Testing Insanity

We can’t succeed without a comprehensive national program for COVID testing

“Testing Insanity” – Bill Gates, Global Pubic Square

What exactly was Bill Gates trying to communicate when Fareed Zakaria interviewed him recently on his CNN GPS show? Zakaria is a serious interviewer who pries information out of his guests. And Gates, well what can you say about a guy who built the largest personal fortune in the world (until Jeff Bezos came along) by founding and building Microsoft into one of the largest corporations in the world, and then went on to start the Bill & Melinda Gates Foundation with assets in excess of $36 billion (yes, that’s “B” like in billion)?

Bill and his wife, Melinda Gates,have led the funding and technical effort to eradicate malaria globally. From funding basic R&D, to distributing millions of mosquito nets, to innumerable other initiatives, the Gates Foundation has been at the forefront of improving humanity’s health on every continent. The Gates Foundation has also played a significant role in investigating the COVID-19 virus, how it is transmitted, how it can be controlled/contained, and funding for basic vaccine R&D, as well as funding for a rapid manufacturing process while the vaccine candidates are still in clinical trials to the tune of billions of dollars already.

Even more impressively, Bill Gates gave a TED Talk in 2015 where he predicted a coronavirus pandemic was coming, for which he said we weren’t prepared which immediately needed to change.

He was right.

When asked about that amazing prediction, Gates explained that he was aware of the global health conditions that would likely give rise to a cross species virus, and since the SARS epidemic originated in China’s wet markets and was in the coronavirus family, he figured there was a good chance the next mass infection could similarly originate from an Asian cross-species infection (which it did).

Smart people often make good guesses because they have so much information at their disposal. It’s more like making a calculated judgment than the way you or I might throw out a similarly portentous “guess.” As Gates later explained, if you looked at all the data, it was an “obvious” conclusion for him. Right. And of the approximately 7 billion people on the planet at the time of his “guess,” He was one of the few who saw it all coming, predicted it would be a virus from the coronavirus family, and understood that we were critically unprepared for it. As I write this column there are more than 775,000 deaths globally and more than 22 million cases from COVID-19. Wow, that is one very smart, prescient guy!

So… what did he mean when he said only America has this “testing insanity”? He was referring generally to the total absence of a national program to utilize testing as a key weapon in containing the virus. More specifically, he was saying it was “crazy” to pay billions of dollars (as we currently do) for test results that come back more than three days after being administered. He said those tests are practically worthless, so we should say to the labs, “We won’t pay if you can’t get us the results within three days.” To put a finer point on that, he said the residual value of such a test result is less than 20 percent and it drops off to zero quickly thereafter. What we’ve created, he observed, is precisely the exact wrong incentive for the testing labs since they had every reason to drag getting the test results back so they can optimize their respective work flows and profitability. He said we shouldn’t pay anything for any test returned in more than three days. That way, the private sector would be incentivized to get timely data back to the public because their economic interests would be aligned with the public’s health interests.

If you don’t receive the results in a timely fashion, you are of limited value for contact tracing; contact tracing is really the second biggest point concerning testing. Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, tells us we have to flatten the curve of infection to the point where contact tracing is meaningful (defined as getting below 5 percent infection rate on random testing). If you have thousands of new infections per day, and it takes a week to get test results back, it means you can’t effectively trace a meaningful percentage down. You’re requiring those contact tracers to track down many tens of thousands of contacts. It isn’t possible when the pandemic is raging at this level.

Here’s something positive to think about: we actually can flatten the curve by simply wearing masks every time we leave our homes, observing proper social distancing, and practicing good personal hygiene. Frankly, that isn’t a lot to ask knowing that it has worked in every developed country in the world that tried it. Failing to wear masks has provoked rapid social contagion in every country foolish enough to try it – think Brazil and the good ole USA. Social distancing is similarly part of the effective way to flatten the curve, and it is rather shocking that young people particularly haven’t been willing to give up their “night out” in order to bring this virus under control.

I hope people realize that we could be going back to a “new normal” in as little as eight weeks if we just flattened the curve. Is that a lot to ask to end this nightmare? Come on folks, you don’t have to be as smart as Bill Gates to know the answer to that question. And you don’t have to be as smart as Bill Gates to know that the way we execute and pay for testing in the absence of a thoughtful national policy is insane. Not using a smart testing regime to unlock our ability to do contact tracing is insane. Letting this pandemic drag on here while the rest of the world has already begun to reach the “new normal” is insane. Yes Bill, this is “insane.” Thanks for pointing it out.