The Health 202: Antibody tests to pinpoint number of U.S. coronavirus infections are key to reopening country

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THE PROGNOSIS

Here’s a twist: Discovering that hundreds of millions of Americans have been infected with the novel coronavirus might actually be good news.

It would indicate this: That lots of people have already developed immunity to the virus and could safely reenter society — and that the death rate from the virus is lower than originally suspected.

But right now, we have no idea just how many Americans have been infected with covid-19, the disease caused by the virus, and experienced only mild or no symptoms. While the United States has now administered more coronavirus tests than any other country (although not per capita) — nearly 1 million — that’s still only a small fraction of the population, and it includes mainly people who experienced severe-enough symptoms to qualify for a test at all.

The answer to the crucial question of how many actual infections there are in the United States carries major implications for the Trump administration, governors and mayors, who have been forced to consider hugely consequential policies — for example, how long schools and businesses stay closed — with incomplete information about how widespread the virus truly is.

“I don’t know how you make policy without these numbers,” Stanford University researcher Jay Bhattacharya told me. “They’ve had to make very difficult calls with very imperfect information.”

Researchers are racing for answers using tests just now becoming available, with permission from the Food and Drug Administration. These serology tests — which detect disease-fighting antibodies — could be hugely helpful in determining when and how to gradually reopen parts of the mostly shuttered U.S. economy, experts say.

If, for example, many Americans are discovered to have immunity, they could potentially start returning to work, school and other public settings soon. It would also indicate the U.S. fatality rate is much lower than the 1 to 2 percent scientists have estimated.

“The theory is that such testing could be used to divide the world into people who’ve had it and aren’t at risk anymore — and those who are,” my Washington Post colleague Carolyn Y. Johnson explains.

“Health-care workers with immunity could return to the front lines. Large employers could test their workers to find out who could return to work first. Health insurers might use the tests to tell members whether it is risky to go out into the world. People who know they have a level of immunity could help others.”

But if researchers find no such “herd” immunity, that could underscore a need to extend social-distancing guidelines for some time. And it could indicate a higher fatality rate from covid-19.

New York Gov. Andrew Cuomo (D):

Bhattacharya is among a group of researchers finalizing plans to administer thousands of finger-prick tests to residents of Santa Clara County, Calif., at drive-through sites later this week, hoping to shed light on the country’s infection rate.

The group, which includes professors from Stanford and the University of Southern California, organized the Santa Clara testing project in a few weeks, although such a project would normally take months to get off the ground. Bhattacharya told me the group has received enormous interest from researchers around the country, who are deeply invested in getting better information about the extent of coronavirus infections in the United States.

The study will work like this: At three separate testing sites around the area, volunteers will be able to drive by in their cars and receive a simple finger-prick test. Bhattacharya said he hopes to report some results early next week. He’s hoping to receive an additional 10,000 tests but is unsure when they’ll be available.

But he’s sure of this: Policymakers need a better understanding of the rate of infections before they can make informed decisions about how to enforce social distancing.

“We need this number, or else we’re flying blind,” Bhattacharya said.

The infection rate is just one of several assumptions researchers must plug into models of how quickly U.S. infections could spread and how many deaths would result. They typically separate people into four groups: the non-infected; the infected who are sick; the infected who have recovered; and the infected who died. They have to estimate how quickly the virus is transmitted from person to person and how many people one person infects on average.

They also have to consider the mitigation steps being taken on the ground, such as to what extent people are staying at home and when they started social distancing. As we’ve reported, states have taken a variety of approaches, some more stringent than others.

All of this means policymakers have to choose from a wide range of projections as they respond to a fluid and rapidly changing situation on the ground.

Trump administration officials have focused on two models of how the pandemic could play out in the United States: one fairly dramatic projection from London’s Imperial College and another projection out of the University of Washington.

— In modeling by London’s Imperial College, researchers projected 1.1 million people in the United States could die with three months of social-distancing measures, including closing all schools and universities, isolating infected patients and ordering household quarantines. They said deaths could be double that figure without such measures.

— More recently, administration officials have been citing a more conservative model from the University of Washington’s Institute for Health Metrics and Evaluation, which projects the virus will kill about 84,000 people over the next four months.

That projection was based on the assumption that people will continue practicing social distancing through May, professor Chris Murray told my Post colleague James Hohmann. And Murray stressed the projections will change as he gains access to more data throughout the country.

“It’s hard to predict the weather,” Murray told James. “It’s going to be hard to predict this epidemic, and so the best we can do is just keep updating with the best information available at the point that different leaders are making decisions.”

At yesterday’s daily briefing, Deborah Birx, coordinator of President Trump’s coronavirus task force, said she and other officials regularly check this model as Murray updates it daily. She reiterated the administration’s estimate of 100,000 to 200,000 deaths in the United States, based on this model, even with what they describe as near perfect compliance with social distancing edicts. And she warned Americans things could look worse if they don’t follow social-distancing guidelines through the rest of April.

“Without continuation for the next 30 days, anything could change,” Birx said.

The Post’s Josh Dawsey:

PBS reporter Yamiche Alcindor:

Anthony Fauci, head of infectious diseases at the National Institutes of Health, stressed that deaths could stay below the projection of 100,000 to 200,000 if the nation can suppress other potential cities and hot spots from following the pattern in New York and New Jersey. Birx pointed to the lower rates of spread in states like California and Washington, which took aggressive measures to control early outbreaks.

The Post’s Derek Hawkins:

AHH, OOF and OUCH

AHH: Fashion designers, auto manufacturers, small businesses and other companies have stepped in to redirect their resources to making personal protective equipment as hospitals face shortages.

Brooks Brothers announced it will begin producing medical-grade masks and gowns, converting its New York, North Carolina and Massachusetts factories to produce supplies for health-care workers. The company plans to produce up to 150,000 masks a day. 

Furniture giant Ikea is also producing face masks and other protective gear for hospitals, including hand sanitizers, visors and single-use aprons, Reuters reports.

Our Post colleague Arelis R. Hernández wrote this week about a family-owned linen company, one of the last U.S.-based textile manufacturers, which is now making medical masks. 

It’s not just masks. Ford Motor and GE Healthcare said they plan to produce 50,000 ventilators within 100 days at a facility in Michigan. 

— Meanwhile, state officials are pleading for medical equipment from federal leaders. Governors are making increasingly panicked requests to the Federal Emergency Management Agency for materials. 

“State and congressional leaders are flooding FEMA with letters and calls seeking clarity about how it is allocating suddenly in-demand resources such as masks, ventilators and medical gowns,” our Post colleagues Toluse Olorunnipa, Josh Dawsey, Chelsea Janes and Isaac Stanley-Becker report. “… Governors and state officials have become increasingly frustrated by what they describe as a byzantine and unsteady process for distributing medical supplies from the Strategic National Stockpile.” 

Some states are seeing responses. “States including Oklahoma and Kentucky have received more of some equipment than they requested, while others such as Illinois, Massachusetts and Maine have secured only a fraction of their requests,” they write. “It’s a disparity that has caused frustration and confusion in governors’ offices across the country, with some officials questioning whether politics is playing a role in the response.”

OOF: Internal memos from the Centers for Disease Control and Prevention to the White House and to the Department of Health and Human Services detail discussions on whether to recommend people wear face coverings in public. 

The memos obtained by The Post explain that simple cloth masks can prevent virus transmissions between people out buying groceries or seeking medical care, our Post colleagues Lena H. Sun and Laurie McGinley report. The masks wouldn’t necessarily protect the wearer but would prevent the spread, if the wearer is infected, of the virus to others.

The recommendations, if the White House eventually adopts them, would “represent a major change in official CDC guidance that healthy people don’t need masks or face coverings,” they write. 

Here’s what you should know: The masks would be an additional mitigation tool – and social distancing of at least six feet would still be recommended, even while wearing a mask. The memo makes clear these would not be medical masks, such as surgical coverings in short supply and desperately needed for front-line health workers. The recommendations would call for do-it-yourself cloth coverings that extend above the nose and below the chin to “completely cover the mouth and nostrils.”

Lena and Laurie add: “It should also fit snugly against the sides of the face and be secured with ties or ear loops, and be composed of multiple layers of fabric but not be ‘overly restrictive to breathe through.’ An ideal face cover can be cleaned in a washing machine and machine dried without damage or distorting its shape, the memo said.”

OUCH: New CDC data shows people with chronic medical conditions, including diabetes, lung disease and heart disease, are at an increased risk of being hospitalized and requiring intensive care if they contract the coronavirus. 

“The report reinforces a critically important lesson: Although the disease is typically more severe among older people, people of any age with underlying medical conditions are at increased risk if they contract the virus, for which there is no vaccine or approved drug treatment,” our Post colleagues Joel Achenbach and William Wan report. But the study did not break down the exact demographics of the disease. 

The data are based on analysis of 7,000 confirmed cases of covid-19 and covered preexisting conditions including heart and lung diseases, diabetes, chronic renal disease, chronic liver disease, immunocompromised conditions, neurological disorders, neurodevelopmental or intellectual disability, pregnancy, current or former smoker status, and “other chronic disease.” 

Seventy-eight percent of people who were admitted to an ICU had one underlying health condition. Of those who were hospitalized but not admitted to the ICU, 71 percent had at least one such condition, compared with just 27 percent of people who didn’t need to be hospitalized.

— The pandemic has also brought another layer of physical and mental stress for people who are immunocompromised and hurdles for their loved ones and caretakers. 

This category includes cancer patients undergoing chemotherapy, people with untreated HIV and people with chronic lung, live or kidney disease, Clifton Bingham, a physician, professor of medicine and director of the Johns Hopkins Arthritis Center, told our Post colleagues Laurie, Jenna Portnoy and Rebecca Tan report. 

“Such individuals’ underlying medical conditions, or the drugs they are taking to suppress their immune systems and manage their illnesses, make them more susceptible to contracting the virus and more likely to face complications, experts said,” they write. “… Such individuals’ underlying medical conditions, or the drugs they are taking to suppress their immune systems and manage their illnesses, make them more susceptible to contracting the virus and more likely to face complications, experts said.” 

— The man of the moment is Anthony Fauci. The director of the National Institute of Allergy and Infectious Disease has become, in some ways, the public face of the federal response to the coronavirus. And he’s attracted a cult following, our colleague Antonia Noori Farzan writes

A small doughnut shop in Rochester, N.Y., sold out of buttercream-frosted treats with Fauci’s face. “Even as whole swaths of the global economy collapse, the pandemic has created a robust cottage industry of Fauci-themed merchandise, including bottle openers, magnets and mugs,” she writes. “On Etsy, you can buy ‘Honk for Dr. Fauci’ bumper stickers, prayer candles depicting ‘St. Fauci’ and socks printed with Fauci’s face.” 

Reporter Jillian Jorgensen:

— Other news to know: 

Efforts in Washington, D.C.: 

  • The Trump administration wants the FDA to allow a decades-old flu drug championed by Japanese Prime Minister Shinzo Abe to be authorized as a possible coronavirus treatment, Politico’s Dan Diamond and Nahal Toosi report. But there’s limited evidence the drug would work as a treatment for the coronavirus.
  • Trump and administration officials have decided not to reopen enrollment for the Affordable Care Act amid the pandemic, Politico’s Susannah Luthi reports.

In Washington state:

  • A new study has found social distancing is reducing coronavirus transmission in the Seattle area, but not enough to contain it completely, the Los Angeles Times’s Richard Read reports.

The hardest hit: 

  • Online trolls are breaking into Alcoholics Anonymous meetings being held via video conference and harassing participants, Business Insider’s Aaron Holmes reports.
  • Many Americans are seeking out help for the first time in their lives. They’re applying for unemployment, turning to online fundraisers or social media for assistance, and showing up to food banks, the New York Times’s Cara Buckley writes.
  • Rent is due today for many. It’s not clear how many people will have trouble paying, but in New York, landlords and the real-estate industry are expecting up to 40 percent of tenants to skip payments, and that could have a ripple effect, the New York Times’s Matthew Haag reports.

On a happier note: 

  • Psychologists are concerned about the long-term impact of this socially distant reality, but research shows human connection, generosity and expressions of love — even from afar — can be good for your heath, our Post colleague Sarah Kaplan reports.

SUGAR RUSH

— This must-watch clip made our day:

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