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Is it time to rethink the way we’re testing people?

Wednesday, Aug 5, 2020

* Harvard Magazine

“At the moment, the United States has no semblance of public-health testing” for the coronavirus, says Michael Mina, an assistant professor of epidemiology at both Harvard Medical School and the Harvard T.H. Chan School of Public Health. What does Mina—an expert in viral testing protocols—mean by that?

Current tests for active infection with SARS-CoV-2 are highly sensitive—but most are given to suspected COVID-19 patients long after the infected person has stopped transmitting the virus to others. That means the results are virtually useless for public-health efforts to contain the raging pandemic. These PCR (polymerase chain reaction) tests, which amplify viral RNA to detectable levels, are used by physicians, often in hospital settings, to help guide clinical care for individual patients. In general, members of the public have not had access to such tests outside clinical settings, but even if they did, would find them too expensive for frequent use.

Furthermore, such tests detect tiny fragments of viral RNA even after the patient has recovered. Mina says that means “the vast majority of PCR positive tests we currently collect in this country are actually finding people long after they have ceased to be infectious.” In that sense, a positive result can be misleading, because the results can’t be relied on to guide the epidemiological efforts of public-health officials, which are focused on preventing transmission and controlling outbreaks: “The astounding realization is that all we’re doing with all of this testing is clogging up the testing infrastructure,” with results arriving a week or more after tests are administered, “and essentially finding people for whom we can’t even act because they are done transmitting.” In fact the testing backlog is so dire, and so “absolutely horrendously useless as a system for public-health surveillance,” that Mina believes the United States should at the very least throw away the millions and millions of samples that are waiting to be tested—and perhaps even halt the current testing regime and just start over.

“We need to change the whole script of what it means to test people,” he says. “In our country, we have always assumed that testing belongs in the clinical sphere, in the diagnostic sphere, and has to be run by laboratories or diagnosticians. The result is that we have a system for coronavirus testing…which is flailing, with raging outbreaks occurring.” What the country needs instead are rapid tests, widely deployed, so that infectious individuals can be readily self-identified and isolated, breaking the chain of transmission.

To do that, Mina says, everyone must be tested, every couple of days, with $1, paper-based, at-home tests that are as easy to distribute and use as a pregnancy test: wake up in the morning, add saliva or nasal mucous to a tube of chemicals, wait 15 minutes, then dip a paper strip in the tube, and read the results. Such tests are feasible—a tiny company called E25Bio, and another called Sherlock Biosciences (a start-up spun out of Harvard’s Wyss Institute for Biologically Inspired Engineering and the Broad Institute in 2019) can deliver such tests—but they have not made it to the marketplace because their sensitivity is being compared to that of PCR tests.

Mina says that is beside the point. “Imagine you are a fire department,” he says, “and you want to make sure that you catch all the fires that are burning so you can put them out. You don’t want a test that’s going to detect every time somebody lights a match in their house—that would be crazy: you’d be driving everywhere and having absolutely no effect. You want a test that can detect every time somebody is walking the streets with a flame-thrower.”

Go read the rest.

* Meanwhile

Most classes at Illinois State University will be online-only when the fall semester begins later this month, officials announced Tuesday.

President Larry Dietz said in an email to students and faculty that the university learned late last week it would not receive some testing equipment and supplies that were expected before classes started. The U.S. Department of Health and Human Services “reallocated” the equipment and supplies to other agencies, he said. HHS did not immediately respond to a request for comment Tuesday.

Yeah, that federal government. Always doing the right thing by the people. Yep.

- Posted by Rich Miller        

27 Comments
  1. - Pundent - Wednesday, Aug 5, 20 @ 10:01 am:

    =What the country needs instead are rapid tests, widely deployed, so that infectious individuals can be readily self-identified and isolated, breaking the chain of transmission.=

    Schools are moving in the direction of requiring temperatures to be taken each morning with results reported before attending. Switch that to daily test results and we might be on to something. Sure we might give up some reliability with the paper based tests. But we’ll also significantly reduce the number of people unknowingly walking around with the virus which our current testing process does nothing to address.


  2. - Just Me 2 - Wednesday, Aug 5, 20 @ 10:01 am:

    I’d bet serious money that the reallocation conveniently benefits swing states.


  3. - Moe Berg - Wednesday, Aug 5, 20 @ 10:03 am:

    Perhaps I’ve missed it, but though IDPH reports the number of positive tests each day, it doesn’t provide any information on how old those tests are.

    So, what does it mean that 1,471 new cases were reported yesterday? When are those results from, on average? 3 days old? 7? 10 or more?

    The presentation of the data makes it seem real-time. But, it’s not.

    It’s possible we are getting a snapshot of what the situation was a week or more ago. Given the upward trend of late, that’s concerning.


  4. - Bruce (no not him) - Wednesday, Aug 5, 20 @ 10:05 am:

    “reallocated” Red state needed them.


  5. - M - Wednesday, Aug 5, 20 @ 10:10 am:

    ==”The U.S. Department of Health and Human Services “reallocated” the equipment and supplies to other agencies”==

    I would bet that is shorthand for sending equipment and supplies to the Republican states.


  6. - M - Wednesday, Aug 5, 20 @ 10:14 am:

    ” Sure we might give up some reliability with the paper based tests.”

    What good is it to get tested if it isn’t reliable?


  7. - Anon221 - Wednesday, Aug 5, 20 @ 10:20 am:

    US Population according to worldmeter is around 331,002,651 million.

    If everyone was tested daily with a $1 test, that would run to $120,815,967,615 yearly.

    If this type of “Manhattan Project” for CVOID-19 could be done, we would be trillions of dollars ahead in this country. Instead we fight over mask wearing and file lawsuit after lawsuit.

    https://www.forbes.com/sites/shaharziv/2020/06/02/coronavirus-pandemic-will-cost-us-economy-8-trillion/#14610d8a15e4


  8. - Benjamin - Wednesday, Aug 5, 20 @ 10:21 am:

    ==What good is it to get tested if it isn’t reliable?==

    If it tends to give false positives, that’s not so bad–you go in for a follow-up test using a more reliable method. But as long as it isn’t giving too many false negatives, you can feel confident that that you’re cleared once your cheap test says “all good.” That cuts down on the number of people needing the more time-consuming and accurate test.


  9. - West Side the Best Side - Wednesday, Aug 5, 20 @ 10:29 am:

    As the Harvard article concludes: “Imagine if the federal government took over…” Yes, imagine if we had a president who would actually pay attention to this article ( after someone pointed it out, can’t expect the president to be scrolling through Cap Fax)and decided to act on it. Imagine that, but… it is what it is.


  10. - Groundhog Day - Wednesday, Aug 5, 20 @ 10:34 am:

    Yes, I mentioned this type of test the other day. It would make functions such as sports, school, etc feasible. You would also test health care workers to be sure that they are not spreading it around. You would not have to test every man, woman and child every day, only those going out into the world. This is just another example of how our federal government is failing us.


  11. - illinifan - Wednesday, Aug 5, 20 @ 10:36 am:

    The FDA standards and certification processes need to adapt more because of this pandemic and allow these types of tests to be used. If this is done with PCR pool testing this could help identify outbreaks and allow for broader reopening. But as said this requires federal leadership.


  12. - 1st Ward - Wednesday, Aug 5, 20 @ 10:37 am:

    “What good is it to get tested if it isn’t reliable?”

    What good is a reliable test if it takes a week to know the results?

    To the post:

    This would be an effective way to have schools and the economy re-open somewhat “normal”. Bureaucracy amazes me.


  13. - 47th Ward - Wednesday, Aug 5, 20 @ 10:39 am:

    You’d think Rodney Davis would be shouting from the top of Watterson Towers over this federal screw up. When a targeted GOP Rep can’t get a little favor from HHS, what good is he to the district? Or has the Administration already written him off?


  14. - Amalia - Wednesday, Aug 5, 20 @ 10:46 am:

    well, per the Vanity Fair piece, we had a national testing plan in place but Trump did not want to save voters who would not be his. Do this everyday testing. but I’m sure it will wait until we have another President.


  15. - Joe Bidenopolous - Wednesday, Aug 5, 20 @ 11:03 am:

    ===What good is it to get tested if it isn’t reliable?===

    Even if a rapid test only caught 50% of infections, that would still take 50% of the contagious people off the streets and reduce the spread.


  16. - Petey L - Wednesday, Aug 5, 20 @ 11:30 am:

    The Feds gave the state of Illinois 3.5 Billion dollars for Covid relief. The state reportedly has only spent about $500 million. Someone may want to ask the governor why there are shortages in testing kits and people to do the testing. Just a thought


  17. - Logical Thinker - Wednesday, Aug 5, 20 @ 11:40 am:

    It’s funny how the same voices criticizing Trump for not having a national approach can’t seem to muster much criticism for the governor of our state who can’t seem to get programs to work in the state. It’s much easier to do on a state level than a national one but let’s not let that get in the way.

    As for “money, money, money” the government is literally printing it right now and giving it freely for Covid relief. I suspect the repeated cries for more money have nothing to do with the virus and everything to do with the years/decades of mismanagement.


  18. - Oswego Willy - Wednesday, Aug 5, 20 @ 11:48 am:

    === It’s funny how the same voices criticizing Trump for not having a national approach can’t seem to muster much criticism for the governor of our state who can’t seem to get programs to work in the state.===

    (Sigh)

    First, and last… any and all responses to Covid-19 should’ve been a national response, with a national leadership driving the entirety of the country in a single direction, not 50 different plans, and 50 states working against each other not in concert towards safety. The President failed by not taking the lead and putting it on governors. That’s one thought.

    Your other thought?

    Who exactly has said that Illinois tracing is all good, or silent on how terribly awful it’s implementation has gone? I know I’ve railed on it. I know others have too, only because it’s ludicrous to think it’s going good.

    Be a victim for the President on Facebook.

    === As for “money, money, money” the government is literally printing it right now and giving it freely for Covid relief.===

    Really? How so?

    Oh. This is how so;

    === I suspect …===

    Cable talking heads aren’t your friend.


  19. - Proud Sucker - Wednesday, Aug 5, 20 @ 12:03 pm:

    ===The Feds gave the state of Illinois 3.5 Billion dollars for Covid relief. The state reportedly has only spent about $500 million. Someone may want to ask the governor why there are shortages in testing kits and people to do the testing. Just a thought===

    A chunk of that is the pass through to the counties and municipalities. Kane has, almost, finalized its distribution after a month of discussions by a committee, not the Chairman (some drama there). So that’s part of the overall delay that gets attributed to the State.


  20. - Rich Miller - Wednesday, Aug 5, 20 @ 12:14 pm:

    ===The state reportedly has only spent about $500 million===

    We covered that here already. Another bogus story.


  21. - JS Mill - Wednesday, Aug 5, 20 @ 12:37 pm:

    =I would bet that is shorthand for sending equipment and supplies to the Republican states.=

    So we won’t “bailout blue states, but we will bailout red states? Which is almost certainly what is happening.


  22. - 1st Ward - Wednesday, Aug 5, 20 @ 12:43 pm:

    “As for “money, money, money” the government is literally printing it right now and giving it freely for Covid relief”

    As they should. Yields are low and consumer spending held up in May, June and July compared to the year prior (roughly flat). This is saving millions of jobs and businesses.

    Your alternative is not spend money and government revenues plummet further and your deficit grows the same over time with a longer recovery. States/Municipalities need more money and sooner to stop mass layoffs further deteriorating government coffers as seen post-08.

    What’s the alternative?


  23. - RNUG - Wednesday, Aug 5, 20 @ 1:11 pm:

    The nasal swab test I had gave the results in less than 48 hours. I was chatting with my nurse after my procedure and he said they do get some false results from it, but it was better than some of the other processes. I have no idea of the cost of that test.

    A cheap, almost immediate test would be a big step to getting on top of this virus.

    I know locally they are going to partially reopen 186, but I don’t think that will last more than 2 weeks before the school district has to go back to remote only. Heck, depending on the trend here in Sangamon County, 186 may have to change their reopening plans.


  24. - Last Bull Moose - Wednesday, Aug 5, 20 @ 1:39 pm:

    The cumulative effect of daily and rapid testing would be enormous. Say a test has 20% false negatives. Not a terribly accurate test. Now give that test three days in a row. The odds on a false negative on all three tests is 20% times 20% times 20%. That is 8 out of 1000 cases when the person tested was infected. If only 10% of the population is infected, you get 8 false negatives out of 10,000 people tested.

    That we can manage.


  25. - harp5339 - Wednesday, Aug 5, 20 @ 2:29 pm:

    So if the “false negatives” are simply due to the test not being sensitive enough, then presumably that person doesn’t have a high viral load and isn’t very contagious anyway, if at all. If that is the case, then these tests are a game changer. Infuriating to think there might be a way out of this mess that isn’t being acted upon.


  26. - Demoralized - Wednesday, Aug 5, 20 @ 3:44 pm:

    ==As for “money, money, money” the government is literally printing it right now and giving it freely for Covid relief.==

    Yeah. They should be doing that. Not sure you’re aware of this or not but we’re in the middle of a pandemic that has destroyed the economy in the country. The Government should be doing all it can.

    ==I suspect the repeated cries for more money have nothing to do with the virus and everything to do with the years/decades of mismanagement.==

    Yeah. Governments were just waiting on a pandemic. Please. You’re suspecting is ignorant.


  27. - Pundent - Wednesday, Aug 5, 20 @ 6:36 pm:

    =It’s funny how the same voices criticizing Trump for not having a national approach can’t seem to muster much criticism for the governor of our state who can’t seem to get programs to work in the state. It’s much easier to do on a state level than a national one but let’s not let that get in the way.=

    A four letter response - FEMA.


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