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Topic:  Is our approach to testing wrong?

Topic:  Is our approach to testing wrong?
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L.C.
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  Message Not Read  Is our approach to testing wrong?
   Posted: 7/26/2020 5:32:04 PM 
Right now we rely on PCR tests, which require a swab stuck far up your nose, then a lab test, and results take 24-72 hours to get. So long as the swab was done correctly, they are fairly accurate. They cost about $100 each to do. While accurate, they are expensive, slow, and inconvenient, so people only get tested when they have symptoms.

The problem is that 80% of cases are spread by 20% of people, often people who have no symptoms, so they go about their business normally. 70% of people get symptoms early, so they stay home, and they also go get PCR tests. The superspreaders, who have no symptoms, however, never get tested.

There exists, an alternate method of testing. You spit on a piece of paper, and dip it in a solution. Then 10 minutes later you have your result. They are inexpensive, at about $1 a test. Unfortunately, they are only 50% accurate. However, the 50% they catch are the 50% with the highest viral loads. Maybe the answer is that we need more of this kind of test, administered in places where we can catch these potential superspreaders.

Suppose, for example, we allow bars to be open, but before someone is allowed in, they need to spit on a paper strip, and wait 10 minutes for the result? Then someone that is asymptomatic, and who has a high viral load, and who is thus a perfect candidate to be a superspreader, gets detected, and they can stay home for awhile. An asymptomatic person would never get a PCR test, but if thye tried to go into a bar, they would be detected.

You could apply the same thing in other settings, as well. Restaurants and gyms would also work. Football games? Basketball games? Maybe a lot more things can be open, if we can weed out the superspreaders. The quick tests may only be 50% accurate, but if they catch the people who need to be caught, they are a bargain at $1 a test.
https://www.usatoday.com/story/news/health/2020/07/26/cov... /

Note that I'm not suggesting discontinuing the PCR testing. That level of accuracy absolutely is necessary to diagnose people for treatment. What I am suggesting, is getting tests out in places where you can test people who appear healthy, where the test is fast and inexpensive, and to thus catch the people who need to be caught, but who are not being caught, the people who are both highly contagious, and who have no symptoms, so they don't realize they are capable of infecting others, and who would never be getting a PCR test under the current system.

Last Edited: 7/26/2020 5:54:26 PM by L.C.

“We have two ears and one mouth so that we can listen twice as much as we speak.” ― Epictetus

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Bobcat Love's Sense of Shame
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Member Since: 7/30/2010
Post Count: 3,472

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  Message Not Read  RE: Is our approach to testing wrong?
   Posted: 7/26/2020 6:21:30 PM 
L.C. wrote:
Right now we rely on PCR tests, which require a swab stuck far up your nose, then a lab test, and results take 24-72 hours to get. So long as the swab was done correctly, they are fairly accurate. They cost about $100 each to do. While accurate, they are expensive, slow, and inconvenient, so people only get tested when they have symptoms.

The problem is that 80% of cases are spread by 20% of people, often people who have no symptoms, so they go about their business normally. 70% of people get symptoms early, so they stay home, and they also go get PCR tests. The superspreaders, who have no symptoms, however, never get tested.

There exists, an alternate method of testing. You spit on a piece of paper, and dip it in a solution. Then 10 minutes later you have your result. They are inexpensive, at about $1 a test. Unfortunately, they are only 50% accurate. However, the 50% they catch are the 50% with the highest viral loads. Maybe the answer is that we need more of this kind of test, administered in places where we can catch these potential superspreaders.

Suppose, for example, we allow bars to be open, but before someone is allowed in, they need to spit on a paper strip, and wait 10 minutes for the result? Then someone that is asymptomatic, and who has a high viral load, and who is thus a perfect candidate to be a superspreader, gets detected, and they can stay home for awhile. An asymptomatic person would never get a PCR test, but if thye tried to go into a bar, they would be detected.

You could apply the same thing in other settings, as well. Restaurants and gyms would also work. Football games? Basketball games? Maybe a lot more things can be open, if we can weed out the superspreaders. The quick tests may only be 50% accurate, but if they catch the people who need to be caught, they are a bargain at $1 a test.
https://www.usatoday.com/story/news/health/2020/07/26/cov... /

Note that I'm not suggesting discontinuing the PCR testing. That level of accuracy absolutely is necessary to diagnose people for treatment. What I am suggesting, is getting tests out in places where you can test people who appear healthy, where the test is fast and inexpensive, and to thus catch the people who need to be caught, but who are not being caught, the people who are both highly contagious, and who have no symptoms, so they don't realize they are capable of infecting others, and who would never be getting a PCR test under the current system.


Short answer: yes, our testing strategy is wrong.

Longer answer: the sort of testing you're suggesting, coupled with strong contact tracing is essential, and having both would have allowed for much more effective reopenings.

As an employer, I've been trying to get in my hands on these tests for a month now. They're basically impossible to find. I've found a couple of vendors who have access, but they're always sold out.

I completely agree this is how we should be testing. This is a very obvious part of every successful 'return' strategy, and the right testing infrastructure would have greatly reduced shutdown times. The lack of this sort of testing infrastructure is exactly why there's so much uncertainty around businesses being able to reopen, office workers going back to in-office work, schools reopening, etc.

As a country, we've been behind the curve on our response since day 1.
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L.C.
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Location: United States
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  Message Not Read  RE: Is our approach to testing wrong?
   Posted: 7/26/2020 11:10:55 PM 
I don't believe any of paper strip tests I described have been approved yet. I know that there are regular PCR tests approved, that take up to several days to get results back, there are fast PCR tests, such as the one from Abbot, but they are somewhat less accurate, and there are also antigen tests from Quidel (Athens, Ohio), that give results in 5-10 minutes. Here's an article that discusses those two latter tests:
https://www.investors.com/news/technology/coronavirus-tes... /
The Quidel test requires a Sofia 2 machine, which they sell for $1200, and a cartridge for each test, that sells for $20. That's much less than the PCR test, but not nearly as low as the paper strip test, but still 90% accurate. The paper strip tests are only $1-2 each, but only 50% accurate. The Quidel test will be popular at places like Urgent Care clinics, where they have a Sofia 2 machine already, and want answers quickly whether a patient has Covid (and at the same time, whether they have RSV, Influenza A, or Influenza B with a single test), but wouldn't work at home.

The paper strips are tests you could do at home, and they are inexpensive. Here is one that is under development:
https://www.mprnews.org/story/2020/07/14/3m-developing-pa...
Here's one that may be available now in Australia:
https://www.msn.com/en-au/news/australia/instant-paper-st...

Note that they only detect very high viral loads. In a Covid infection, you start with no virus, and within a day or two it climbs high, peaks, and then after 4-5 days starts falling. The home tests will not detect it early, until the viral load gets high enough, and it will not be positive late, when most of the virus is gone. A PCR test will detect both.

If you test every day, though, you are going to catch it when the virus peaks. Is it better to test with a really accurate test only when you have reason to believe you are infected, or better to test often, knowing that you will catch it if you ever get infected?

Last Edited: 7/27/2020 8:56:20 PM by L.C.

“We have two ears and one mouth so that we can listen twice as much as we speak.” ― Epictetus

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rpbobcat
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Member Since: 4/28/2006
Location: Rochelle Park, NJ
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  Message Not Read  RE: Is our approach to testing wrong?
   Posted: 7/27/2020 7:00:31 AM 
There's an article by Elizabeth Weise of USA today in The Nations Health section of today's The Record about the CDC taking a different approach to retesting.

The Record won't let you link it.

I presume its on USA TODAY'S web site.

It goes into symptoms vs retesting.
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Bobcat Love's Sense of Shame
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Member Since: 7/30/2010
Post Count: 3,472

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  Message Not Read  RE: Is our approach to testing wrong?
   Posted: 7/27/2020 7:51:09 PM 
L.C. wrote:
I don't believe any of paper strip tests I described have been approved yet. I know that there are regular PCR tests approved, that take up to several days to get results back, there are fast PCR tests, such as the one from Abbot, but they are somewhat less accurate, and there are also antigen tests from Quidel (Athens, Ohio), that give results in 5-10 minutes. Here's an article that discusses those two latter tests:
https://www.investors.com/news/technology/coronavirus-tes... /
The Quidel test requires a Sofia 2 machine, which they sell for $1200, and a cartridge for each test, that sells for $20. That's much less than the PCR test, but not nearly as low as the paper strip test, but still 90% accurate. The paper strip tests are only $1-2 each, but only 50% accurate. The Quidel test will be popular at places like Urgent Care clinics, where the have a Sofia 2 machine already, and want answers quickly whether a patient has Covid (and at the same time, whether they have RSV, Influenza A, or Influenza B with a single test), but wouldn't work at home.

The paper strips are tests you could do at home, and they are inexpensive. Here is one that is under development:
https://www.mprnews.org/story/2020/07/14/3m-developing-pa...
Here's one that may be available now in Australia:
https://www.msn.com/en-au/news/australia/instant-paper-st...

Note that they only detect very high viral loads. In a Covid infection, you start with no virus, and within a day or two it climbs high, peaks, and then after 4-5 days starts falling. The home tests will not detect it early, until the viral load gets high enough, and it will not be positive late, when most of the virus is gone. A PCR test will detect both.

If you test every day, though, you are going to catch it when the virus peaks. Is it better to test with a really accurate test only when you have reason to believe you are infected, or better to test often, knowing that you will catch it if you ever get infected?


Gotcha, that makes sense. I actually didn't recognize the difference between the two types of rapid tests. I did think you're $1 price tag felt wrong based on my experience looking for rapid tests, but figured the healthcare industry marking up a $1 test to $110 was just par for the course.
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L.C.
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Member Since: 8/31/2005
Location: United States
Post Count: 10,303

Status: Offline
  Message Not Read  RE: Is our approach to testing wrong?
   Posted: 7/27/2020 8:53:48 PM 
I asked around, and so far as I was able to learn, none of the $1 "home" tests, where you spit on a strip of paper, have been approved yet, even for emergency use.

Edit - And, here's another test under development, this one from Iowa State. They are trying to make a test where you can pee on a paper strip:
https://phys.org/news/2020-06-chemists-paper-strip-urine-...

Last Edited: 7/28/2020 2:55:29 PM by L.C.

“We have two ears and one mouth so that we can listen twice as much as we speak.” ― Epictetus

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BillyTheCat
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Member Since: 10/6/2012
Post Count: 9,797

Status: Offline
  Message Not Read  RE: Is our approach to testing wrong?
   Posted: 7/30/2020 3:33:03 PM 
L.C. wrote:
I asked around, and so far as I was able to learn, none of the $1 "home" tests, where you spit on a strip of paper, have been approved yet, even for emergency use.

Edit - And, here's another test under development, this one from Iowa State. They are trying to make a test where you can pee on a paper strip:
https://phys.org/news/2020-06-chemists-paper-strip-urine-...


No worries, you can now purchase test guaranteed to be negative.
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L.C.
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Member Since: 8/31/2005
Location: United States
Post Count: 10,303

Status: Offline
  Message Not Read  RE: Is our approach to testing wrong?
   Posted: 7/31/2020 8:21:42 PM 
The FDA actually did authorize a saliva test that was developed at Rutgers:
https://www.cnn.com/2020/05/08/us/covid-19-at-home-saliva...

It is not a test of the type I described, however. First, it costs $150. Second, you have to have a doctor's order to get it. Third, you have to collect the sample under supervision, using a Zoom call. Fourth, you send the sample back to a lab, and don't get the results for a 48-72 hours.
https://www.vaulthealth.com/covid

There is also an at-home test from Lab Corp, where you stick a swab up your own nose. Good luck with that.
https://www.pixel.labcorp.com/at-home-test-kits/covid-19-...

“We have two ears and one mouth so that we can listen twice as much as we speak.” ― Epictetus

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