testing

Innovation for Safety

It is impossible to grasp all of the ways in which the pandemic is changing our way of life around the world. While most of the news coverage tracks the spread and death toll and the national/state government response to the virus, there is news on the efforts of local government, schools, business, and individuals to mobilize, survive and thrive in this new world.

Innovations in this time of disruption are inspired by our impulse to meet some basic human needs. We are searching for solutions; for our safety and security, our sense of belonging, agency (power), and expression (attention) to name a few. As with any innovation, some will be a flash in the pan, some will endure, evolve and be adapted into the fabric of our society. They are aimed at some basic need we have.

Safety and security

The need for safety and security is inescapable right now. The threat of infection and death, loss of loved ones, loss of our livelihood, and our entire way of life has us in it’s grip. While we stay at home, we search for new antidotes to our insecurity. This time of isolation has been a source of inspiration and reflection to some while it has led others to act out in protest, fearing the loss of livelihood more than death.

Following are a few examples of innovations inspired by our need for safety:

Thermometers

One development towards safety has been directed at an early warning system that is familiar to us all, the use of thermometers. By checking our temperature before we enter public locations and checking and sharing personal rises in temperature as they happen we may create a more effective safety net by identifying the pattern of infection.

Kinsa Health debuted it’s internet-connected thermometers eight years ago to track flu. The data the company is uploading for free to government and research scientists is helping pinpoint both where the next outbreak might occur and which communities are flattening the curve. They’re also proving that social distancing is working. – Here and Now – April 9, 2020

A Chinese startup “Rokid” is promoting COVID-19 detection glasses in U.S. : https://news.yahoo.com/chinese-startup-rokid-pitches-covid-070543421.html . Rokid’s T1 thermal glasses use an infrared sensor to detect the temperatures of up to 200 people within two minutes from up to three meters away. The devices carry a Qualcomm CPU, 12 megapixel camera and with hands free voice controls — to record live photos and videos.

How many tests do we need to feel safe? Labs around the world and in the US are exploring new methods for testing people suspected of infection. Some of these methods will evolve into new standards while some will prove inaccurate or impractical. Hospitals have adapted new ways of administering tests in an effort to reduce exposure by creating drive through testing. At the same time scientists are trying to lower barriers to testing. While supplies and personnel continue to be in too short supply, lacking a national effort at distribution, we must increase testing in order to feel safe to interact.

An average of 145,000 tests a day were carried out over the past week nationwide, or about a million a week, according to the COVID Tracking Project. Experts disagree about how many tests would be required to get a handle on the outbreak, but even the most conservative recommendations from former officials like Scott Gottlieb — head of the Food and Drug Administration until last year — call for at least doubling the current level of testing now and tripling it by the fall.
N BC News – April 1 7

While we continue to struggle with the necessary components of tests in the critical short run, researchers are moving forward with innovations that address the long term. Home tests are one of the approaches. While home tests run the risk of false positives due to contamination, there is an effort to improve them.

Saliva tests. A “Rutgers University scientist who oversaw the development of a saliva test to detect coronavirus said he believes this new way to collect patient samples could serve as a bridge to widespread national testing — modeled off the kits used by familiar commercial genealogical brands like Ancestry.com and 23 and Me.” – ABC News – April 16, 2020
Antibody testing. These tests determine if a person has had the virus and carries antibodies that protect them. A team in the UK is working on a home antibody test kit. A team in California has an antibody test that is administered in the lab. They hope to “expand manufacturing of its new coronavirus antibody test for use by the public within two months.” The same story describes other antibody tests under development…

Only one [antibody] test, produced by the Research Triangle Park, N.C., company Cellex, is already approved and being rolled out for use in select groups. Two others are awaiting FDA approval. One is from Aytu Biosciences/Orient Gene Biotech; the other is ScanWell Health/INNOVITA.
Six other tests have been approved in the U.S., but they are only for research or surveillance purposes. Other tests are still in development.
Five antibody tests have been approved for use in China. In addition, one is approved in Singapore and one in Korea.
Mercury News – April 12, 2020

Tracers – Tracking

The success of re-opening our economy will depend on our ongoing success at containment. One essential component will be the ability to track person-person contact when an infected person is identified. Tracing these associations and contacting and supporting people with information and resources will be essential to providing a safety net for movement.

Last night I searched for a job as a Tracer and found this information in the job description:

Contact Tracers will use a web-based client resource management (CRM) platform to reach out to contacts of patients diagnosed with COVID-19 with the goal of documenting a symptom check; referring contacts for testing according to established protocols; and providing them w/ quarantine guidelines
Indeed – searched on April 17th, 2020

Digital Tracking Approaches

Human tracing can be augmented by technology that helps an infected person remember and report contacts they have had. Here are a couple different approaches.

Tim Brookins, a Microsoft engineer in Fargo, tweaked the Bison Tracker to build Care-19, an anonymous location tracker. It had more than 10,000 downloads in its first 36 hours.
The app can serve as a record for people to remind them where they’ve been if they test positive, and to alert them to possible contacts with infected people. They can choose to share information with state health workers.
Bloomberg – April 11, 2020

Google and Apple have announced a joint effort to enable the use of Bluetooth technology to help governments and health agencies reduce the spread of the virus, with user privacy and security central to the design.

The system uses on-board radios on your device to transmit an anonymous ID over short ranges — using Bluetooth beaconing. Servers relay your last 14 days of rotating IDs to other devices, which search for a match. A match is determined based on a threshold of time spent and distance maintained between two devices.
If a match is found with another user that has told the system that they have tested positive, you are notified and can take steps to be tested and to self-quarantine.
Tech Crunch – April 10

As I continue to read about innovations, I intend to share them in the context of how they derive from and serve our most basic needs. While our instinct to meet these needs is active even in good times, the pandemic has us on high alert. We have to find new ways to meet familiar needs. Behavior is goal oriented. We act in order to fulfill our needs; sometimes for social good, sometimes for our selfish satisfaction. Sometimes pro-actively and sometimes reactively.

Next to safety and security, the need for belonging and affiliation is another need on high alert. In keeping with the directive of 6 foot social distance and safe at home, we are inclined to find ways to socialize and connect. In future posts I will describe some of the new ways that we have found to bridge this gap.

Slow path to recovery

Last weekend health experts and politicians warned that the week of April 6th would be the deadliest week of the pandemic. The week did meet those expectations and put the US close to the lead for deaths by country. It is a surprise that, on the heels of that week, one of the main headlines is “how quickly can we open for business?” While it is a valid question (who isn’t concerned for their long term economic future) it is still seems premature. Such is the still intangible nature of the spread of Covid-19 and the political and economic angles that are complicating rational and regional interventions.

As we watch and hope for a reduction of infection and death, there are a few variables that seem key:

Supplies of PPE and ventilators in hard his areas.
Supplies of tests and the materials required to support tests.
Health of health care workers.
Health of “essential workers” still engaged in business and public service.
Access to tests by health care works and “essential workers”.
Good data: accurate accounts of infection by locale and group (race, age, living conditions,

Without progress on these variables, we can’t begin economic recovery in a sustainable way. We will be cycling in and out of economic insecurity.

Testing – How? Who?

As we embark on the journey to reopen the economy, there are a few basic ingredients that most agree need to be addressed. The most notable is testing, for without testing, the spread vs elimination of the viral infection is just speculation. Granted we have indicators (symptoms, hospitalizations, deaths) of the spread but these numbers don’t help us with a pro-active plan. They are but indications of our failure.

As we contemplate the re-opening of business and social gatherings, testing will be one of the most important and often discussed issues. The scientific community has moved at miraculous speed to develop tests for infection and anti-bodies. With tests in hand, one would think that administering it would be fairly straightforward, but history and the current political climate shows us otherwise.

The first hurdle in the quest for widespread testing is the supply and distribution. There is no indication that the federal government will play a significant role in coordinating the supply of tests or the components that are required to do testing. so states will be left to compete with each other and will set their own protocols for administration. On March 6th Trump said:

“Anybody that needs a test, gets a test. They have the tests. And the tests are beautiful.” He said the same day: “Anybody that wants a test can get a test.”
ABCNews – April 11

Clearly Trump’s declaration wasn’t true in March and isn’t true today. While there are indications that (as of April 12th) there is an uptick in the number of tests, the shortage has created a train wreck of problems in the management of the disease. First of all, doctors and nurses have to treat patients as if they have covid-19 until they determine their diagnosis. This leads to an overuse of precious PPE and an overuse of precious hospital space. Without tests, hospitals cannot safely discharge patients. Without adequate tests for doctors and nurses, they are excluded from work creating an even larger shortage of staff.

Testing for an open economy – When?

This week’s news cycle will be full of speculation regarding when our economy will reopen for business. We can expect tension between those assuring us that relief is right around the corner and people with more sober assessments. The decision should be linked to the rate of infection and the availability tests. Based on the precautions taken thus far, you can expect that the approach will vary from state to state, county to county and city to city. The Trump administration may continue to act a cheerleader rather than make a commitment. Or in the worst case, they will disparage the recommendations of local governments.

Fortunately there true models of testing procedure, social engagement and business management in other countries who are further down this path. New Zealand, Iceland and South Korea are 3 examples. Despite the tendency for the president to discount the success of others, our state and municipal leaders will find these models useful as they chart their own path.

Jared Polis of Colorado has extended sheltering recommendations to April 26th. This date has been tagged as a point of reassessment more than a solid deadline. Pragmatically, he has placed the onus our success on the behavior of Coloradans.

“If there is any way to safely end it sooner, then we will,” Polis said. “And likewise if Coloradans aren’t staying at home and the numbers of the dead and dying continue to increase, then it could go longer.”
Denver Post – April 11th

Who will be tested? Will tests be administered strategically? Will guidelines be provided so that we make best use of a limited resource? These questions underline where the rubber (test) meets the road (people).

On the question of who will be tested there are some obvious gaps already. To date, essential workers and black americans are not being tested. These workers are exposed and exposing themselves to large numbers of people and they are dis proportionally minorities. Even if there is no overt bias against testing blacks and hispanics, the placement of testing sites mirrors the disparity in access to medical care, with a lack of availability in poor (typically black) neighborhoods. There are many reports of this disparity emerging:

On Monday Governor John Bel Edwards announced that a shocking 70% of deaths were among African Americans, despite making up only 33% of the state’s population.
The Guardian – April 8

In the days since I started writing this post, my prediction has been confirmed (though it doesn’t require omniscience to anticipate the broad strokes of Donald Trump)…

As states begin to cooperate and take the lead on strategies to reopen commerce and travel, the Trump administration has done an about face on the question of who is leading this response. The states’ initiative is assuring given the commitment to use data rather than “gut feelings” to bring the idling economy back into gear. The work has only begun of course but the reins are in the right hands with the governors. Even as the governors begin the work, Trump waves his hands and while reading names of his new “Opening the Country Council”. The list of almost 200 includes many who have been criticized by the president in the past. He will be “calling them” in the days to come.

Day 4-5 – Care for each other

In times of crisis people are motivated to watch out for themselves. We’re hardwired to survive. It’s a primal reaction for self preservation. When there is a threat, the instinct is intense.

On the other hand, humans have evolved to value community. This is the recognition that we are interdependent; my survival depends upon a group on whom I rely. Our willingness to work for the greater good operates in tandem with selfish motivations. The Dalai Lama calls this being “wise selfish”. Interdependence – the web of dependent links that we have created through social arrangements (business, government, formal and informal) is being put on display right now. One change leads to another. What other conclusion is there but, “we’re all in this together”.

I’m going to sidestep the debate about whether we are more selfish or community minded. Most of us exercise different instincts depending on prevalent conditions; including personal, generational, and situational. A crisis (especially of this scale) is a situation that calls people to step up and do their best for themselves AND their community. The crisis calls us, motivates us, to do our best work in the service of our community. The question is, are we addressing the most critical needs of people who are most critical to OUR survival?

https://www.wordhippo.com/what-is/another-word-for/community-minded.html

Healthcare on the brink

The people who are carrying this crisis at the moment are the health care workers and support staff on the front lines. Are we doing enough to support their work.? Since 9/11 we have legitimately paid homage to our firefighters and first responders. I doubt that much money has flowed to them but they have been honored as critical members of our community. Many of us have the same admiration and appreciation for the hospital staff but there is real concern that they are not getting the tangible resources that they deserve (to serve our community). Reports abound on this topic. We are risking the lives of our health care workers at this very moment. Losing them to the virus or to burnout is not only criminal but irrational.

“In the area of testing we are still not creating capacity and applying it to the people most in need. So we have health workers who are symptomatic who can’t get a test. They don’t know if they should go in or not go in. And yet we have lots of testing given to people who are not symptomatic.” – Bill Gates – March 24, 2020.

The essential missing resources are: 1. Adequate Staff, 2. Tests to determine when a staff member is infected, 3. Protective gear, 4. Ventilators, 5. Space for people who are infected (ICU and quarantine) and space for those who are not infected but require medical help.

The economy unraveling

Reading current economic forecasts, opinions vary, but the majority of economists describe an increasing drop in consumption related to unemployment related to sheltering for safety due to the increase in Covid-19 infection and death rates. While some sectors have remained in business and others may find ways to work safely, we are in the early stages of understanding what is safe. Testing, when it becomes widespread, will be a legitimate tool to chart a safe economic response. As reliable information (who is infected, how is it spreading, what regions require support) is available, I expect the creative and entrepreneurial instinct of people will find ways to provide service and build novel businesses. An economic rebound will rely on this creativity and on government to support their initiatives.

It is safe to say that the coming days will require sacrifice. No matter how long this pandemic persists, we will have to navigate the mysteries and perils of Covid infection while picking up the pieces of the world economy. While everyone agrees that we need to be strategic the way we manage the economy, there are already major disagreements on who comes first. Expect a repeat of the debate leading to the 2 trillion dollar bill that was just passed. Money for people, small business or corporations?

“This is why governments are now responding on a massive scale. In addition to the magnitude of policy response, governments need to get their focus right, targeting effectively to support the most vulnerable links in the economy. What has been announced so far is just the beginning–there will be much more to come.” – Forbes

Triage for the economy

The question is what are the most vulnerable links. Is it the unemployed, small business, healthcare (including preparation for repeated infections), or corporations? Will we assume that corporations are most important to economic recovery? Will we feel compelled to compensate them for their losses. Or should we support the poor, the middle class, small and medium sized business? All of us have lost, to greater or lesser degrees. How to we rebuild our community of services?

We can hope that conditions will not be as dire as I have described but it is safe to say that we will be facing a recovery, the likes we have not seen since the depression. Granted it will be different than the depression of the 30s but policies will need to be aimed at jobs, unemployment, housing, health care and other basic human services. It is safe to say that we won’t have as much “disposable” income (what a horrible term) on the other side of this crisis and that people will need support for housing, education, and health care to name a few.

As the dust settles and we emerge from our shelter in place, the question will remain – Can we resist selfish (individualistic) impulses and respond a community-minded fashion?