Local Councilmember Mark Levine Says Widespread Testing is No Longer Useful in NYC, and Could Strain the Health Care System
Photo of a model of COVID-19 via CDC.
By Carol Tannenhauser
“The three most important parts of the bill are testing, testing, testing,” Speaker Nancy Pelosi said, in a press conference following the passage of the Families First Coronavirus Response Act by the U.S. House of Representatives, on Friday, March 13th. “We can only defeat this outbreak if we have an accurate determination of its scale and scope so we can pursue the precise, science-based response that is necessary.”
“Without testing, we’re flying blind,” FDA Commissioner Dr. David Kessler agreed, in an NPR interview on March 14th. “We don’t have an antiviral to slow the epidemic. We don’t have a vaccine. All we have is to take people who have the virus and isolate them, to quarantine them. But that entire system is — if you look at the CDC guidance, it says to isolate, to quarantine confirmed cases. But how can you know whether someone is a confirmed case without a test?“
Local City Councilmember Mark Levine (at right), chair of the Council’s committee on health, thinks the time for large-scale testing in New York City has passed. The day the House bill was announced, he issued a strong warning against calls from elected officials for large-scale Coronavirus testing here, because of the “evolution” of the NYC outbreak.
“There was a time when we needed to test as many people as possible to identify, trace, and contain individual cases,” Levine said. “Now in places like New York City, where we see increasing ‘community spread,’ we are in an entirely new phase of the crisis and the time for blanket testing for the virus is over. We are staring in the face of an epic overrunning of our health-care system and we need to preserve every element of our system for people who are acutely ill,” Levine explained. “If every person who feels ill or thinks they were exposed to someone with COVID-19 (the disease caused by the Coronavirus) tries to get a test, it will push our health-care system to the breaking point.”
And it serves no purpose, Levine emphasized. “Individuals…need to realize that this information has zero practical implications for their course of treatment because there is no unique treatment for COVID-19. We are in a whole new world of testing. We are in the triage stage. Public officials need to stop misleading the public on the value of city-wide testing. At this point, testing — and the staff, facilities, and resources around it — needs to be reserved for the acutely sick. Everyone who is mildly sick needs to stay home and self-cure.”
“Councilmember Levine makes an intelligent point,” said Dr. Irwin Redlener, director of the Center for Disaster Preparedness at Columbia University and a professor at the school of public health. “In some ways we’ve gone beyond the utility of mass screening, with a caveat that contact tracing in some circumstances might still be appropriate.
“At this point, New York City needs to focus on preparing for what might be an overwhelming crisis that may well paralyze our health-care system,” he said. “I also know that New York City is working around the clock to make sure our health care system, already one of the best in the United States, is as prepared as it can be to deal with whatever we face in the weeks and months ahead.”
There are special ways of treating COVID even though there is no cure. And this help can happen at home. But it is not true that people can “self cure”. He is wrong. Some people can and should get oxygen at home and supportive meds that have to be prescribed. It’s not an over the counter disease. Levine is not doing New Yorkers a service.
If someone feels unwell enough to go to urgent care, obviously that person can be tested then, but no one is being treated for “COVID-19” — rather, doctors are treating for shortness of breath, pneumonia, fever, etc. The treatments available for these symptoms are the same, regardless of diagnosis. Levine’s point is that people with a mild case of the disease or no disease will indeed “self-cure” — the disease will run its course for them without medical intervention.
Amelia, there are no special ways of treating COVID-19. In fact, there is no treatment beyond supportive measures.
A positive test for someone who can care for themselves at home will be the same advice – stay home, rest, hydrate. That positive test results adds nothing but it does utilize resources that should be saved for the most sick among us.
Finally, a voice of reason! Testing helps the CDC gather data, nothing more. Everyone should behave as if he and everyone around him has already tested positive for the next 6 weeks or so.
Gathering data with testing is important. The prevalence of a disease is extremely useful in learning how to manage it. Management would be quite different if10,000 asymptomatic people are randomly tested and only 2 test positive versus 2,000
Widespread testing should have happened at points of entry months ago. Because it didn’t happen before community spread, we are now well past the point where testing would be helpful as a management tool. Managing it now depends upon everyone — sick and well — self-isolating. A person who tests negative today can become positive tomorrow, and the tests themselves are of varying conclusiveness — a 10% false-negative rate, by some estimates. I’m happy to see someone acknowledge this at last instead of using inadequate testing as a political bludgeon with few real-world health ramifications.
South Korea tested 10,000 people a day, stemmed the epidemic which initially seemed out of control, and ended up with a 1% mortality rate. Testing is crucial. People are making excuses because we have no tests!!!!
Testing allowed the South Koreans to accurately calculate a death rate. It didn’t change the number of people who died. We are calculating the death rate as # of deaths / # of cases. # of cases is know through testing. Assuming the number of real cases is much higher (with most not having been diagnosed through a test, or diagnosed at all), then out death rate is indeed lower. But this serves only to reduce the fear of death, not lower actual deaths.
How are you supposed to quarantine those carrying and capable of spreading Covid-19 to others without testing? How do you even have a sampling to determine whether the rate of infection is increasing or decreasing? How do you find the edges of spread to help design isolation techniques that do slow progression down through the community without testing?
Yes, that information is vital data for the CDC and actual epidemiologists to do their jobs. It isn’t testing for diagnosis. It’s testing for incidence and prevalence. Can we please leave these off the cuff remarks by laymen to the side and work with professionals who, like, do epidemiology for a living?
Henry, take a look at the fact sheet released by the NYC DOH yesterday.
It discourages testing and is written by epidemiologists and other public health experts.
So please take your own advice and rely on the recommendations of true experts.
Excuse me, is Mark Levine a doctor? What experience and knowledge does he have to advise the public on this? His experience is in the education system. Unbelievable.
And WSR you should be vetting the comments so that no one who does not have a medical degree can make statements about how this virus should be handled or what people should do to take care of themselves. Very irresponsible otherwise.
I have a medical degree and license. I completely agree with what is quoted of Mark Levine above. At this stage, it’s about increasing triage and intensive care resources. Sure, testing there is useful for sorting of patients. But testing for screening and contact tracing becomes less and less useful the more common the infection is.
Kathleen, Mark Levine is clearly relying on the advice of the physicians and epidemiologists at our city health deparment.
A quick look at their coronavirus webpage will confirm this for you.
You’re excused.
I think Mr Levine’s comment about over testing should be heeded. Stay home if you are sick whether it is covid19 or the flu or just a cold.
Mr. Levine’s capitulation before the sad fact that testing is hardly available… If tests WERE made as available as they should be, they would provide crucial and life saving data on what to expect next. Furthermore – having been tested is NOT determining who will take up any of the limited intensive care units or highly limited ventilators: it’s patients with most SEVERE symptoms – no matter if caused by the corona virus or something else. Testing will however show if patients are infectious and require strict quarantine – AND if their valiant actions taken to keep everyone healthy are rewarded.
how about we let the medical experts make these calls not politicians!
Mass testing is not the answer. What if you test negative and contract it afterwards? Reliable basic triage is the first step towards identifying required treatment options. Obvious symptoms are red flags for some sort of potential health issue. Those that are asymptomatic may be a threat to others. Asking the right questions may determine if testing is required. Local health departments and facilities using proper procedures and best practices will make a big difference. The federal government can provide money and determine basic guidelines while remaining flexible under changing conditions.
There are many points of view on how to manage this emergency. Political and ideological differences are making it difficult for government to make policy decisions. The public’s conspiracy theory mentality further causes people to panic. Spreading misinformation or disinformation is just scaring people to death.