The COVID-19 Mirror
- By Ljiljana Djukanović
Late mornings in Spain are particularly grim during the COVID-19 confinement. That’s the time of the day when the entire nation listens to the daily broadcast of the COVID-19 press conference. One hour of densely packed updates: new death and infection counts, modeled predictions, new confinement measures, social initiatives. . . Every day is deadlier than the previous one, and every day seems to bring more stringent isolation measures. By April 3rd, Spain had registered more than 10,000 COVID-19-related deaths and it had become the country with the highest number of infections.
During one of these press conferences, in mid-March, it was announced that the government had just bought 600,000 rapid COVID-19 tests from a Chinese company. These rapid tests were meant to alleviate and accelerate the standard testing process. Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) is a standard laboratory technique currently used for COVID-19 testing all around the world. This technique has been extensively deployed, both in research and diagnostics, for almost four decades, and despite its long and complicated name, the scientific principle behind it is quite elegant.
To carry out the test, a special instrument, as well as validated laboratory and competent personnel are necessary. In non-epidemic situations, there would be no need for every hospital to have this whole setup. The demand for diagnostic testing with RT-PCR could be met simply by having several centralized hospitals or diagnostics centers where the samples would be shipped and analyzed. However, in a situation of an epidemic, where thousands of people must be tested every day, the standard testing system becomes logistically cumbersome, slow, and easily saturated.
The rapid tests bought from China, on the other hand, wouldn’t require any laboratory infrastructure. They are “point of care” devices that could be used anywhere by any medical personnel, would only require a drop of person’s blood, and would give the results in thirty minutes. This test is based on antibody detection, a method commonly used in diagnostics. As a reaction to an infection, our bodies produce unique antibodies that can be found in our bloodstream and serve as an “pointer” that signals which virus caused the infection.
As soon as the rapid tests arrived in Spain, the country’s microbiology experts performed a quality control analysis and quickly concluded that the tests were not reliable and could not be used. The chance of getting a false negative result with the test was too high. For example, it might mean that, of ten patients infected with the virus, seven tests would give negative results. Such inaccuracies were contrary to the product specification documents, issued by the company, which claimed high sensitivity and validity for the test. The tests were returned to China shortly afterwards, and Spain’s Health Ministry ordered that RT-PCR continue to be the standard method of testing.
Frank M. Snowden—a professor of history of medicine at Yale who extensively studies how pandemics and outbreaks shape societies—explains that pandemics hold up a mirror to human beings; they reveal who we really are, our morals, our values, our politics, and our infrastructures. How Spain got into this “test mess” and how the Chinese company took advantage of the situation is all a mirrored reflection of systematic problems that our societies have today. In Spain, as in most other countries around the world, the healthcare system infrastructure and coordination for epidemic situations was barely ever planned, let alone implemented.
If we look in the COVID-19 mirror, we can’t help but pose a question: How is it possible that our nations prepare our militaries so meticulously for hypothetical wars with other countries, but no such preparation exists for a pandemic—a war of another kind? And then, as if the deadly-new-virus-meets-unprepared-healthcare-system wasn’t enough of a problem for Spain, capitalist opportunists had to come along and take advantage of the global crisis and human despair. And the Chinese company is by no means an isolated case.
But the news isn’t all bad. According to Snowden’s analyses, societies also invariably show a heroic side during pandemics. I believe it will be true for this pandemic as well. (And former Yugoslavs, like me, have learned something on this score; Svetlana Broz, the granddaughter of Tito, actually wrote a book on the subject: Good People in Evil Times.) There may well be a great deal of resilience, compassion, knowledge, and creativity reflected in the COVID-19 mirror. Pandemics bring out our dark side, but also our highest qualities.
This isn’t a question of optimism, just realism: there is no question that we have everything—the science, the industries, and the solidarity— necessary to make things better from now on. We just have to put the heroes in charge.
Ljiljana Dukanović was born in Sarajevo, Bosnia; she earned a BA at Bard College and a PhD in Molecular Biology at the Spanish National Cancer Institute. She currently lives in Lisbon, Portugal, and works as a scientific consultant for biotech companies.