CareTalk Podcast – Testing, Testing 2021

Testing was a big problem at the start of the pandemic. Did we fix it? As the world grapples with the Delta variant, John and David argue about whether or not testing has gotten more or less important. 

David Williams:

Welcome to Care Talk. America’s home for incisive debate about healthcare, business, and policy. I’m David Williams, president of Health Business Group.

John Driscoll:

And I’m John Driscoll, the CEO of CareCentrix

David Williams:

John, I thought today’s topic is so boring. COVID testing is so 2020. Why are we talking about it here in late 2021?

John Driscoll:

Can you stop trying to avoid the hard stuff, David? I mean, we have Delta, we’ve got COVID, we’ve got a problem. And we still have not got our arms around testing. Any antivirus strategy has to have three components. You have to have vaccinations, they’re never going to be 100%. You have to have testing. So, you know the problem, you’ve got where it is, how big it is, how rapidly it’s growing. And you have to have therapeutics, those therapies that can help you either lighten or eliminate the symptoms and the risks of getting any virus that’s causing, making people sick. I mean, come on, we’ve got Delta. Aren’t you going to, what’s your strategy?

David Williams:

Yeah, no, John, my strategy is just to get you revved up so that we can talk about what matters, which today is testing. So John, President Biden’s latest plan to address the pandemic, emphasizes testing a lot. What is he actually pushing for too?

John Driscoll:

You have to know where the enemy is and where it’s attacking you. So by going out and pushing the defense production act, this sort of vague, but very powerful tool that the federal government has to compel industry to actually create a supply chain. Because if you remember, David, once the CDC bungled the testing for the US and the White House bungled the priority under the Trump administration to get testing. And then they declared that, like so many other things, that the war was over, and everyone could go home, that we already had all the tests we needed.

And then they argued that we shouldn’t test at all, that testing was jumbled and the vaccines came so quickly. We thought we wouldn’t have to unpack that. And actually, companies went so far as to destroy some of their own stockpiles, like Abbott of their testing materials. It turns out to be, it’s sort of an untimely interval just before Delta exploded, and people needed a lot more Abbott tests. The defense production act allows the federal government to demand that the supply chain stay open. The federal government’s going to require the tests be free, and the test be available at 10,000 pharmacies. I mean, it’s actually exactly the right strategy for a year ago, and hopefully we’ll be able to pull it together effectively right now.

David Williams:

John, I remember now back in 2021, we were saying that the Trump administration didn’t want testing because if you tested, then that would show there was a virus and somehow create the number of cases based on how many people were tested. I forgot about that logic. One of the things that Biden is doing in addition to some of this free testing at the pharmacies and purchasing rapid tests for community health centers and food banks, is actually to lean on some of the retailers to say, to offer these at-home tests at cost, not for the next three months, and also making Medicaid pay for at-home tests, which before had been uneven. So there’s some specific things in there now, as you said, this was a big problem at the start of the pandemic. And I thought-

John Driscoll:

But most importantly, David, most importantly, it feels like we’ve now got this air, land, and sea solution to attack this virus. We’ve got the vaccines, which work very well, better than we expected, booster, no booster. The number of people who were getting sick, dying and hospitalized is in the high 90s for those who are unvaccinated, and in the low single digits for those who are, and that’s a really good sign for the vaccines, but there will be breakthrough infections as there always are. We’ve got, we’re fast surging that testing capacity and making it available. So we’ll at least know, I mean, I don’t know how you manage what, you can’t measure, how many people are sick.

And finally, the therapeutics, the monoclonal antibodies that once you test and test positive, if you get that monoclonal antibody infusion, soon after you’re identified as going COVID hot, even with Delta, it’s severely, it reverses a lot of the symptoms and reverses a lot of the illness. And now, because of the education around therapeutics, I know you would just want to talk about testing, but it all matters. People can get better fast, but it, each one of those components depends on testing, which gives us the information we need to manage this public health crisis.

David Williams:

John, one of the things about testing now compared with a year ago is we need the information faster. Now a year ago was kind of a joke. People would-

John Driscoll:

We always needed, I mean, stop. We always needed the information faster, but you keep defending the old administration. First, they didn’t need testing. Then they declared that we had more testing than we needed. I mean, President Trump had a machine on the south lawn, didn’t even work. And then we declared the testing war over. And then it was anti-testing; each one of these strategies has a critical piece in terms of defeating this virus. But you can’t manage this virus if you don’t know where it is, and you can’t even provide a life-saving and changing drug without knowing that people are sick.

David Williams:

Well, John, let me, you paint me into the corner there as a supporter of the old regime, which I don’t think it’s a fair label. Nonetheless, let me say, let me explain why I was talking about needing things faster now. So the thing, why we need it faster is because Delta moves faster. So it’s not enough to say, “Hey, I might’ve had an exposure. I’m going to quarantine.” People aren’t doing that now.

What’s happening now is you need to move quickly because the Delta variant is going to move faster by the time, even if you have the three-day turnaround, it’s probably already moved beyond that. And then just thinking about some of the logistics, if you want to travel. If you want to go on an international trip, you need to be tested within three days of travel, which means you better get the results back. And with the cruise, it’s two days before. So people are really hustling in order to just to get the logistics of this done right. And, just because the cruise line says, you need it two days in advance doesn’t mean you’re going to get the test turned around that fast. So it adds some extra stress.

John Driscoll:

Well, I mean, while you’re out cruising around, let’s put some numbers around this. Now, a year ago, we said that with the pandemic going, we needed to have the capacity and the surge capacity to get to three to five million tests per day. And that was, we were laughed out of the argument. It was the testing for American Group, I’m involved in, Rockefeller Foundation. Where you went to school, Harvard, all the smarty pants, people, and they-

David Williams:

Oh, yeah.

John Driscoll:

The majority of clinicians and public health leaders, didn’t focus on that. Our national capacity went down to 1.2 million; it’s actually now up to 1.2 million a day. And we’re going to surge to two million. I think we need more capacity than that. And I’m really excited that the President is focused on it. And I think we need more rapid tests. We need the ability to do rapid PCR tests, not just to Antigen because of the accuracy of those PCR tests.

I mean, the statistics are pretty clear. Now, those school districts that are testing all the time, whether they’re in Tulsa, Oklahoma, or some of the counties in California, they’re only losing, they’re identifying and quarantining less than 10% of their population. There’re some school districts in Georgia where they’re not testing at all. And they’ve had to shut down the entire district because schools open probably a second week in August. Testing really can keep our schools open. It can keep our economy open and we should be doing pooled and rapid PCR testing far more than we are right now.

David Williams:

Which I know you’re not a fan of my travels, but I had a couple of international trips lately would showed me something about testing. When I went to Europe, I paid-

John Driscoll:

You’re probably bringing the darn thing back with you. I mean, have you ever thought about this David?

David Williams:

I did fly, I was flying that Delta airlines variant, so maybe it has, maybe they’re carrying it. I don’t know, but John, no, when I went to Europe, I paid $160 for a rapid antibody test. And then when I came back and I was in Sweden. Sweden is expensive for everything, right? Except the same exact test there was $45, and I got it right away. And they were very helpful in getting it done. And when I went to Canada, I had to pay, there were four of us that went. I got it from the CIC Health here in Boston. I was able to get tests for $80. So that was great PCR tests within 24 hours. But then they have very limited hours. So for one of my kids, who’s in school, he had to pay $200. And yeah, I got a PCR test in 15 minutes. It was like hundreds and hundreds of dollars just to go to Canada. Now, the good thing was there was no line at the border because most people don’t want to shell out hundreds of dollars.

John Driscoll:

Most people wouldn’t pay hundreds of dollars to go to Canada.

David Williams:

Yeah.

John Driscoll:

That’s right. But I actually think the country of your wife’s family, you should be willing to pay that 200 bucks to prove that you’re safe.

David Williams:

Yeah. Yeah. They ask you, when you go in into Canada, they still, they ask you mostly about the virus and they actually have a good arrival app. They ask you about that, but they can’t help, but ask. And also about if you have any weapon with you as well. That’s the other question. So do you happen to be carrying a virus or you carrying something else? I don’t want to get [crosstalk 00:10:09]-

John Driscoll:

Let’s focus on the test.

David Williams:

They have a tent there to John, which they’ll pull you into and test you right there on the spot if needed. So, and they keep calling me.

John Driscoll:

Oh, I probably, am the reason and I kept telling them that you were carrying on.

David Williams:

Yeah, yeah. Now I don’t think that. Now, John, you’re big on the at-home stuff. It’s supposed to be at home. I don’t know why you don’t like hospitals. Everybody else likes hospitals and you want people to be at home. What’s the story with-

John Driscoll:

Nobody likes hospitals, stop. I mean, I think the one thing that I mean, COVID more than anything, and then we can… The thing that CareCentrix does with the mission to heal and age at home, we’re creating alternatives and what you’re going to find, is that more and more technology is going to be a DIY test. I mean, you can do it yourself. You’re going to see more and more care moved to the home because sniffs in hospitals are more dangerous every day. And I think that at a time of COVID, I think we can feel very personally the risk of spending time around a bunch of other sick people.

David Williams:

Well, the home is where the action is, John. And I would say, even with some of these tests that you can test at home. Now you need to test fairly frequently because you can get some false positives and false negatives that you want to avoid. But these tests are inherently cheaper and they’re less risky. I mean, I know somebody-

John Driscoll:

But make distinction-

David Williams:

All right.

John Driscoll:

I think that the Antigen tests are slightly less accurate. You have to do, they’re really cheap, but you have to take a lot more of them in order to develop a trend line. I think the PCR test, the gold standard, is really highly accurate, but you need to test it after exposure. There’s a three to five day gestation periods, sometimes even longer, where the virus is going to develop that antibody response so that your body starts to react so that you’ll actually register. So just one PCR test, even though it’s more accurate, doesn’t necessarily get you out of Dodge. But more and more people doing pool testing where it takes two-three minutes and you spit into a sample or it measures waste in the water and viral load there. We can test by neighborhood, by class, and then the individual tests we can start to test by community and individual. I mean, the tests are accurate. You just need to know what test, you need to know what you’re doing.

David Williams:

Well, I don’t know what I’m doing. So I’m not worried about it either way, but they do have this concept, John, of having a supervised test. So you can actually, by tele-health you can actually have somebody to take a look and to see if you’re actually doing your test properly. And they’ll look at the result and verify it. And that can mean that people don’t have to go in to a medical facility and risk getting infected. Let’s face it. If you’re going to get tested and other people are going to get tested, you might get the virus right then and there.

John Driscoll:

From just standing in line. No, you’re absolutely right. And you’re going to, and we’re going to see more and more diagnostics moved to the home for exactly that reason.

David Williams:

Sounds good, John. So once you’re next-

John Driscoll:

So, David, I was just wondering, where are you going to travel next?

David Williams:

No, my next trip is going to be to Washington DC. And actually, there’s no requirement for being tested to travel domestically, but I’m going to visit some older relatives who lived there. And I think I actually will do a test, a self-test, before going down there. And the other question I had, John, was… No, but go ahead. I see you’re itching to ask me a follow-up question, sir.

John Driscoll:

Well, just wondering, what do you think of Biden’s vaccine and testing mandate? Because if you don’t get further vaccine for those employers over a 100 and he’s requiring a lot more testing, what do you think of that? I mean, it’s a testing mandate-

David Williams:

Yeah.

John Driscoll:

… people talked with the vaccine mandate, you’re in favor of mandates.

David Williams:

I’m in favor of a vaccine. I’m in favor of, I think Biden did a good job of trying to persuade people to take the vaccine. He made the vaccine available, easy to do. And then, you get to a certain point and people are resisting. And so everyone wants a philosopher, until it turns out, “Hey, you need to actually be vaccinated in order to do your job.” So in order to keep your job. So I think the mandate is a good idea, and it has to have some teeth in it. In this case, it’s about getting tested weekly.

Now getting tested is not exactly a punishment. It’s a good idea to do it. Maybe you should make people get tested every day and make them pay for it. The thing is, that does rub up against some other issues. If an employer is requiring something, then the employer is probably going to actually have to pay for it and pay for the time that someone’s going to have it. But I think you could implement, I’d like to see it, maybe they have to pay a higher health insurance premium if they’re not vaccinated, if that’s going to be, if you can have an exemption. Religious or not medical, but religious.

John Driscoll:

I think that’s going to happen. I mean, we’re definitely going to do that at our company. And I think, it shows up in the data your unvaccinated people are more likely to get sick. When they get sick, it’s going to cost these self-insured employers more. You’re going to find that that’s more of a thing.

David Williams:

Yeah. And I think, John, you see, I noticed these religious exemptions are sort of being stretched. I’m not sure how many religions have legitimate vaccine exclusion. If you take everything in common, I don’t think anything’s written specifically about vaccines in the Bible or in the founding books of other religions.

John Driscoll:

No, but in the center of the Bible belt in Mississippi, they do not allow religious exemptions for avoiding the vaccine for the Measles, Mumps, Rubella. And so it’s interesting that the governor of Mississippi is saying, this is anti-constitutional, while he’s got a tighter mandate on most vaccines in most New England.

David Williams:

Well, John, I would like to see, to sort of summarize, I’d like to see testing be very widely available, easy to do. I’m very used to navigating the health system. I’m used to paying through the nose, so to speak. I don’t think they allow payment through the nose. Actually, you could probably have a test where you have payment through the nose and it’s taking your sample at the same time. We have to patent that one.

John Driscoll:

Stop.

David Williams:

But still-

John Driscoll:

I’m done.

David Williams:

Okay. But I would like to see testing be widely available. I’d like to see it be free. I think Biden’s on the right track. I want to see more testing and I want you to see the end of this virus, if at all possible.

John Driscoll:

We have to know where the virus is people, their families, individuals. You got to know whether your kids have it. If we know where it is, we can cure it, contain it and kill it.

David Williams:

Those are the three Cs, John? Cure, contain, and kill. All right. I think we’ve come to the end of the line. Well, that’s it for yet another edition of Care Talk. I’m David Williams, president of Health Business Group.

John Driscoll:

And I’m John Driscoll, the CEO of CareCentrix. If you liked what you heard or you didn’t, we’d still like you to subscribe. (silence)