George Packer: We are living in a failed state
Everyone in our group agrees that most governments were unprepared for a pandemic and underestimated this one, and that health-care workers were imperiled by a shortage of protective gear and diagnostic-test kits. Without effective treatments to reduce frightening death rates or vaccines to protect against infection, societies have had to resort to simple measures to blunt the pandemic. Seven centuries ago, in The Decameron, Giovanni Boccaccio wrote about 10 fictional citizens of Florence who hunkered down in a forest to tell stories, while escaping a world largely shut down by a plague. Today’s distancing and sheltering are even more severe, but at least information technology is allowing people of varied expertise—including the 10 scientists in our group—to meet and think about how to put an end to the present dilemma.
After a very shaky start, the United States may finally have developed enough tests to diagnose most patients who come to hospitals for treatment of COVID-19 symptoms. Nevertheless, we believe that expanding current testing capacity remains a matter of extreme urgency—one that justifies a level of intense, coordinated work at a national, even international, scale that resembles the campaigns we associate with world wars. This means, at a minimum, marshaling the enormous physical and intellectual capacity of biomedical-research labs across the United States. The shortfall in testing isn’t just a problem for individual patients and their doctors. It is also holding back large-scale surveys of seemingly healthy populations, in workplaces and elsewhere, and scientific research into fundamental properties of the virus and the disease it causes. The ability of states and communities to reopen without risking calamity depends on a rapid acceleration of scientific discovery.
With the number of new cases declining in many places, the purposes and required scale of testing have shifted. While doctors in hospitals still need to make diagnoses of individual patients, there is an escalating need to test much larger groups repeatedly—to track the spread of the virus as restrictions ease—and to carry out population-based studies that will reveal more about how this virus behaves.
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Testing for the virus is based on detection of the coronavirus’s unique RNA sequences in swabs of the nose or throat or in saliva. Most tests in the United States are currently performed in large reference laboratories using automated commercial instruments that can each process only 1,000 to 3,000 tests a day, yielding the current national total of about 150,000 tests a day. While that number could double over the next few months, the methods now in use are unlikely to yield the level of testing—in the range of 2 million tests or more a day—necessary to monitor large populations and conduct ambitious experiments.