Testing, testing, testing…

Readers of these posts know that we are extremely disappointed in how the whole testing story unfolded throughout the entire COVID-19 pandemic in the US.

On the 7th May we wrote in these columns:

“If there is any single major failure of policy and implementation of the science at the CDC, and at every level of government, it is in the area of testing.”

Things have not improved much since then. Below is the chart we showed yesterday, updated to current date, which shows States with a positivity above 5%, which is the level that indicates that only those that seek medical attention are being tested. This indicates that those states may not be able to understand whether the disease is spreading, and whether opening is recommended.

Uploaded from https://coronavirus.jhu.edu/testing/testing-positivity on 7/27/2010 at 13:00 EDT USA

There are other, profound problems with our testing. It’s too slow, taking days and sometimes weeks to return a result. And it is too difficult…requiring PPE clad, trained professionals to administer. This means that it is also too expensive and too ponderous to be used either universally, or frequently. And, to cap it all off, it takes to long to return, sometimes days, even weeks, by which time it is too late.

The Fix

We believe there is a real solution to the problem on the horizon. A shout out to Daniel Gerson, whose relentless researching, turned up some exciting developments that offer great promise if their advocates can overcome huge bureaucratic and regulatory hurdles endemic in our regulatory and healthcare systems today.

Daniel pointed us to https://www.youtube.com/watch?v=h7Sv_pS8MgQ&fbclid=IwAR21wiBpz4aI9hfp_BpiYlSGDcBkG4eiH7m_vfuxPHcXfEvhyWXSajL1ulM, a video on the MedCram YouTube channel. Apart from highly recommending the channel, and in particular Dr. Seheult the host of MedCram, Daniel was excited to have me learn about the work of Dr, Michael Mina of Harvard.

We highly recommend watching the video, but if you wish the Cliffs Notes, we will summarize the key takeaways below.

First, it is necessary to talk about Dr. Mina’s credentials, as he comes as an expert. He is an Assistant Professor of Epidemiology at Harvard T. H. Chan School of Public Health and a core member of the Center for Communicable Disease Dynamics (CCDD). He is additionally an Assistant Professor in Immunology and Infectious Diseases at HSPH and Associate Medical Director in Clinical Microbiology (molecular diagnostics) in the Department of Pathology at Brigham and Women’s Hospital, Harvard Medical School. His professional background and published work may be found here: https://ccdd.hsph.harvard.edu/people/michael-mina/

The summary of the video: Dr. Mina shows that the COVID-19 tests currently being conducted are – apart from being too costly and taking too long – too accurate!

Yes, you read that correctly, too accurate. His thesis is simple: the accuracy makes the test highly susceptible to finding positive results from people who are no longer infectious, and to make the test that sensitive, we have sacrificed speed, ease of use of the test, and economy. The video provides clarity by going into great detail on this issue.

Dr. Mina explains that we could produce, today, an extremely inexpensive, paper-strip/saliva test that could be self-administered, comfortably, at home that would immediately – in a matter of minutes – indicate whether a person is infected with COVID-19 and is infectious, and with an appropriate level of accuracy. In scientific terms it means printing monoclonal antibodies onto paper strips. The cost? At most, he says, a couple of dollars a strip.

Think about it. If every household in the US had a set of strips that they are able to use daily, then each and every one of us would be able to test ourselves on, test our children, every day.

Each of us could daily determine whether we were clear of disease, and therefore free to attend school, work and recreation without fear of infecting anyone.

Sound too good to be true?

The Science and the Politics of Testing

Without going into the science in excruciating detail, we can say that we have done a great deal of due diligence, and to our understanding, Dr. Mina’s findings are solid. We have the means to deliver at scale the tests he mentions, and these tests are capable of being used by the lay person, at home, in about 10 minutes or so, with no discomfort or difficulty. It the simplest possible terms, all that is required is spitting on a paper strip.

In short, it is a reliable test that determines whether a person is infected with COVID-19, and is thus infectious.

The test is not as sensitive as the current clinical tests. However, the sensitivity and accuracy of the clinical tests are not an advantage – and in some respects may be a disadvantage. The reason is well explained in the video, but essentially the virus, below certain levels of viral load, is not communicable. So the highly sensitive tests that we give could well quarantine people who are not longer infectious.

But this is the rub: our bureaucrats are fixated on sensitivity and accuracy, and will have a hard time accepting and investing in a test that they consider less than perfect. So in this sad case, the perfect may drive out the good, when ironically the good is better than the perfect.