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To better advise some policy-makers we’re speaking with, what do we view as the key barriers to scaling up testing and strategies to overcome them. See thread below. Figured public sourcing would be helpful here. @ScottGottliebMD @paulmromer @steventberry @erikbryn
The returns to testing are MASSIVE. @ATabarrok has written about this. This is @Austan_Goolsbee first rule of virus Econ. If we assume daily costs of shutdown are in $billions, we should be spending huge amounts (100s of billions) to speed reopening https://marginalrevolution.com/marginalrevolution/2020/03/a-solution-if-we-act.html
One constraint a la @paulmromer might be regulatory - e.g. FDA says you need to use swab x even though unapproved swab Y is nearly a perfect substitute https://twitter.com/paulmromer/status/1249115887413743616
Another possibility per @steventberry is a sort of Leontief style rigidity whereby the x test is missing swabs, the y test is missing reagents etc https://twitter.com/steventberry/status/1249117348583407616
It could be literal funding - CMS pays surprisingly little for COVID testing given the seeming return per test
. @nature has an article that says unused capacity is an issue because a hospital electronic medical system cannot order a test easily from a new vendor. https://www.nature.com/articles/d41586-020-01068-3W
Is it conditionality of payment? EG would @SutterHealth do tests rapidly if we paid $200 per test and payment was conditional on 8 hour reporting or if we paid them $10,000 per test for 4 hour reporting?
Is it that we haven’t had long enough for new technologies to come online, like protein testing, where solution might be huge contracts to new vendors or X-prizes?
Is the answer all of the above? If so, likely answer is a shotgun approach.
I, for example, was shocked that CMS payments for tests were ~$35.00
. @ScottGottliebMD seems to say unused capacity https://twitter.com/scottgottliebmd/status/1248969808835641346
Likewise, payments that are too low (which is crazy, since willingness to pay is sky high) https://twitter.com/scottgottliebmd/status/1248970410785484801
Another aspect might be personnel to literally run the PCR process.
