Under the state of disaster declared on Monday, the Victorian government says anyone in self-isolation must stay home all day every day.
Each day about 20,000 coronavirus tests are done. This means tens of thousands of Victorians could be compelled to stay home 24 hours a day for three days. That’s a lot to ask of anyone, let alone essential workers who’ll miss out on pay, people whose mental health is fraying, people with kids.
The government says lab turnaround times are averaging about two to three days. Bill Gates has said tests that take longer than two days to come back are “a complete waste” and pathology companies should not be paid for them.
Faster testing won’t just mean you’ll get your result sooner — it will encourage people to get tested.
Expected delays in receiving results means people will seek a test only when they feel truly ill. Delays create uncertainty for the chief medical officer about who is sick, where, and what policies are working.
Ending the pandemic sooner
If the government wants to manage the pandemic it needs timely and complete information. A paper published in the Lancet in July found the most important thing government can do to improve contact tracing is substantially faster testing.
“Reducing the testing delay — i.e. shortening the time between symptom onset and a positive test result, assuming immediate isolation — is the most important factor for improving contact tracing effectiveness,” the authors from European universities concluded.
“Once testing delay becomes three days or longer, even perfect contact tracing (i.e. 100% testing and tracing coverage with no tracing delay) cannot bring [the reproduction value] values below one.”
And as we know, with a reproductive value over one, the virus keeps growing.
It’s not impossible. But it’s expensive
Since I began advocating for a 24-hour results guarantee, most of the pusbback is about being polite and undemanding of the government at this difficult time.
Nobody has a public health argument in favour of long testing delays, and nobody rejects the idea they discourage people from getting tested.
In this era of $70 billion for JobKeeper, being polite is a preposterous argument. We will support an economy devastated by coronavirus. We must therefore be willing to throw more money at fighting it on the front line.
The reason we’re not spending more to speed up results is we have low expectations. People are used to waiting for lab results. That’s what psychologists call “anchoring” — waiting a week for lab results seems normal. But that’s not longer a relevant anchor. We’re in a health emergency. A better anchor might be the waiting times that doctors expect when they order a test for a hospital inpatient — generally results are back within an hour or two. Looked at that way, 24 hours is generous.
Once we open the floodgates to spending more on the problem, there are many ways to solve it.
We must expand laboratory capacity urgently. We should locate testing sites near laboratories and vice versa. We should run labs 24 hours a day. And if our labs are truly backed up, we should run hourly charter planes full of swabs to laboratories in Perth and Adelaide, Sydney and Brisbane, Wellington and Auckland — perhaps even Bangkok, Singapore and KL. Use ADF planes if need be.
If we are only willing to do testing on the cheap, it will be slow. As soon as we make an ironclad commitment to speed, we will find the resources.
Note this also. Labs might not be the choke point. Look at this quote provided to me by a Department of Health and Human Services spokesperson:
Lab turnaround times are currently averaging around two to three days but there may be cases where this is longer. Positive results are prioritised and generally communicated to the patient within 24 hours.
If they can send a positive result within 24 hours, why not a negative one? It suggests some delays are actually about communicating the result. Bureaucratic and process delays rather than physical delays. Eliminating those must be an urgent priority.
The government is understood to be paying $100 a test. At 20,000 tests a day, that’s just $2 million a day. Given the cost to the economy is in the hundreds of millions every day — not only during the pandemic but for months and years afterwards — I can’t see why that’s the limit of our testing budget.
If I were in charge I’d design a testing contract with a sliding scale where companies get incentives for being fast. Something like this:
- $500 if tests are returned within four hours
- $300 for within 12 hours
- $100 for within 24 hours
- $50 for within 48 hours
- $0 for within 72 hours
- -$50 for within four days
- -$100 for within five days
- -$200 for after five days.
The government has placed a huge burden on its citizens: stay home, wear masks, close your business, in many cases lose your livelihood. We bear these burdens stoically. But duty runs two ways. It’s fair to ask more of our government. It is fair to demand a 24-hour results guarantee.
Should the government enforce faster testing in Victoria? Let us know your thoughts by writing to letters@crikey.com.au. Please include your full name to be considered for publication in Crikey’s Your Say column.
Great to see some suggestions. However, why pay via a contract rate, how about just nationalise them? I would like to know if there are really enough technicians to resource up but at least through nationalisation you can forget about cost per test model and focus on throughput. And, how about we get testing done by NZ – just a little closer than singapore and I’m guessing would they would have capacity. Another suggestion, is mass testing – why wait for people to be symptomatic and why wait for a letter(!!) to arrive to tell you that the contact (who has already told you) is a contact and you need to get tested. Yes, I said letter!!!. So if it takes 5 days to become symptomatic, 3 days for results, and 1 day for contact identification, 2 days tracing and then 1 day letter printing, plus 3-5 days for a piece of paper to arrive in a mailbox (assuming you check it because who actually gets mail these days). Then 15-17 days has potentially elapsed before the contact gets tested from when the first contact was infected. I’m not sure what the R is on that but it is not 1. And, that kind of process for the sake of process is what will undermine responsiveness.
On the testing front, my personal experience and my family’s is from 24 – 40 hours turnaround for negative tests.
Test test test by all means, but lets spell out a few things out.
We Victorians are all under “house arrest”, gagged from speaking, prevented from shopping from within 5 ks from where we live, we now need to carry a document that verifies that we have been tested and all for a virus that The Dept Health Surveillance 14 June reports – 36 influenza deaths which is more than deaths from Covid-19.
Is there something rotten in the state of “Denmark?”
If you are gagged from speaking, who wrote this dodgy comment in your name?
Chimpo – I have asked a valid question that presently sits on the lips of many Victorians and most other Australians. The “gagging” is a symbolic term for the mask. Have have another banana.
If “gagged from speaking” is anti-mask rhetoric, you really need to come up with a term that doesn’t imply that you are being, err, gagged from speaking and not allowed to talk the issues that you appear to be talking about…
D2Ands
You do have a genuine question or two in there, about the comparison with ordinary flu and the necessity for masks and stage 4. But “house arrest”, and gagged from speaking” do not help anyone to get at those questions. I for one had no idea what gagging referred to. I’ll let the reference to Hamlet pass, though as far as I know no-one is accusing Andrews of having murdered his predecessor.
It is misleading to compare COVID-19 with the flu as there is a widely-used vaccination for flu which reduced its speed and damage significantly.
What is more important is the information that will only emerge slowly over time about the ongoing morbidities caused by COVID-19: kidney, heart and lung damage, “brain fog” have all been reported in scientific literature, in the media (especially in the US) and, of course, on social media.
The fact is, we just don’t know how serious COVID-19 is.
Yes. Thankyou for that clarification KeithT
Keith1 – Of course he has n’t murdered his predecessor, please. But if he continues to lock down the entire economy of Victoria the damage done to millions could be something akin to Pol Pot.
With companies, SME’s, retailers, manufacturers etc, you can’t keep turning the tap on and off. It becomes fruit withering on the vine and eventually they fade into oblivion leaving behind an enormous human cost. That cost will be shared by everyone.
This is not instinctively a political issue and neither is it Lib/Lab. It’s the simple logic of concern for one another at the grass roots level.
D2Ands
Your post reveals the genuine question at stake behind your reference to Hamlet. This is being debated at length in and under articles by Rundle, Keane (when he can resist trailing his coat) and others. I have different views to you but I do not doubt for a second that you are driven by “concern for one another at the grass roots level”. We all are, in the end.
Jeez, who’d be a State premier during this pandemic!
No matter what you do, you won’t know what impact it will have for at least 10 days. And whatever measures you reckon will deliver the outcome you want, you have to add in another turn of the screw to account for those who are refuseniks through to people making genuine mistakes who effectively sabotage your plans. And all the while, as you proceed through those 10 days, the environment is changing and thousands of well-meaning people are urging you to either go harder or to ease up.
Perhaps you can’t keep turning the tap on and off., but tell that to the virus. Premiers are playing catch-up.
Chances are that Victoria is NOT going through a second wave; it may be just the first State to resume the interrupted first wave. We could yet have an Italy-like or a USA-like experience ahead of us.
D2Ands:
1. There has been 162 covid deaths in Victoria alone (and rapidly rising, despite mandatory masks and severe stage 3 restrictions).
So when you say there has been more flu deaths at 36 than covid deaths, either your calculator or your brain is broken.
2.
Without the ‘home detention’ you so despise, in Victoria alone we’re on track to reach conservatively 50 deaths every single day until christmas, using the best case estimate infection fatality rate of 0.5% and the plateued current active case rate of 5000 for the state under stage 3 restrictions.
Since your calculator is broken, I’ll use mine- we’d be looking in the order of 5000+ deaths by christmas in victoria alone, dwarfing the usual death toll from flu which is annually a couple of hundred.
Damien. Statistics can be impressive but if they lack the appropriate context then they can be very misleading.
Please furnish us with the average age of the deceased and any pre-existing medical conditions they may have had prior to diagnosis of covid. This will have a big bearing on your statistics.
Now also combine that with the massive disparity between the official Vic Health figures and those of politicians pointed out by Adam Schwab last week.
And while you are at it, consider that world wide heath department covid testing figures have been found to be completely bogus.
The reference to Hamlet from a previous poster says more than he/she may realize.
Adam Schwab is your trusted source for information but not the army of medically trained professionals in the various health departments across Australia and the world?
You’re too far gone for me mate sorry.
We all have our limits, and mine is the roswell/ area 51/flat earth/fluoride in the water crowd of which you appear to be a loud and proud card carrying member of.
Damien, you may need a new calculator. If the infection rate is 0.5% as you suggest, do you know how many daily cases are needed to reach 50 deaths per day? Florida, with 4.5 times Melbourne’s population had 225 deaths yesterday.
Hint: It’s a lot more than we currently have.
Wow I’m truly honoured to get a reply from Dr. Luxury Escapes MD.
You forgot to mention that deaths is a lagging indicator (because people don’t instantly die from this horrific disease).
You forgot to mention that floridas deaths have increased 14% in just the last week alone and are continuing to climb despite their cases falling over the last week.
Those 225 daily deaths yesterday in florida are going to look like small potatoes in the coming weeks as more and more people who were reported as cases in the last few weeks die.
Once that occurs in the coming weeks, floridas IFR will resemble the consensus IFR that the WHO has researched to be around 0.5-1% give or take.
While I have your attention Adam I’m dying to know why you didn’t disclose in your article advocating for no lockdowns, that your own personal business interests are directly and catastrophically affected by lockdowns?
Nor did you make any mention of the fact that sweden haven’t shown any signs of having derived any economic benefits of significance by not locking down.
The cynic in me says those omissions amount to your article being nothing more than a gross exercise in self preservation.
Given you have so much personally riding on lockdowns not occurring, I genuinely am unsure if you paid crikey to publish it as an ad or not.
Ok, so what most people were doing in Sydney for 4 months, except for the masks, which many of us did without being told, because, you know, not all of us are numpties.
There’s been a huge drop in deaths from influenza this year because the measures that prevent transmission of Covid-19 also prevent the transmission of influenza, in fact, as the R naught for Covid-19 is x6 that of Covid-19, the measures are demonstrably even more effective as you point out.
Of course, the real reason why you are confined to your home is that the lizard people that rule the world through their front organisation, the Illuminati, are prowling the streets and will eat you if you are out after dark. I read it on Facebook so it must be true.
Speed and accuracy are usually opposites. Offer a pathology company $500 for a 4 hour turn around and they’ll do it. But don’t pay them until a second test gives the same result.
I don’t know if speed is a factor at all in the accuracy of the tests, but you are right to point to the very significant rates of false positive and negative test results which contribute to great uncertaintly about most of the statistics. Seeking corroboration through an additional test should help, but must slow things and it has to be done in a way that that there is no common cause failure making both tests identically false…
Yes, the accuracy of the results is even more important than the speed – and I do agree that we need to get the speed lifted dramatically from where it mostly is at the moment (and by all accounts it is much worse in regional areas).
This is a critical point. In NSW, I received my test result in less than 48 hours. I could have had it earlier if I’d hassled them more. Had the wait been longer, I may not have been so keen to have the test. I am self-employed, so any extended delay would have cost me money. The quicker the tests are returned the quicker we can get on with our lives (if the results are negative, as was the case for me). There seems to be something very wrong with Victoria’s healthcare bureaucracy given these delays.
One example doesn’t prove anything. My partner (in Vic) got a result within 24 hours, but I’ll believe others took longer.
But isn’t there a shortage of testing kits?
I have been told of one pathologist’s lab where they are testing four samples at once to save on kits and then going back to testing each specimen independently only if there is a positive result in the merged specimens.
Merging specimens is an accepted way of doing it, although it’s more like you take 100 samples and split them into 20 x 5 merged samples and test the 20. If about 1% of tests come back positive, only one of the merged samples will come back positive, then you can test the 5 individual specimens and identify the one positive. So you’ve used 25 tests to test 100 samples. It’s not necessarily an indication of a shortage of test kits. Reagents don’t grow on trees.
Yep. If Rwanda can do it…
https://www.npr.org/sections/goatsandsoda/2020/07/15/889802561/a-covid-19-success-story-in-rwanda-free-testing-robot-caregivers
A very good argument Jason. And timely.
I can’t agree that Jason has made a good argument, because he hasn’t presented any research. All he’s done is publish a proposed table of incentives and disincentives for temporal performance, inspired by an article that quotes a multi-billionaire saying “complete waste” ad nauseum (4 times).
Is it possible to conduct these tests faster? That would depend on having the facilities, consumables, technical staff, and logistics in place. Are these elements in place? If so, what’s causing the delay? If not, why not? The article didn’t present any research.
That’s not investigative journalism. It’s not even really journalism. It’s fetishism.