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Where are things working
Screening and information practices around the world
Welcome to Plugging the Gap (my email newsletter about Covid-19 and its economics). In case you don’t know me, I’m an economist and professor at the University of Toronto. I have written lots of books including, most recently, on Covid-19. You can follow me on Twitter (@joshgans) or subscribe to this email newsletter here.
The other day, the New York Times did a profile of the CDL Rapid Screening Consortium that has been a big part of my life for the last few months. The consortium members are now up to about 2,000 people regularly screened (that is, twice every week) and the reason it has taken so long is that our focus is on sustainability — not just a once-off screening push but building it into regular life to break chains of transmission over the next year or more as we wait for the vaccine to be distributed widely enough. Over the next few months, those regularly screened will grow exponentially, but right now, it is the beginning.
There are places, however, who have already built regular screening systems and I wanted to highlight them today. Each is more targetted than the challenge of large cities where Covid-19 is actively circulating. But each is important in highlighting what can be.
Since December, Nova Scotia, a Canadian province that has largely kept Covid-19 out, has been offering pop-up rapid antigen test screening. From the Globe and Mail:
Downtown Halifax’s restaurants and bars have become home to volunteers offering rapid COVID-19 tests so patrons can socialize with some assurance they are free of the virus, an experiment that is giving a window into what a new normal could look like.
Since the pop-up clinics launched in Nova Scotia in December, just a handful of the nearly 14,000 people who have been tested were confirmed to have COVID-19. Public-health officials in Nova Scotia see even that low rate as a success: Fifteen people who were asymptomatic – and likely shedding the virus – did not end up inadvertently spreading COVID-19 in their community. As well, by testing asymptomatic individuals, the province is gaining an early warning system for potential outbreaks.
Basically, they are making screening easy and available. It was the result of some persuasive clear thinking:
Dr. Barrett is an infectious-diseases expert in Dalhousie University’s department of medicine, who approached public-health officials in November with an unusual pitch: Medical professionals could train members of the public – ranging from high-school students to retired librarians – to take nasal swabs and run them through the Abbott Panbio rapid test. The next day, she had the first clinics up and running.
Count me as very impressed. Here is a report on that very first outing — at a nightclub no less. Importantly, they found a needle in the potentially flammable haystack.
Overall, Nova Scotia is showing how to get to Covid-Zero when you are not an island.
When colleges reopened back in August, we all worried about potential outbreaks. But largely, colleges have adopted regular testing of students and staff and have been able to keep things in check.
But the University of California, Davis, tried a more ambitious approach. Rather than cocoon within the University grounds, they put in a place a screening bubble that included the surrounding town. From the New York Times:
Public health experts say the initiative is the most ambitious program of its type in the country and could be a model for other universities. U.C. Davis, part of the 10-campus University of California system, has made free coronavirus tests — twice weekly, with overnight results — available to all 69,500 people in the city of Davis and hundreds of nonresidents who just work there.
It has also trained dozens of graduate students to help with contact tracing; recruited hotel and apartment owners to provide free isolation and quarantine housing to anyone in town exposed to the virus; and hired some 275 undergraduate ambassadors to combat health disinformation and hand out free masks.
The university has also recently expanded campus wastewater testing into Davis, and in coming weeks plans to administer vaccinations at its coronavirus screening centers and to bring screening to some public school sites.
Funded by major philanthropic donations, state and federal grants and CARES Act money, the program, projected to cost up to $38 million, has caught more than 850 potential outbreaks in Davis since it got underway shortly before Thanksgiving, according to Brad H. Pollock, who chairs the university’s department of public health sciences and directs the project.
This is simply incredible. And the results ….
But he noted that participation had risen sharply since the holidays as more sites have opened. More than 160,000 tests have been processed, not counting diagnostic tests done for people with symptoms, and more than a half-dozen Davis residents have received free quarantine or isolation housing. The program has cost the university about $14.5 million, with about half of the money spent in town and half on campus, said Ms. Ratliff, the vice chancellor. She said the school expected the initiative to continue at least through 2021.
Though Davis has about a third of its county’s population, it has logged only about 15 percent of the coronavirus cases. That is partly because many in the college town can work from home. But it is also because of Healthy Davis Together, city officials and public health experts say.
“We’ve taken some 850 people off the street who were walking around, asymptomatic,” Dr. Pollock said. “Every infection caught prevents, like, three more infections. And for every one of those three, three more get prevented, and so on. That has to make a difference, right?”
And it even gets better:
“Hey, better safe than sorry,” said Marc Hicks, 54, a school district employee whose infection was caught in November three days before he experienced symptoms. The lead time, he said, enabled him to notify his supervisor at work and made it possible for contact tracers to identify people he might have infected. He still comes in every week, he said, because he cannot be sure whether he is immune or not.
And that is the whole point.
Australia has had its ups and downs but compared to most places it has avoided the long-term restrictions on activities. This magnificent article from ABC News gives the Australian story and if you are a reader of this newsletter, you’ll find it very interesting and captivating.
One aspect I wanted to highlight was the level of knowledge Australian authorities have had regarding how individual cases acquired the coronavirus. Here are the relevant charts.
The interesting thing is how few unknown transmissions there are. What this means is that contact tracing could work effectively. Contrast this with Ontario.
Notice how as the prevalence increases, the ability to trace links breaks down (the green and purple bits). In other words, there is a virtuous cycle whereby having great information initially keeps conditions such that information can do its job persistently.
The point is that getting good information is a tool for keeping a virus in check. It’s costs rise as prevalence rise. In each of these three cases, governments saw that and proactively engaged in information collection even when things were not dire. That will be our challenge going forward.