Thread by @JeffJacksonNC

“Hey Jeff, you know we can't stay home forever, right?”

Let’s talk about how North Carolina gets back to work.

And let’s skip the obvious stuff - like hand-washing and staying home if we’re sick.

/thread - #ncpol #covid19 #coronavirus/

To fully reopen, we’re going to need to know four things:

Who’s sick, who’s not, who’s been sick, and who hasn’t.

That’s the information that will let us track and control future localized outbreaks (which are inevitable) without requiring wide-scale shutdowns.

It will also give the public confidence that it’s safe to become customers - not just employees - of restaurants, theaters, barber shops, airlines, hotels, sports arenas, food trucks, colleges and universities.

We missed the opportunity to get ahold of this on the front-end because we didn’t have widespread testing, and we didn’t have it for three reasons: a lack of test kits, a lack of related chemicals needed to use the test kits, and a lack of PPE needed to administer the tests.

But we can’t just call that a failure a move on. We actually have to solve the problem, only now it’s much bigger because the universe of those who are potentially infected has grown by several orders of magnitude.

One more factor: The testing can’t just be widespread - it also has to be rapid. Waiting ten days for a result isn’t particularly helpful when that person can easily infect dozens more while results are pending.

So what will it take to get rapid, widespread testing in NC?

MOLECULAR TESTING

Broadly speaking, there are two types of tests: molecular and antibody.

The molecular tests are the ones we’ve been using. You take a swab from the back of someone’s nose or throat, you extract the RNA, then you see if it matches the COVID RNA.

We’ve done about 60,000 so far in North Carolina (that number includes private labs, which are currently doing the vast majority of the testing). We did about 4,000 yesterday. We are strictly rationing them due to supply concerns.

Molecular tests are highly accurate, but the global demand for them is so high that we’ve been plagued by a number of material shortages needed to perform them. The biggest shortage right now is the PPE needed to administer the test (discussed at length in many other posts).

That brings us to the molecular test kits themselves.

We’ve seen increased capacity, but we’ve also seen innovation. Abbott now has a machine which will give a result in 15 minutes. It got FDA approval two weeks ago and is probably the most in-demand medical device on earth.

Abbott says they can only make 400 of these machines per week for the foreseeable future.

The federal government is in charge of allocating them to states.

So far, North Carolina - like most states - has received 15 machines.

Let’s do some quick math.

Over the next six weeks, Abbott should be able to make 2,400 of these machines.

North Carolina has roughly 3% of the national population, so let’s say we get 3% of the machines (big assumption).

That means we might get another 70 machines...

within the next six weeks, for a total of 85 machines. 85 machines working 24/7 at a rate of roughly 4 tests per hour = roughly 8,000 tests per day.

That would more than double current capacity. So more Abbott machines won't be the whole solution for us, but it’s a big piece.

Overall, it is very realistic to expect our state’s molecular testing capacity to grow significantly this month.

HOWEVER, it may not be realistic to expect the kind of 10x growth in testing capacity which some say will be necessary to reopen without resurging the virus.

Which brings us to...

ANTIBODY TESTING

This involves pricking your finger for a blood sample that shows whether you have antibodies that indicate the virus has already been there and has been successfully fought off.

Currently the FDA only recommends antibody tests for screening purposes to see who has already had COVID, but there’s an ongoing conversation about whether the test can be accurate enough to also be used for diagnostic purposes - that is, to see if someone is currently infected.

Different companies report different rates of accuracy, but most report that their antibody tests can detect COVID over 90% of the time. The tests are at the lower end of the accuracy range in the early days of infection, before the body has had time to build up...

enough antibodies to register with the test.

But any COVID test with an accuracy rate above 90% - when the alternative may be no test at all - has to be seriously considered.

And antibody testing at random across the state - or in certain vulnerable communities - might be helpful in identifying hot spots and letting us know where to focus our supply of molecular tests.

Right now, there are only a few companies which have FDA authorization to distribute antibody tests.

These tests are not yet available in the millions, which is what you would need to create a national supply from which NC could receive an amount big enough to make a dent.

But things are evolving rapidly and there’s renewed interest in antibody testing at the national level so this could change quickly.

This week Dr. Fauci said, "Within a period of a week or so, we're going to have a rather large number of [antibody] tests that are available.”

HOW MANY DAILY TESTS DO WE NEED TO PREVENT A RESURGENCE?

No one knows. Estimates vary wildly. But certainly multiples of what we’re doing now.

Bottom-line:

Ramping up testing capacity doesn’t involve just pulling one lever - we have to do several different things simultaneously.

But we've got a sense of what those things are and we're being realistic about what it's going to take.

Most important: There is a set of overwhelming incentives on the part of virtually everyone - state officials, politicians, business leaders, students, parents, workers - to reopen without causing a resurgence. Everyone is working toward the same goal. That's rare - and powerful.