Advocate for Daily Covid Testing
Like many other working parents, I grapple with how we can get a handle on this pandemic and return to normalcy. Our children need to return to school. Friends want to go out freely again, and businesses need to serve customers with confidence. Extended families want to gather for dinners together. The current standard for testing is not working, but as Harvard epidemiologist Dr. Michael Mina proposes, paper strip testing can be a fast and effective-enough solution for us to control this outbreak and get closer to the life we used to have.
Current Testing Challenges
The current testing process falls short for many reasons. The standard nasal swab test, though highly sensitive and accurate, costs $50-$150 per test. It also takes between 2 and 14 days to receive a result. Because of the cost and wait time, 90% of infected Americans never get tested, and those that do typically only test once. While they wait, they most often continue their normal routine, transmitting the virus all the while. Contact tracers also find challenge in asking these Covid cases to recall their whereabouts two weeks prior to their positive result, rendering contact tracing useless.
Testing Frequency outweighs Sensitivity
As Dr. Mina describes in his New York Times editorial, we may have a simple solution within reach that legislators and community leaders need to advocate: Covid paper strip testing. Several companies and laboratories have developed paper strip tests and other inexpensive, rapid result Covid tests that could be done daily. Though not a perfect test, their cost-effectiveness outweighs the deficit in sensitivity, at $1-5 per day. Just imagine: individuals could check themselves often, and given a positive result, self quarantine and notify their doctor to confirm the result with a standard swab test. Taken a step further, the government could affordably provide these tests to all citizens. Businesses, schools, and restaurants could more definitively know how to act if each participant took the test and showed their negative result before entering. The public could move about more freely with confidence if these tests were employed as required for certain establishments like offices, classrooms, and restaurants.
Test Everyone, Test Often
This solution could help our ailing country move in the right direction towards controlling the spread, but requires the support from our legislators and Food and Drug Administration. I encourage you all to share this proposal with your local, state, and national leaders so we can fast track the approval of these tests. See the below template letter and email your neighborhood school principal, district superintendent, mayor, governor, and representatives of Congress. This disease is not something we can eradicate by ourselves. We need to work together to test everyone and test often, and put an end to this unimaginable chapter of our lives.
- A Cheap, Simple Way to Control the Coronavirus https://www.nytimes.com/2020/07/03/opinion/coronavirus-tests.html
- COVID-19 Testing Group Surveillance Policy Calculator https://larremorelab.github.io/covid-calculator3
- Test sensitivity is secondary to frequency and turnaround time for COVID-19 surveillance https://www.medrxiv.org/content/10.1101/2020.06.22.20136309v2
- TWiV 640: Test often, fast turnaround, with Michael Mina https://www.microbe.tv/twiv/twiv-640/
Sign the Change.org Petition
Sample Letter to your Community Leader
Thank you for your leadership!
It’s time for a change. We need frequent and rapid surveillance testing in our community — and the country — to squash this pandemic and get kids back to school.
The key to controlling the spread of this pandemic is frequent testing, with rapid results as quickly as possible, which identifies more infected people faster and can limit new infections. As such, please pressure the FDA to allow tests with a lower sensitivity than PCR. There are several companies developing technologies that can give results within an hour, some even done at home. These tests are sensitive enough to detect the vast majority of infectious individuals, which would mitigate the spread of the virus — even if a couple false negatives allow a tiny handful of actual infections through. Imagine the impact it would have if we could rapidly isolate 80% of all cases immediately.
But the FDA has decided that to be approved, every test needs to be at least 80% as sensitive as PCR, even in cases where individuals are highly unlikely to infect others. Even tests that are 100% sensitive can be useless if there is a shortage of tests and long turnaround, because infected people will have spread the virus before they finally get their results two weeks later.
Please ask the FDA to decrease its sensitivity thresholds or raise the required limit of detection for new tests, and fast-track production and distribution of these rapid result tests.
For more details, see this calculator and its corresponding paper (still a preprint):
You can also listen to this great interview with an advocate for frequent testing:
This Week in Virology (TWIV): https://www.microbe.tv/twiv/twiv-640/
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