Are We Serious About Widespread Testing for COVID-19?

Are We Serious About Widespread Testing for COVID-19?

June 4, 2020

By Crystal M. James, JD, MPH and Lucenia W. Dunn, PhD Recently, Tuskegee University partnered with the Alabama Department of Public Health and Macon County Health Department to provide the transport media to alleviate the shortage of coronavirus tests in Macon County with plans to expand to other Black Belt Counties (BBC) in Alabama that have a majority population of African Americans. However, the barrier for expanding the number of people being tested is the guidelines that prohibit testing unless they show overt symptoms of the COVID-19. This is a critical barrier to the goal of widening testing to a larger population who may be carriers and are currently asymptomatic. Symptoms of COVID-19 are non-specific, and the disease presentation can range from no symptoms (asymptomatic) to severe pneumonia and death. COVID-19 is a mild to moderate illness for approximately 80% of individuals evaluated with the disease; 15% have severe infection requiring supplemental oxygen; and 5% are critical infections requiring mechanical ventilation.

People with COVID-19 generally develop signs and symptoms, including mild respiratory symptoms and fever ~5 days after infection (mean incubation period 5-6 days, range 1- 14 days)1 In a news report on MSNBC, dated April 24, 2020, the Eisenberg Village Long Term Care facility in Los Angeles, California identified 3 symptomatic cases of the coronavirus. However, the decision was made to test everyone in the facility. This testing strategy revealed that 75% of the patients and 90% of the staff were infected and not all of them exhibited overt symptoms of the disease. This is a case in point. More people need to be tested and the university community can play a critical role in expanding the number of available tests.

The cry among health officials and politicians at every level is, “We need to have more tests for citizens to help identify the coronavirus.” It is well established that identification, isolation, and treatment will be major factors in helping to decrease the spread of this deadly virus. A resource that has been overlooked is the biosafety level 2 laboratories commonly found on the campuses of most colleges and universities across the United States. They have the regents and equipment that are needed to prepare the transport media necessary for collecting test samples. In fact, the Centers for Disease Control and Prevention (CDC) has provided guidelines for making the transport media that is readily available on CDC’s website.

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The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) in China]. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):145–151. DOI: 10.3760/cma.j.issn.0254- 6450.2020.02.003.

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The question remains why the Federal Government has not used its vast powers to marshal the university laboratory resources to provide testing for all citizens under the state of emergency that was declared weeks ago. The US President has access to emergency powers contained in 123 statutory provisions according to a recent report published by the Brennan Center for Justice at New York University (NYU) School of Law.2 Moreover, most research-intensive universities are funded by federal dollars to conduct research on a myriad of topics. The laboratories that receive federal resources could be directed to produce tests as well as perform diagnostics to determine the status of individuals tested if they have access to Biosafety level 3 facilities. Tuskegee University is not the only institution of higher learning that would gladly share their laboratory resources to ensure the communities they serve receive tests.

The federal leaders who take main stage each day to provide public service announcements continue to advocate the need for widespread testing to re-open the country. Yet, the question remains why have we not utilized the network of university-based laboratories to assist in the response to this pandemic? The only logical response to this question is that we are only interested in racing towards a vaccine which has economic implications for the companies vested. We want laboratories focused on creating a vaccine which we know from influenza vaccinations may only have 50% efficacy. Stated another way, there is more interest in an economic focused resolution rather than a human focused resolution.

The available data demonstrates that when African Americans and other marginalized communities develop COVID-19, they are more likely to die than their white counterparts. One of the major reasons is because they are more likely to suffer from multiple underlying health conditions because of several systemic economic and healthcare factors. This is exacerbated when these persons have little or no access to medical care. Knowing all these things, the state apparatus still refuses to change its policy of testing only overt symptoms to one that enables more widespread testing regardless of one’s medical status.

In addition, to trust the government or not to trust the government plays a major role in containing the coronavirus in the African American community. Over thirty years ago, William Julius Wilson and his influential book The Truly Disadvantaged: The Underclass and Public Policy (1990), initiated a movement to study how race, poverty, and public policy affected the lives of African Americans.3 A similar study in an earlier century by W.E.B. Du Bois, in his classic study, The Philadelphia Negro (1899), indicated a strained relationship between Black Philadelphians and the local and state governments in Pennsylvania. Wilson’s study of black employment, culture, and relationship with local governments highlighted a continued growth of the schism between Black Americans and the local and state governments.4 States are responsible for providing for the general welfare of all their citizens. This police power has been interpreted to give states ultimate decision-making authority for health policy and how it 2 3

Accessed April 26, 2020: https://www.brennancenter.org/sites/default/files/2019-10/2019_10_15_EmergencyPowersFULL.pdf Wilson, Julius Wilson. The Truly Disadvantage: The Underclass and Public Policy. Chicago: University of Chicago Press, (1990)

James C, Robinson, Jr. E, “Prelude to a Revolution: Expanding the Power of the Black Lives Matters Movement to Decrease Deaths Caused

by Legal Intervention in the United States” Journal of Healthcare, Science, and the Humanities. Vol. II, No. 1 (2017) p. 93-100 4

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will be implemented in their individual state. However, we are still plagued with policies that undermine the ability to aid where it is most needed. The refusal of the federal and state governments to modify testing guidelines and mandate all available laboratories to develop and process test for all Americans, further demonstrates the reasons for the lack of trust in the government.

Most importantly, the lack of trust endangers all citizens no matter their racial identity, geographical boundaries, or economic status simply because the virus does not concede to state jurisdictional mandates, nor does it provide preferential treatment based upon race categories. It impacts everyone. If it remains unchecked; if we cannot identify and isolate; and, if we cannot treat the infected, the nation loses. The health of the citizenry significantly impacts the health of the economy. We must be serious about combating COVID-19. The university laboratories are a major step in eliminating the virus by providing universal testing that includes everyone.

Crystal M. James, JD, MPH Head, Department of Graduate Public Health Associate Professor, Department of Graduate Public Health Board of Directors, Women of Color Advancing Peace, Security, and Conflict Transformation

Lucenia W. Dunn, PhD President/CEO and Founder, Tuskegee Macon County Community Foundation, Inc. Former Mayor, City of Tuskegee Alabama Facilitator, The Movement 46 Civic Engagement Group

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