Though testing is known to effectively reduce the risk of transmission, many experts are beginning to also associate more widespread testing with the statistic of greatest concern — survival from the disease.
The connection seems straightforward. Consider two countries with large outbreaks.
Furthermore, stories abound of sick people in the US showing up at doctors’ offices and hospital ERs, asking to be tested yet being sent away because no test is available or because they don’t fit the testing criteria — leading many to comment that the lack of testing is going to kill us all.
But we should be clear that more testing saves lives by preventing the next infection, not by allowing doctors to catch an individual patient earlier. The “treat early” paradigm works when there is an effective drug against the disease. Give antibiotics early for sepsis, you live; wait too long, you die.
The coronavirus, though, has no specific treatment. Indeed, the syndrome of a rapidly progressing lung failure that appears to kill COVID-infected persons is a familiar clinical condition. Many infections and exposures can cause the same problem; ICU specialists have been treating it for years.
So why does Korea, the poster child of testing, have so few deaths while Italy and its late-to-the-table testing program have so many? Is it only because more testing brings mild cases into the “infected” group, diluting the statistical impact of the handful of the very ill?
Which is probably bad news for those hoping that the United States, which is currently way, way behind in testing for coronavirus, can somehow test itself out of the mess.
In other words, South Korea has an outbreak among youngish, non-smoking women, whereas Italy’s disease is occurring among the old and the very old, many of whom are smokers. (We do not know the male-female breakdown of Italy’s cases).
These basic demographic distinctions explain the difference in death rates between these two hard-hit countries — as well as helping to explain why Seattle, with its nursing home outbreak, accounts for such a large proportion of US coronavirus deaths.
To understand exactly what is happening, we need daily case updates to include information about age and sex.
The blundering lack of an effective testing program in the US is an unconscionable failure and has led (and will lead) to more transmission of COVID-19.
But it is important to recognize that survival with the infection is a completely other matter, one that will require very different investments, training, and expertise.
The optimal program will have special beds to prevent bed sores, pharmacists with understanding of how medications are cleared differently in the elderly, and nurses familiar with frailty. Simply testing more and testing harder will not save the lives of the thousands of already infected Americans.
Better preparation might. And given the glaring differences in the outbreaks in South Korea and Italy, it is time to assemble an expert panel of geriatricians, social scientists, ICU specialists and others to sort out how best to protect and, when necessary, treat coronavirus in the elderly.