Why is America fighting a 2020 pandemic with 1918 medicine?


As the old saying goes, generals always fight the last war.  

We’re doing it again. 

America is fighting COVID-19 the same way it fought the 1918 Spanish Flu.

Just like in 1918, America has risky face-to-face doctor visits. Like in 1918, America has masks, quarantines, and business closures. 

Just like in 1918, America was slow to respond. In Philadelphia, public-health director Wilmer Krusen promised — before a single civilian had died — to “confine this disease to its present limits. In this we are sure to be successful.” As the death toll grew, he repeatedly reassured the public that “the disease has about reached its crest. The situation is well in hand.”

It wasn’t well in hand then, and it isn’t now. It’s 2020. Why hasn’t technology come to the rescue?

In large part, because we’re relying on Artificial Intelligence-based pandemic management, fueled by badly flawed outpatient data. Truly accurate testing, so fundamental to dealing with a pandemic, came too late to be of real help.

The data comes from two types of COVID-19 tests. The first type is to learn if a patient carries COVID-19 RNA. The initial RNA test kits from the CDC did not work. In its place came more nasal swab testing kits, this time without conventional FDA approval or professional level instruction in their use. This is an important point because with a nasal swab, it’s easy to miss the RNA. Don’t swab deep enough? You’ll miss it. If the patient has a lot of mucus and it coats the swab? You’ll miss it. Every physician knows there is an unacceptably high error rate with our current nasal swab testing, yet America continues to base a lot of its policy on this test. 

The second type of test is to learn if a patient carries specific COVID-19 antibodies — and, presumably, immunity. But it takes nearly three weeks for those antibodies to be detectable in the bloodstream. The CDC data doesn’t account for this. Worse, the two flawed data sources were mixed together by CDC and many state health departments in their reporting under a single label of “positive tests.”

As doctors, we find this level of incompetence almost impossible to believe. It is akin to an experienced cardiologist confusing a patient’s blood pressure for their pulse rate. They both convey something about your heart but they are not the same thing. 

Let us state this as bluntly as we know how: mixing two flawed data sources to drive AI-based pandemic management is a disaster.

Instead of continuing down a path that we can be sure leads us nowhere, we need a way out.

The good news? We don’t have to look far. Basing decisions on solid, clinical diagnosis and doctoring will work a lot better than acting on flawed data. But, in this era of social distancing, how do we make that safer for everyone, and how do we make that more scalable?

Telemedicine can do both. Nearly 70 percent of Americans today have smartphones with great cameras, and nearly all laptops sold today have built-in webcams. Medical practices across the country have already built solid basic telemedicine capabilities that make diagnoses more safe, convenient and scalable. That’s a foundation America can build on as a bulwark against a likely second or third wave. 

In our telemedicine practice, we use a common-sense screening algorithm, coupled with management protocols to isolate infected patients and protect their coworkers. Our results prove it works. For example, we saw a patient who clearly had all the symptoms and signs of coronavirus, but his RNA tests said he didn’t. Trusting our instincts, we quarantined him. He got better in 10 days and sure enough, three weeks later the COVID-19 antibodies showed up in his bloodstream. 

Combining clinical medicine with proven technology is a practical idea. It works. Any workplace and any state can adopt it quickly and start making more effective policy decisions almost immediately.

Let’s stop fighting the last war, and let’s start winning this one.

Dr. Dan Carlin is the Founder & CEO of two telemedicine companies; WorldClinic and JobSiteCare. Dr. William Lang is the Medical Director of WorldClinic & former Director of the White House Medical Unit and Deputy Physician to the President and Associate Chief Medical Officer of the Department of Homeland Security.