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White House Watch: Amid the Testing Haze, a Breakthrough

It has been a little more than two weeks since there has been a US Corona Virus Task Force briefing and Monday’s substitute, a presidential briefing, was intended to illustrate vast progress made in making virus testing widely available. The Rose Garden even had added to the background two large banners, proclaiming ‘America Leads the World in Testing.”

There was also a preview briefing by senior administration officials in which it was announced $11 billion is being turned over to the states specifically to be used for testing expenses. That money will be used to pay the commercial laboratories which will be doing much of the testing.

Adhering to a pattern that led to the cessation of the Task Force briefings. the day’s presidential briefing was full of the discordant atmospherics that can preoccupy the immediate news coverage. Trump wasn’t wearing a mask. He repeated his accusation that President Obama was guilty of an unspecified crime the likes of which has been never before seen. He argued with reporters again and finally cut the briefing Q&A short and stalked off.

Ignoring all that, there was nevertheless an important milestone reached that promises to change the entire character of the response so far to the virus. The long-awaited “antigen” test is on the way. It was just one paragraph in the president’s long presentation but it was arguably the most important factoid, the FDA’s emergency use authorisation of a third type of test. It’s an antigen test, one that is fast and easy enough to scale up to the millions a month, and perhaps millions a week at some point, that is necessary.

“On Friday, the FDA authorised coronavirus antigen tests, an alternative testing technology that can be much more readily manufactured,” Trump said. “Quidel Corporation, which makes this newly authorised point-of-care test, estimates that it will be able to manufacture 150,000 tests per day, immediately increasing to 300,000 tests per day within just a few weeks.”

The Task Force’s Deborah Birx had four times in the last two weeks said it is an antigen test that is the key to the massive scale that will allow a much safer re-opening of the economy than the haphazard re-openings now under way with most states.

For the technically inclined, the FDA said the “PCR” types of tests are either ones that can be processed in huge batches but which can take days to report results or the quick 15-minute variety being used at the White House and “hot spot” nursing  homes which can be done only one by one,

The other kind being done now are “serological tests that look for antibodies to the virus, which can help identify individuals who have developed an adaptive immune response,” the FDA said. Now, however, there is a third type of test, one that is not only fast but inexpensive, can be manufactured in very large quantities, and returns the results within minutes – the antigen test.

Again, production of the test materials is only now beginning and it will be more weeks before it is distributed, so despite all the Rose Garden hoopla, still more patience is required. The processing equipment is already used for other kinds of tests and is distributed throughout the country.

The new test will have arrived too late to provide the kind of screening capability the widely ignored White House guidelines say is necessary before the kind of re-openings – already under way- could be safely accomplished. Nine of the states relaxing the virus mitigation see increased virus cases every day. Another 29 are on a plateau of new cases. While not increasing the cases of new infections they aren’t declining either.

Only 15 states can claim the kind of improvements that the NIH’s Tony Fauci and Dr. Birx would agree justifies re-opening under medically approved conditions. Fauci is repeating that in his testimony to a Senate subcommittee Tuesday.

As in most other American responses to the virus, the antigen test is arriving later than would be ideal to save the maximum possible number of lives. Yet it has been approved for use and more of its kind will follow. Combined with the existing tests, the national Public Health Service and all the state health departments can soon begin the critically important “surveillance” phase, detecting the 20% to 40% of virus victims who show no symptoms yet can unknowingly spread the disease.

The four-star general in the Public Health Service’s commissioned corps, Brett Giroir, was at the president’s side and explained: “The largest fraction of (future testing) is really moving into surveillance, that is, testing those who are asymptomatic.  And when you do the numbers, this amount of testing on a state-to-state basis really is in the range that we need to accomplish all of that, certainly within the range that we need.”

Finally the primary tool needed to get ahead of the virus will be available.

“So if we see a blip on that weather radar, combined with CDC personnel in every single state, and with contact tracers, we really run to the fire, right?” Giroir went on. “And that’s when you detect, you trace, and you shut off that outbreak right when it starts.”

Colin Lambert

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