How Excessive Regulation Helped Ignite COVID-19's Rampant Spread
When historians of the future look back at the 2020 pandemic, the heroic work of Helen Y. Chu, a flu researcher at the University of Washington, will be worthy of recognition.
Chu's team bravely defied the order and conducted the testing anyway.
In late January, Chu was testing nasal swabs for the Seattle Flu Study to monitor influenza spread when she learned of the first case of COVID-19 in Washington state. She deemed it a pressing public health matter to document if and how the illness was spreading locally, so that early containment efforts could succeed. So she sought regulatory approval to adapt the Flu Study to test for the coronavirus, but the federal government denied the request because the original project was funded to study only influenza.
Aware of the urgency, Chu's team bravely defied the order and conducted the testing anyway. Soon they identified a local case in a teenager without any travel history, followed by others. Still, the government tried to shutter their efforts until the outbreak grew dangerous enough to command attention.
Needless testing delays, prompted by excessive regulatory interference, eliminated any chances of curbing the pandemic at its initial stages. Even after Chu went out on a limb to sound alarms, a heavy-handed bureaucracy crushed the nation's ability to roll out early and widespread testing across the country. The Centers for Disease Control and Prevention infamously blundered its own test, while also impeding state and private labs from coming on board, fueling a massive shortage.
The long holdup created "a backlog of testing that needed to be done," says Amesh Adalja, an infectious disease specialist who is a senior scholar at the Johns Hopkins University Center for Health Security.
In a public health crisis, "the ideal situation" would allow the government's test to be "supplanted by private laboratories" without such "a lag in that transition," Adalja says. Only after the eventual release of CDC's test could private industry "begin in earnest" to develop its own versions under the Food and Drug Administration's emergency use authorization.
In a statement, CDC acknowledged that "this process has not gone as smoothly as we would have liked, but there is currently no backlog for testing at CDC."
Now, universities and corporations are in a race against time, playing catch up as the virus continues its relentless spread, also afflicting many health care workers on the front lines.
"Home-testing accessibility is key to preventing further spread of the COVID-19 pandemic."
Hospitals are attempting to add the novel coronavirus to the testing panel of their existent diagnostic machines, which would reduce the results processing time from 48 hours to as little as four hours. Meanwhile, at least four companies announced plans to deliver at-home collection tests to help meet the demand – before a startling injunction by the FDA halted their plans.
Everlywell, an Austin, Texas-based digital health company, had been set to launch online sales of at-home collection kits directly to consumers last week. Scaling up in a matter of days to an initial supply of 30,000 tests, Everlywell collaborated with multiple laboratories where consumers could ship their nasal swab samples overnight, projecting capacity to screen a quarter-million individuals on a weekly basis, says Frank Ong, chief medical and scientific officer.
Secure digital results would have been available online within 48 hours of a sample's arrival at the lab, as well as a telehealth consultation with an independent, board-certified doctor if someone tested positive, for an inclusive $135 cost. The test has a less than 3 percent false-negative rate, Ong says, and in the event of an inadequate self-swab, the lab would not report a conclusive finding. "Home-testing accessibility," he says, "is key to preventing further spread of the COVID-19 pandemic."
But on March 20, the FDA announced restrictions on home collection tests due to concerns about accuracy. The agency did note "the public health value in expanding the availability of COVID-19 testing through safe and accurate tests that may include home collection," while adding that "we are actively working with test developers in this space."
After the restrictions were announced, Everlywell decided to allocate its initial supply of COVID-19 collection kits to hospitals, clinics, nursing homes, and other qualifying health care companies that can commit to no-cost screening of frontline workers and high-risk symptomatic patients. For now, no consumers can order a home-collection test.
"Losing two months is close to disastrous, and that's what we did."
Currently, the U.S. has ramped up to testing an estimated 100,000 people a day, according to Stat News. But 150,000 or more Americans should be tested every day, says Ashish Jha, professor and director of the Harvard Global Health Institute. Due to the dearth of tests, many sick people who suspect they are infected still cannot get confirmation unless they need to be hospitalized.
To give a concrete sense of how far behind we are in testing, consider Palm Beach County, Fla. The state's only drive-thru test center just opened there, requiring an appointment. The center aims to test 750 people per day, but more than 330,000 people have already called to try to book a slot.
"This is such a rapidly moving infection that losing a few days is bad, and losing a couple of weeks is terrible," says Jha, a practicing general internist. "Losing two months is close to disastrous, and that's what we did."
At this point, it will take a long time to fully ramp up. "We are blindfolded," he adds, "and I'd like to take the blindfolds off so we can fight this battle with our eyes wide open."
Better late than never: Yesterday, FDA Commissioner Stephen Hahn said in a statement that the agency has worked with more than 230 test developers and has approved 20 tests since January. An especially notable one was authorized last Friday – 67 days since the country's first known case in Washington state. It's a rapid point-of-care test from medical-device firm Abbott that provides positive results in five minutes and negative results in 13 minutes. Abbott will send 50,000 tests a day to urgent care settings. The first tests are expected to ship tomorrow.
Podcast: The Friday Five weekly roundup in health research
The Friday Five covers five stories in research that you may have missed this week. There are plenty of controversies and troubling ethical issues in science – and we get into many of them in our online magazine – but this news roundup focuses on scientific creativity and progress to give you a therapeutic dose of inspiration headed into the weekend.
Here are the promising studies covered in this week's Friday Five:
- Using graphene to repair shoulders
- Testing for PTSD with saliva
- Cancer detection with a microchip
- Best posture for pill taking
- Resilient food for climate change
And an honorable mention goes to research on a new way to induce healthy fat.
Podcast: The Science of Recharging Your Energy with Sara Mednick
If you’re like me, you may have a case of email apnea, where you stop taking restful breaths when you open a work email. Or maybe you’re in the habit of shining blue light into your eyes long after sunset through your phone. Many of us are doing all kinds of things throughout the day that put us in a constant state of fight or flight arousal, with long-term impacts on health, productivity and happiness.
My guest for today’s episode is Sara Mednick, author of The Power of the Downstate, a book about the science of relaxation – why it’s so important, the best ways to go about getting more of it, and the time of day when our bodies are biologically suited to enjoy it the most. As a cognitive neuroscientist at the University of California, Irvine, Mednick has a great scientific background on this topic. After getting her PhD at Harvard, she filled her sleep lab with 7 bedrooms, and this is where she is federally funded to study people sleeping around the clock, with her research published in top journals such as Nature Neuroscience. She received the Office Naval Research Young Investigator Award in 2015, and her previous book, Take a Nap! Change Your Life was based on her groundbreaking research on the benefits of napping.
In our conversation, we talk about how work and society make it tough to get stimulation like food and exercise in ways that support our circadian rhythms, and there just as many obstacles to getting sleep and restoration like our ancestors enjoyed for 99 percent of human history. Sara shares some fascinating ways to get around these challenges, as well as her insights about the importance of exposure to daylight and nature vs nurture when it comes to whether you’re a night owl or an early bird. And we talk about how things could change with work and lifestyles to make it easier to live in accordance with our biological rhythms.
Show notes
3:10 – The definition of “upstates” and “downstates”
5:50 – The power of 6 slow, deep breaths per minute to balance the nervous system
9:05 – Watching out for mouth breathing and email apnea
13:30 – Different ways of breathing for different goals
16:35 – Body rhythms – what is heart rate variability and why is it so important?
21:05 – Are you naturally a morning or night person? Nature vs nurture
27:10 – The perfect storm that gets in the way of following our circadian rhythms
29:15 – The evolution of our pre-bedtime downstates – why it's important to check in with your cave mates
30:10 – The culture shift needed for more people to follow their circadian rhythms and improve their health
35:10 – Employers and communities can build downstates into daily work and life
38:15 – Choosing how we react to the world
41:00 – Being smarter about peak performance
45:09 – The science of pacing yourself for long-term productivity
49:42 – The science of light exposure for circadian rhythms
52:20 – Where to learn more about Sara Mednick’s research and writing
Links:
Sara Mednick’s website https://www.saramednick.com/ and her Twitter
Mednick’s recent book - The Power of the Downstate
Mednick’s book on the benefits of napping - Take a Nap! Change Your Life
The blue light blocking glasses recommended in Mednick’s book https://www.amazon.com/dp/B019C3O2UE?psc=1&ref=ppx_yo2ov_dt_b_product_details
An app for measuring heart rate variability - Elite HRV app https://elitehrv.com/
Thorne take-home Melatonin test