Home Covid Testing

[sengsational]

It seems that the idea that widespread, quick turn-around, inexpensive testing is getting more attention lately. The idea is that the so-called "paper" antigen tests that cost $2 and supply results in 15 minutes can be leveraged to reduce the velocity of the spreading of Covid-19.

Michael Mina, a doctor / epidemiologist has written a paper (my bold) that concludes:

These results demonstrate that effective surveillance, including time to first detection and outbreak control, depends largely on frequency of testing and the speed of reporting, and is only marginally improved by high test sensitivity. We therefore conclude that surveillance should prioritize accessibility, frequency, and sample-to-answer time; analytical limits of detection should be secondary.

The test sensitivity isn't as important if what you're trying to do is keep the "worst offenders" from going to school or from serving you at a restaurant. The way he puts it is "A critical point is that the requirements for surveillance testing are distinct from clinical testing."

Link to the paper: https://www.medrxiv.org/content/10.1101/2020.06.22.20136309v2

Next Wednesday (August 5), Dr Mina will be recording a live question and answer session with the folks at MedCram. Details here: www.medcram.com/pages/live. In the mean time, you can get background on this idea searching "medcram 98" and watching the 17:06 video released July 20 where the idea is examined.

I think this issue is important for ER people because we rarely ever "have to" go out of the house. But we don't want to spend the time we thought we'd be adventuring, instead sequestered. So if we want to be active in our retirement, if we can be assured that routine, frequent testing is in place for people we will get near during that activity, that will be a path to getting back to normalcy, even if vaccination isn't available.

 

[MissMolly]

Although I think this is encouraging news, wouldn't our safety in relying on these tests mean we would have to rely on everybody else taking the test in before venturing forth? I know a lot of people would not bother taking this on any sort of routine basis. How could we be assured that other people are taking these tests? Or perhaps you were referring to more controlled circumstances like going to see family only?

 

[audreyh1]

Yes, absolutely. We need a quick, cheap, minimally invasive test that can be done daily if necessary, get the results at the workplace/school. Screen groups of people who are going to be together.

Save the fancy lab tests for those that are likely positive and are showing signs of symptoms, or as a follow up if necessary.

 

[Aerides]

Although I think this is encouraging news, wouldn't our safety in relying on these tests mean we would have to rely on everybody else taking the test in before venturing forth? I know a lot of people would not bother taking this on any sort of routine basis. How could we be assured that other people are taking these tests? Or perhaps you were referring to more controlled circumstances like going to see family only?

to an extent, yes, but if it means you can expand your circle from 2 to 4, or 12 (i mean the holidays are approaching), then it would be awesome. "hey y'all come over, test 48 hours before and again at the door!" something.

Or if I want to travel and then come home, I can self-test in a day vs. quarantining for 14 before I see anyone else.

To me, the idea of quick self-testing opens things up and would serve as a stop gap along the way.

 

[easysurfer]

I didn't find a mention of what the home covid testing is like.

If a saliva test then ...

If a nasal swab then ...

 

[EastWest Gal]

Dr. Mina spoke on This Week in Virology last week. He has some really good points. If it is done at home and is a nasal swab, there could be false negatives due to poor sampling, I'm afraid.

 

[audreyh1]

Oops - please, no more nasal swabs!

 

[gauss]

With the words "antigen" and "paper" used in the OP, I assumed that it was a pin-prick blood test.

-gauss

 

[donheff]

I heard epidemiologists on TV talking about rapid testing to open businesses and schools. They were adamant that the tests are good enough and fast enough to be a game changer if used widely and frequently. BUT, the problem was they didn't see a path to widespread adoption or ramp up by the companies unless the federal government put in about a $60B order under the Defense Procurement Act and led a coordinated national rollout with the states. With the trillions we are spending I think this sounds reasonable but I can't see it happening in the current environment.

 

[audreyh1]

Yes, you would think folks anxious to get the economy going and schools opened would put this kind of testing on a very high priority including funding.

Otherwise we’re going to open up, shut down, open up, shut down.....

 

[stepford]

I assume we'll just wait for some civilized country to develop such a test... then buy it. Our dollars still work even if not much else in the USA does.

 

[MichaelB]

Here’s a recent article from Harvard’s Chan School of Public Medicine. The conclusion is lower sensitivity tests can have positive impact on reduring the spread of infection if carried out on a large scale. The abstract https://dash.harvard.edu/bitstream/...haffer Baym Hanage.pdf?sequence=1&isAllowed=y

Abstract: Preventing future infection waves of COVID-19 will depend on effective and efficient contact tracing. SARS-CoV-2 transmission appears to be characterized by high individual variation and a large role of superspreading events. Taking this into account can improve the cost-benefit tradeoffs of contact tracing. In particular, an individual who is known to have transmitted the infection once is more likely to have transmitted to other individuals. We propose a strategy of identifying transmission events, making use of the variability in secondary case numbers. A rapid, high-specificity test with only 50% sensitivity can still identify the vast majority of these transmission events. This strategy can lead to the isolation of a large proportion of infected individuals while drastically reducing the isolation of uninfected contacts.

So, to confirm an infection, the test needs to be highly accurate, but to screen large numbers of people, even a low sensitivity test makes a big difference.

 

[donheff]

I assume we'll just wait for some civilized country to develop such a test... then buy it. Our dollars still work even if not much else in the USA does.

Just buying a few tests for ourselves or a few employers buying them doesn’t help much toward getting back to normal. That would take a serious national investment and that doesn’t appear forthcoming.

 

[sengsational]

Dr. Mina spoke on This Week in Virology last week. He has some really good points. If it is done at home and is a nasal swab, there could be false negatives due to poor sampling, I'm afraid.

It can (and should) be saliva, to make sure more people do it. They are already doing video consults to monitor people doing the collection, so that could be leveraged. Of course, the cost will be greater than $2 if there's a video conference with an expert monitoring the process. But if it's as simple as saliva, I think we might not let being slightly imperfect get in the way; most people will do it right, so most of the highly infectious people will know it right away. A few will slip through, that's ok. If someone is heading to a gathering (ie school), get most of the heavy shedders out of circulation and you've likely significantly hit the brakes on transmission.

 

[audreyh1]

It can (and should) be saliva, to make sure more people do it. They are already doing video consults to monitor people doing the collection, so that could be leveraged. Of course, the cost will be greater than $2 if there's a video conference with an expert monitoring the process. But if it's as simple as saliva, I think we might not let being slightly imperfect get in the way; most people will do it right, so most of the highly infectious people will know it right away. A few will slip through, that's ok. If someone is heading to a gathering (ie school), get most of the heavy shedders out of circulation and you've likely significantly hit the brakes on transmission.

That sure sounds great. I hope we can do this!

 

[gauss]

I think the powers that be are banking on approving a vaccine of some sort and then declaring victory. They will then say that massive testing would be unneeded.

 

[sengsational]

A billion or two vials of an effective vaccine would be better than any testing, for sure. If I ruled the world, eggs would be placed in more than one basket.

 

[braumeister]

Preventing future infection waves of COVID-19 will depend on effective and efficient contact tracing

Yes, everything I've read seems to show that the places that have had the most success have put great effort into contact tracing as well as testing.

 

[audreyh1]

Well there is clearly some effort going on with NIH backing.

Federal Push For Faster, Cheaper Coronavirus Tests Focuses On 7 New Technologies
https://www.npr.org/sections/health...n-coronavirus-tests-advance-toward-production

There is a Washington Post story titled “ college students can safely return to school if tested every 2 days, study says”.
Here is a Forbes report on that study that was released today:
https://www.forbes.com/sites/susana...ays-can-return-to-campus-safely/#7e05a5ff11dc

So the drumbeat is getting much louder on this.

 

[Aerides]

Dr. Mina spoke on This Week in Virology last week. He has some really good points. If it is done at home and is a nasal swab, there could be false negatives due to poor sampling, I'm afraid.

Hah, most of us can't be trusted to put q-tips in our ears per the directions, any test that actually required home-swabbing wouldn't make it off the drawing board.

Saliva testing seems like a great idea, very low bar of entry.

 

[CaptTom]

This is all very encouraging, but I see a possible roadblock in the US. Can testing have a positive impact if only 50% of the people get it?

Right off the bat, 40% will refuse because they believe it will negatively impact their preferred candidate's chances in the election. I'm guessing another 10% (probably more) are simply too busy, too lazy or just unable to deal with the process of getting tested.

I could see it having a positive impact if workplaces and schools required - and performed - the testing before allowing employees and students in. That would at least create a safe "bubble" on company or school property. Maybe that's our best hope.

 

[audreyh1]

I could see it having a positive impact if workplaces and schools required - and performed - the testing before allowing employees and students in. That would at least create a safe "bubble" on company or school property. Maybe that's our best hope.

Yes, I see that where rapid and cheap testing is most useful. To help keep places where people must gather as safe as possible.

Contact tracing too, as much as it can be done in this country. Lots of resistance to contract tracers, many people won’t cooperate from what I read.

 

[sengsational]

Live Event with Dr. Michael Mina

This is the virologist from Harvard that's championing the rapid antigen testing.

Starts in 10 minutes.

Not the 'live' means much when you can always watch the replay, hehe!

www.medcram.com/pages/live


Here's a link to a free NYT article penned my none other than our buddy Larry Kotlikoff! Larry is the guy who's famous for "won the game, why gamble" approach to retirement investing! Small world.

https://www.nytimes.com/2020/07/03/opinion/coronavirus-tests.html

 

[sengsational]

If you think rapid tests are a good thing, you can visit here:

https://www.rapidtests.org

to learn more about how to support the idea.

 

[audreyh1]

Texas does not include rapid antigen tests positive results in its COVID-19 case counts.

Texas, unlike 27 other states, excludes the results of increasingly popular, rapid COVID-19 tests from the numbers it reports publicly — obscuring the scope of the pandemic, records and interviews show. The antigen tests are used in doctor’s offices, hospitals and stand-alone clinics and deliver results in less than 30 minutes.
.....
And while there is no way to independently estimate the scope of the undercount, based on the 11 Texas counties that publish antigen tests results separately of their own accord, the state’s tally is short by at least tens of thousands of cases — but likely far more, a Houston Chronicle analysis found.

And the undercount is about to get worse. The federal government is rolling out a program to use thousands of antigen tests in nursing homes across the country — including Texas.

https://www.houstonchronicle.com/ne...-Texans-are-getting-rapid-result-15452709.php