Don't open businesses until rapid reliable testing available everywhere

Don't open businesses until rapid reliable testing available everywhere
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The U.S. is on the verge of a mass reopening of businesses in many states. 

This mad rush, most notably led by Georgia’s Governor Brian Kemp (R), is fraught with the danger of new, uncontrollable surges of COVID-19. If the reopening is not done properly, there could well be tens of thousands of potentially avoidable pandemic deaths throughout the nation.

I had the opportunity recently to speak with the Mayors of Georgia’s two largest cities. Both have had long, mostly positive relations with the governor. But this inexplicably dangerous policy promoted by Kemp has left mayors frustrated and worried, with no obvious course of action other than to comply with a directive to open the shopping and recreational floodgates. 

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According to Atlanta’s Mayor Keisha Lance Bottoms, once the governor issued the directive that actually included some persistent public health guidelines, the population of Atlanta took the entire message to mean all clear, back to normal. She told me, “I was stunned to look at my City’s streets filled with people, so many without masks, not following physical separation guidelines and popping in an out of stores.”

And Augusta’s Mayor Hardie Davis, called the policies “an absolute train wreck”, endangering the health and well-being of his citizens. Both mayors were acutely aware of the terrifying fact that cases of COVID-19 and associated fatalities were far from under control. Neither could understand what was driving the governor to push so hard to resume “normal life” at this time for danger. Perhaps the governor hopes to regain favor with President TrumpDonald John TrumpUS reimposes UN sanctions on Iran amid increasing tensions Jeff Flake: Republicans 'should hold the same position' on SCOTUS vacancy as 2016 Trump supporters chant 'Fill that seat' at North Carolina rally MORE. And are race-based disparities somehow a factor?  Some 80 percent of hospitalized COVID-19 cases in Georgia are black, although they represent only 32 percent of the state’s total population.

Here’s the fundamental problem:  the absence of ubiquitous testing prior to reopening businesses puts any every American community at unacceptable risk if “back to work” directives are not predicated on robust testing and contact tracing.

It’s been three-plus months since it was apparent that we were facing the possibility of a deadly pandemic. Yet, the U.S. remains stuck in an inexplicable, sputtering process of perfecting both testing for presence of SARS-CoV-2 and serology tests to help establish if a person has developed antibodies and, presumably, immunity as a result of a previous infection. 

Strikingly, the FDA has been working with nearly 400 diagnostic test developers, as well as many serology test developers. All are seeking — some have obtained — Emergency Use Authorizations to allow such tests to be used for clinical or research purposes prior to fully establishing reliability. A vast number of these tests have already been proven to have high levels of false positives or false negatives. Either of such inaccurate results is misleading and dangerous.

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Right now, given the state of testing and the absence of an effective vaccine in the near term, we must implore all governors, starting with Brian Kemp, to rescind or reconsider  decisions to prematurely reopen their state’s businesses.  The fact is that in many states, cases of COVID-19 are still rising, or the curve has not flattened — and thousands are still dying from the horrific disease.  Some of the most vulnerable citizens are still suffering the biggest impact in terms of disease prevalence and fatalities.  

In fact, we still need to know the full prevalence of COVID-19 in order to understand the extensiveness of the outbreak.  Yes, good data early on would have allowed disease modelers to be much more accurate and more helpful to policymakers in terms of decision-making and response planning.

Regardless, we need to make an early and accurate clinical diagnosis on patients presenting to our health care symptoms, as well as being able to trace the contacts of those exposed to positively tested persons. 

And without widespread available and frequent testing, neither employees nor customers can be assured that businesses of all types can function safely. And if we see a steep rise in COVID-19 cases and deaths will governors pushing hard to “reopening” their state’s economies accept responsibility for this horrific outcome? Will they blame Donald Trump? Or will the master gas-lighter blame the governors who seem more than happy to follow,  lemming-like, the president right off the cliff?

Finally, even if and when testing is sufficiently available, Americans may still need to sustain public health measures such as the use of masks and gloves as appropriate, physical separation methods and avoiding crowds. This is clearly a major burden for all of us, but we must continue whatever needs to be done to manage the worst biologic threat to the world since the great Spanish Pandemic of 1918.

Irwin Redlener, M.D., is a professor of Health Policy and Management at Columbia University's Mailman School of Public Health. He is also director of the National Center for Disaster Preparedness at Columbia's Earth Institute. You can follow him on Twitter: @IrwinRedlenerMD.