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Following the advice, actually, requirements of the experts and CDC/FDA, the US ramped up testing and tracing for Covid infections, which was supposed to be the way forward to getting back to some semblance of normal life.
Many here bemoan how badly we have done this, because despite ramping up testing in what I think was pretty quick given the unknowns at the time plus the scale of the problem, the testing does not seem to have made any real difference. I would note that even places like Hong Kong, which were lauded for how well they did all of this testing and tracing, now are seeing a surge in new infections. Regardless, a main reason for this is another point that people like to complain about: results delays.
Now, it is in fact true that delayed results make the data not so useful for tracing and isolating, so I cannot argue about that.
However, what if the entire testing/tracing playbook is wrong? What if there is another way?
In a nutshell, the tests that are approved by the FDA are too sensitive. They are returning results for people that are likely not contagious and may not even have any viable virus left in their system. This type of test will always require the same sort of process: Train some sort of "expert" to administer the test, normally within a medical environment, pack it all up with proper documentation and handling, send it away to a lab with more trained "experts" for logging and running the test, make the run, log the results, transmit the results, etc. Of course there are limited numbers of people and equipment to do all of this, and then there is the handling and transit times. It will never be fast enough.
Instead, as has been proposed in a couple of very interesting papers and studies listed below (not yet peer-reviewed, GASP!), what if you had a cheap test (like the pregnancy test) that could be administered anywhere by anyone? To make it cheap and fast it would be less sensitive.
It does seem a little counter-intuitive that a less sensitive test would be a better choice, but there is solid logic behind the thinking:
It seems that the high sensitivity tests are giving positive results for people that either have low enough viral loads to be non-contagious, or for people that just have bits and pieces left in their systems, which can be detected many weeks after the infection is cleared.
So, the idea is to have a test that is so cheap and available that you could test every student before they went to school, test anyone that enters a space, and so on. A high percentage of people (not all, for sure) are responsible enough to stay home if they tested positive, and you could certainly stop anyone that tested positive from coming into your bar or restaurant.
Apparently these tests exist but have not been submitted for approval due to the FDA requirements for higher sensitivity.
Frequency, fast results, and finding mainly those that are infected at a level to transmit is the key concept.
It really is a different mindset of a diagnostic versus a clinical test.
BTW, my boss's elderly mother became infected, had some symptoms, was treated and recovered, but was still testing positive weeks later. They sent her home citing the same issue, which was that the tests are showing positive weeks after she was sick or contagious. She is doing fine.
One thing is for sure: For the cost to the economy and the spending the government is doing during the pandemic, we could easily afford to have this sort of test paid for and distributed by Uncle Sam. That would also resolve any economic disparity concerns with regards to paying for testing.
The question is:
How do we get this across to the government establishment? As we have seen, the folks making the decisions are not so prone to taking chances or working outside the box, and new ideas that differ from the dogma are generally not welcome.
Some references:
From Yale -
Dr. Michael Mina Harvard:
https://www.microbe.tv/twiv/twiv-640 (specifically minutes 22-33)
Dr Mina's paper can be found here:
Sacrilege I know, but from the New York Times, an article by Dr. Mina and a professor of economics:
Many here bemoan how badly we have done this, because despite ramping up testing in what I think was pretty quick given the unknowns at the time plus the scale of the problem, the testing does not seem to have made any real difference. I would note that even places like Hong Kong, which were lauded for how well they did all of this testing and tracing, now are seeing a surge in new infections. Regardless, a main reason for this is another point that people like to complain about: results delays.
Now, it is in fact true that delayed results make the data not so useful for tracing and isolating, so I cannot argue about that.
However, what if the entire testing/tracing playbook is wrong? What if there is another way?
In a nutshell, the tests that are approved by the FDA are too sensitive. They are returning results for people that are likely not contagious and may not even have any viable virus left in their system. This type of test will always require the same sort of process: Train some sort of "expert" to administer the test, normally within a medical environment, pack it all up with proper documentation and handling, send it away to a lab with more trained "experts" for logging and running the test, make the run, log the results, transmit the results, etc. Of course there are limited numbers of people and equipment to do all of this, and then there is the handling and transit times. It will never be fast enough.
Instead, as has been proposed in a couple of very interesting papers and studies listed below (not yet peer-reviewed, GASP!), what if you had a cheap test (like the pregnancy test) that could be administered anywhere by anyone? To make it cheap and fast it would be less sensitive.
It does seem a little counter-intuitive that a less sensitive test would be a better choice, but there is solid logic behind the thinking:
It seems that the high sensitivity tests are giving positive results for people that either have low enough viral loads to be non-contagious, or for people that just have bits and pieces left in their systems, which can be detected many weeks after the infection is cleared.
So, the idea is to have a test that is so cheap and available that you could test every student before they went to school, test anyone that enters a space, and so on. A high percentage of people (not all, for sure) are responsible enough to stay home if they tested positive, and you could certainly stop anyone that tested positive from coming into your bar or restaurant.
Apparently these tests exist but have not been submitted for approval due to the FDA requirements for higher sensitivity.
Frequency, fast results, and finding mainly those that are infected at a level to transmit is the key concept.
It really is a different mindset of a diagnostic versus a clinical test.
BTW, my boss's elderly mother became infected, had some symptoms, was treated and recovered, but was still testing positive weeks later. They sent her home citing the same issue, which was that the tests are showing positive weeks after she was sick or contagious. She is doing fine.
One thing is for sure: For the cost to the economy and the spending the government is doing during the pandemic, we could easily afford to have this sort of test paid for and distributed by Uncle Sam. That would also resolve any economic disparity concerns with regards to paying for testing.
The question is:
How do we get this across to the government establishment? As we have seen, the folks making the decisions are not so prone to taking chances or working outside the box, and new ideas that differ from the dogma are generally not welcome.
Some references:
From Yale -
Dr. Michael Mina Harvard:
https://www.microbe.tv/twiv/twiv-640 (specifically minutes 22-33)
Dr Mina's paper can be found here:
Sacrilege I know, but from the New York Times, an article by Dr. Mina and a professor of economics:
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