massive surveillance operation, a technological break-through, an inconvenience for all of us, a potential danger for our health care workers and a genuine test of our institutional capabilities — but what’s the alternative? Let the virus rip and hope for herd immunity? Sacrifice tens of thousands of Virginians and risk not only the collapse of our health-care system but also our essential services?

Other states are starting to come online with test-and-trace infrastructure. For example, Massachusetts Governor Charlie Baker is working with the nonprofit Partners in Health to hire an army of contact-tracers. Utah and North Dakota also announced making planes for test-and-trace. One resource local leaders should investigate is the site, a national coalition of volunteer activists working to coordinate a test-and-trace strategy across the United States.

Virginia got lucky with this virus in one respect. Places like San Francisco and New York were seeded earlier and have denser populations, so when we shut down the country, the commonwealth had fewer cases of community outbreak. If we can hold the line for a few more weeks, we should be able to reduce the spread to a place where the virus can be contained through traditional test-and-trace measures and we can all get back to work.

I know everyone has been fighting brushfires these first few months of the crisis, but I would challenge Virginia leadership to look beyond merely re-opening this summer. A test-and-trace infrastructure may be the only thing that will allow us to stay open for business until a vaccine arrives. We might not be able to have conferences and concerts for a year or more, but at least our children could go back to school and families could go out to dinner, confident a containment strategy is in place.

The coronavirus is fast, and nimble and relentless. Our institutions must be faster, more nimble and more relentless. We needed testing in February and March. In May and June, we need test-and-trace. Our lives — and our livelihoods — depend on it.

Jon Sealy is a communications consultant with Rhudy & Co. in Richmond. He may be contacted at [email protected]

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