I won’t give you the details, but lets suppose that there is a disease X that is caused by agent Y and that agent Y is found in Z. Further, Z is found everywhere in the world. So, if you catch X, odds are you were exposed to Y from Z here, there, and everywhere.
Epidemiologists will tell you that it’s useless to test for the presence of Y in Z based on one case of X because finding Y will not tell you that the person caught it from that location of Z. Of course, this is of little relief to the friends and relatives of a person with X because they want answers. We put a man on the Moon, so why can’t we do a simple test and determine how the person got sick, or where they were exposed before they got sick.
However, if a group of people come down with X and all were in location A where there is plenty of Z, then Z will get tested to see if our suspicions are confirmed. Location A will also get tested if one person spent all of their time, 24/7, in that location an nowhere else. Again, these tests are done to confirm the outbreak, not to diagnose a single case of X.
It seems simple, right? There are rules based on evidence and science on when and where to test for Y in Z. Unfortunately, these rules, like many others, are subject to the whims of the people in power.
The people in power tend to want to stay in power. In the United States, most of the political power is subject to the demands of the electorate in an election year. (I think they could care less the rest of the year.) So, if someone related to a case of X knows someone in power, that someone in power will demand that those of us in public health, who work at the whims of those in power (because they sign our paychecks), go against the scientific rules and epidemiological guidelines.
This is exactly the situation an epidemiologist friend of this blog is going through. He is being asked, bullied, and strong-armed into testing for Y in location A because of one case of X. Testing will achieve nothing. It will not confirm the diagnosis, which has been made using advanced lab methods on the patient’s specimens. It will not cure the patient. It won’t even keep other people from getting sick because, as I told you, Y is everywhere where there is Z. People are just unlucky enough to get the right dose at the right time. (And smoking, cancer, lung disease, and old age don’t help, either.)
I advised our friend to swallow hard and endure, take it. They’ll hate him for it, but that’s the point of being an Epi, he can be the outcast. He can make the choice that no one else can make, the right choice.
Or he can just do the goddamn test and get it over with before the weekend.