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Saturday, April 18, 2020

The governor on Covid-19 testing

Saturdays are no-tie days for the gov. ((Mike Groll/Office of Governor Andrew M. Cuomo)
I thought this chunk of verbiage from Gov. Andrew Cuomo's briefing earlier today was worth posting, as he does a decent job of laying out the logic and logistical challenges behind the state's coronavirus testing plans, amid protests and calls to spring society from lockdown like right [expletive] now. (This is copy-paste of the "rush transcript" sent out by the governor's office later in the day, unedited by me.)

Andrew Cuomo:
Testing. Testing is the single most important topic for us to understand I think and it's important that we understand it. I spoke to one of my daughters last night who shall go nameless but she said to me, why do they all talking about testing? Which was sort of sobering. I think I'm communicating information and facts and my daughters are probably some of the most informed people on the situation given the hardship they endure being my daughters during this period of time. And she was like, I don't understand all of this about testing, which is again, it's a wakeup call to me. I think we're communicating. I think we're putting out this information. But you know people have lives to live even in this crazy time. But for me the best thing I can do in my position is to communicate facts to people so they have the information to make decisions. That's what I've been trying to do since day one. Here's the information, here are the facts, you decide, and I'll tell you what. I think the course of conduct should be given these facts, but here are the facts right before you tell me what you think. Just tell me the facts and then we'll get to your personal interpretation of the facts.

So facts on testing, because it is granular and it is a little boring, but it's also vitally important. Testing is how you monitor the rate of infection and you control for it and that is the whole tension in reopening. Everybody wants to reopen. You don't need to hold up a placard saying we want to reopen. Nobody wants to reopen more than me. Nobody wants to get the economy going more than me. Nobody wants to get on with life more than me and everybody else. We're all in the same boat. We all have the same feelings.

The tension on reopening is how fast can you reopen and what can you reopen without raising that infection rate so you go right back to where we were overwhelming the hospitals? The infection rate now is one person infects .9 other people. You can't infect .9 but it's basically one person is infecting one person. A tad less - and I don't even know if it's a tad less because I don't even know that the statistics are that accurate frankly.

So let's say one person now infects one person. That's where we are now. When that is happening the virus is basically stable. Where we were was one person was infecting 1.4 people and that's when you have outbreak widespread epidemic. We brought it down from 1.4 to .9. How did you do that? Those were the New York Pause policies. Close down business, close down schools, everybody has to social distance, everybody has to take precautions, masks, et cetera. But it worked and we went from 1.4 to .9. Wuhan says at one point they got down to .3 which is where you really start to see the numbers drop. But that's where we are.

The tension is when you start to open business you start to have gatherings, you put people on a bus, you put people on the subway, you put people in a retail store. Then you're going to see more infections. You see that infection rate rise and then you're going to be back to where we were. So how do you gauge this, right? How do you calibrate it?

That is all about the testing. And you have a very tight window. You're at .9 now. You can only go up to 1.2 before you see those hospitalization numbers start taking off again. You're talking about a very, very tight window that you have to calibrate and this is all without precedent so how do you actually do that intelligently? Well, you have to test and testing informs the calibration.

What is testing? Testing is you test. You test the person to see whether they are positive or negative for the coronavirus. There is also something called antibody testing but let's put that aside for a second. On the diagnostic testing, positive or negative, you test the person.

When you find a person who is positive you then trace. Trace, they call them detectives. You find the person and then you interview that person and find our who they came in contact and you follow that tree down. That's testing and that's tracing, when they talk about tracing.

Trace all those contacts and then you find the people who are positive. You isolate the positive people so they can't continue to spread.

Tracing requires an army. Literally an army. You would need thousands of people who just trace in the State of New York because any one person then leads to 10, 20 possible people who were infected. You have to trace all through those people. You find the positive person, you isolate them. The trick with testing is not that we don't know how to do it. We've done it better in this state than almost any other state, almost any other country. It's bringing this up to scale. These are private sector companies that are doing this. We have done a very good job in testing. The state has played a pivotal role in testing.

You look at New York and the number of tests we do. It's more than California, it's more than any other state. It's more than any other country. We have had great success in ramping up testing. We know how to do it. We know how important it is. We had that hot spot in New Rochelle, Westchester. It was the hottest cluster in the United States of America. We jumped on it and we jumped on it with intense testing and it worked. We still have an issue, but it's no longer a hotspot cluster because you do a lot of testing, you take the positives and you isolate them. The challenge is now bringing this up to scale. We did 500,000 tests in a month. That's great news. Bad news is it's only a fraction of what you need. The more you test, the more information, the more you can open society.

How does testing actually work? This, again, you have to know the facts otherwise this is all a blur and it becomes a he said, she said. There are about 30 private companies, large private companies in the country that are even international. Thirty large companies make equipment to test and they all have their own test. You have the ACME test, the this test, the this test, the this test. Well, those 30 companies have been selling their machines to local laboratories and that's their business. They make a machine, Roesch makes a machine. They then sell it to people. You have to buy their machine and they then sell these local labs their testing protocol because their test works on their machine. You buy the Roesch machine, you then have to buy the Roesch test from the Roesch Corporation. You buy the ACME machine, you then have to buy the ACME test from the ACME Corporation. They sell these tests to local labs.

We have about 300 local labs in our state who have bought these 30 types of manufacturers and 30 types of tests. Then every time the lab goes to run that test, if I'm running the ACME test, I have to have the ACME equipment and the ACME vial and the the ACME swab and the ACME reagents. What are reagents? When you take the swab, nasal swab, throat swab, you then test it with other chemicals. The other chemicals are reagents. Depending on what test you bought, they have their own reagents for every test. The ACME test has one set of reagents. The Roesch test has another set of reagents and you have to go back to them to buy these reagents. That's the basic chain. It gets very complicated very quickly because you have the national manufacturers who sold their machines to local labs. The local labs then need to go back to that manufacturer to run their tests. There's very little uniformity among the tests. You're trying to coordinate this whole private sector system. We have some public labs, the state has a Wadsworth Lab, but the real capacity is in these private labs.

So how do you bring this up to scale and how do you cut to the chase on this one? We called the top fifty producing labs in the state and said tell us what it takes to double your output, okay. And this is literally what they said. So there's no interpretation here. Most of them come back.

Sometimes they talk about the equipment, nasal swab, vial. But what you see is most of them are talking about, we can't get the reagents. We can't get these other chemicals that we need to test. Where do they get the reagents from? Their manufacturer who made the machine in the first place, okay. And they all say with the machines we bought we could actually be doing more if they would give us the reagents. That's the logjam that we are in. They bought the machine. They have the machine. They have the test but they need the reagents to do a higher volume of tests. When you go back to the manufacturer and say why don't you distribute more reagents, they say one of two things. I can't get more reagents because they come from China, they come from here, they come from here. We don't make them in the United States. Or they say the federal government is telling me who to distribute to.

And this is why I say you have the federal government involved in this situation, rightfully so, because the federal government is saying to Acme pharmaceutical, give X to California, give Y to Chicago, give Z to New York. These manufacturers are regulated by the federal government and the federal government clearly has a role in addressing this crisis. But, we need two things from the federal government. We need help on that supply chain, especially when it becomes international, and we need coordination and basic partnership. I get the state's role. We've been testing. I get this is hard. I get that it's difficult. I get that it's never going to be perfect. I get in this society there's going to be a blame game, and everyone's going to say, why didn't we have enough testing? It's the feds, it's the state. That's going to happen anyway, right. That's the world we live in. And I'm not asking for the federal government to come in and do any more than they need to do, but we do need their coordination and we do need their partnership.

And we also need from the federal government, we need funding. I get that we have to fund airlines. We have to fund this business. We have to fund small businesses. I agree a hundred percent, but you also have to fund state governments. And by the way, when you fund the state government, you're not funding a private business. We're not an airline. So you don't have an issue of should government really be giving tax dollars to this private entity. When you fund the state government you just are funding a state government to perform the functions you want us to perform, which is the reopening function. I get it. I'll do it. But I need funding. And when you fund a state government, you're funding small businesses anyway, and you're funding hospitals anyway, and you're funding schools anyway. And you know, the Republican doctrine used to be limited government and states' rights. I'm a good distribution mechanism to small businesses and hospitals and schools because I know what's going on in the state. But if you want to us reopen, we need funding.

National Governors Association is highly relevant because this is now all up to the governors. The National Governors Association is bipartisan. The chairman is a republican. I'm the vice chairman, I'm a Democrat. I'm the incoming chair person. We did a press release yesterday saying we need funding in this next bill. We need $500 billion for the states so we can do this reopening. Federal government yesterday sent 1.5 million cloth masks to New York State and I want to thank them for that. These are cloth masks that we can distribute to people to help implement our policy where if you're in public you have to wear a mask. It's not a surgical mask. It's a cloth mask manufactured by the Hanes corporation I believe. But we're asking people to wear masks. And this is going to be very helpful because we're going to have additional masks to distribute to the public.

Last point, personal opinion. This is not a fact. It's just my opinion. You can throw it in the garbage. The emotion in this country is as high as I can recall, people are frustrated, we're anxious, scared, we're angry. We've never been through this before and on every level this is a terrible experience. It's disorienting, it threatens you to your core. It makes you reflect on your whole life and it really has -- it's mentally very difficult, it's emotionally difficult, economically, it's disastrous. I mean the market goes down. Your retirement funds go down. You're not getting a paycheck. It is as tumultuous at times as we have ever seen. But in the midst of this, there is no time for politics.

How does the situation get worse, it gets worse quickly? If you politicize all that emotion. We cannot go there. That's why I work so hard when anyone raises any political agenda to me. I work so hard to distance myself from it. I'm not running for anything. I'm not going anywhere. I'm going to be governor of the state of New York until the people kick me out and then I'm going to go spend time with my family and that's that.

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