Adoption of strategies that aim to allow people to test themselves, privately,simply, at home, 1-2x/week could help suppress outbreaks quickly. Especially in context of other public health measures.
We don’t need perfect compliance, at all. We just need decent compliance - we can achieve this. Like herd immunity, we don’t need this to be everyone, just enough people to drop R<1. I estimate 10% of people in a community would test at home per day. So need not have perfection
We still need reporting so public health officials can keep track
No problem... we work w Google, Apple and whoever else to make voluntary reporting easy as a FaceTime call. If I can see my twin brother 2000 miles away w the push of a button, I should be able to report a result
What will a program like this cost the US - probably $10-20B. (That includes messaging/logistics - $5-10B just for the tests). Pennies compared to the cost of the virus thus far.
Also, the purpose of this sort of public health screening is to suppress whole outbreaks vs stopping all cases. These are different. Most ppl think in terms of individual cases, but here the broader idea is to focus on ensuring stopping every outbreak, not every case....
If we can do this, maybe sooner rather than later we can find ourselves in position where we can go back to work and resume normalcy bc incidence could get very low/absent in a community.
testing could then slow down. Survey wastewater. If cases return, start the testing again
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Frequent testing is needed to detect people early before infecting others. They must be highly scalable and for buy in, very convenient - i.e. home use
10M Rapid tests/day (i.e. antigen bc scalable / simple) can form the foundation to build back economy
Frequent tests alone won’t be the end all be all of this pandemic. Not by a long shot. These can greatly reduce odds of transmission - when used en masse, odds of onward transmission (i.e. Rt) can plummet.
To work, also need huge social/economic safety nets, + masks/distancing.
Although new administration will not officially start till January, we have options now. @JoeBiden and team led by @vivek_murthy can start now to engage manufacturing and begin planning/building these at scale w promise of payment once in office, as one example.
Headline says as much as 1M Americans getting COVID daily. This is based on a back of the envelope calculation
We know that only 10% of cases may be diagnosed. So if we have 100k diagnosed daily, then the thinking is that x10 = 1 million
But this misses a crucial piece
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Even though 100k+ new cases DETECTED daily, and we can multiply by 10 for underdiagnosis and get 1M... this is not NEW cases happening daily. This is prevalence of virus positivity daily....
To convert to daily INCIDENCE (Ie new infections daily) takes another step
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The specificity of the PanBio, BinaxNow and SD Biosensor tests (the three leading manufactured rapid tests in the world) are looking very good!
In this paper, specificity was 100% in >400 samples... thus >99.2%
Now multiple studies showing very high specificity!
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The sensitivity metrics AND specificity metrics are now completely in alignment with what we have proposed for frequent rapid testing that can control outbreaks without vaccines.
In light of the recent article from the UK discussing antibody waning - it’s important to read additional reports that show that while the antibodies are waning, they are not disappearing. This is expected and the natural course of an immune response.
After a primary infection, antibodies go sky high - along with the cells that produce them - and then after the virus clears, those cells must subside and the antibody production falls. Antibodies this wane, almost by definition, after a primary infection
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Importantly, the antibodies do go down and, like in the UK report may fall below the limit of detection. But like in the @SciImmunology paper above by @florian_krammer among others, when a more sensitive test is used, they often remain detectable...
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