Thursday, October 8, 2020

Dr. Osterholm's Take on the White House COVID-19 Outbreak

White House covid-19 protection plan - like secret service agents with squirt guns to protect the president against an assassin 


But let me do take a step backward and say, if you were on this podcast as early as July, you heard me say that I thought that the testing program put in place at the White House to protect the president and other senior leadership was not a plan at all, and in fact it reminded me of providing all the secret service agents with squirt guns and expect them to protect the president against an assassin.

 Let me just say a couple of comments about testing and what was done at the White House. This is one of those examples where there was a mindset you can test your way into safety, i.e. test your way out of the pandemic. Simply not possible to do! Testing is always going to be after the fact. It is going to be a situation that even if it is highly reliable it doesn’t protect you from being exposed, all it does is tell you that you were.   And now some people would say but if I know that I am infected then I can take steps to reduce my risk of transmitting to others, and that’s a great idea. But let just us be honest, first of all, what test we are talking about, these point of care tests are often coming up with more than 30 to 50 percent false negatives, meaning  you are missing people who are positive, and so if you are trying to xxx yourself  that is one thing.

 Second, I would acknowledge to those who promote this new testing approach or strategy for containment as they call it, this would help, but with one caveat. As we just saw what happened at the White House -  will people actually use this information to actually change their behavior so that they do not transmit. And we have seen a number of examples of people who were contacts of cases, who were cases, who did not abide by what we would hope would have been risk reduction behavior. So I am not suggesting that’s widespread in the population, but when you have almost a third of the public who does not believe this pandemic is real. You have a number of people experiencing pandemic fatigue, they think this is too much I do not want to deal with it, and you have a number of people who are bubbled in today because of their high risk of serious disease if they get infected, that does not leave a lot of people left in the middle necessarily who are going to be impacted by this kind of testing.

And so, the last piece is of this point in care testing, we are going to show very shortly that there is actually a very important number of false positives, and wait until people are taking these rapid tests and call false positives only to be confirmed by PCR that they were not positive at all, and see how long that is going to last, and watch that spread around as a challenge why not to take them, because the next thing you know you have to be worked up, you know you got everybody upset and concerned and it wasn’t even true positive.

 So, I just want to come back to this issue. I would support any kind of testing that might help actually reduce the number of cases. And I think the White House experience really is that. It shows you the challenges of using testing in regards to behavior change and what it means and what it does. So yes, it can have some impact, but it is not going to have this major containment strategy outcome. And I am sorry that the White House situation ever occurred, but I think it is illustrative of the point that we are making, and again false positives and false negatives point of care tests are occurring much, much more frequently than people realize and they will dramatically impact even among that limited number of people who are even willing to consider taking these on a routine basis that they ultimately would do.        

 Now what I have a hard time with is that no one addressed that situation at the White House, even though it was raised with them at numerus occasions that this was a terribly inadequate plan. Keeping in mind that, this is what I have been basically saying, as many of you know, it is emblematic of we do not have a national plan for responding to this pandemic, so why should we be surprised if we don’t have a White House protection plan? And so what this episode should tell us is that we desperately need for a national plan how to respond and how we bring the 50 states together, recognizing their diverse differences whether they be urban or rural, whether they be west, south, north, east, whatever. But we need a comprehensive plan. We don’t have that. People will say we do but I defy anyone to come forward and tell you what our plan is.