Short of a game-changing vaccine, our only sure way of ending COVID-19 before it kills or sickens millions more of us is testing every American every day. Imagine we could do this and quarantine everyone who tested positive until they were no longer infectious. The virus would be fully imprisoned within days. With no ability to spread to the healthy, our modern-day plague, whose annual death rate exceeds that of any armed U.S. conflict, would be history.
Yes, we’d need to continue testing everyone, including those entering the country until a vaccine became available. As for compliance, it needn’t be perfect to eliminate the virus’ ability to spread. In epidemiological parlance, R0 — the number of people infected by someone who is infected — would be driven far below the critical value of 1 at which point the virus rapidly disappears.
Compliance would be exceptionally strong thanks to the private market. Same-day, time-stamped cell-phone pictures (videos if there is concern about person X displaying person Y’s test results) of negative test — tests, which were approved and supplied to everyone for free by Uncle Sam — would be required to enter the workplace, fly on an airplane plane, frequent a restaurant, enter a store, or attend a school, college, or university. If home tests weren’t perfectly precise, you’d likely need to show several days of negative test results. These requirements would be established by market players, not by government decree. But every enterprise would adopt such strictures to keep their workers, customers, and students safe. Even friends and families would require confirmation of negative test results for participating in social events.
As Harvard epidemiologist, Michael Mina, and I recently explained, quick, daily, at-home COVID-19 tests, little different from pregnancy tests, could realize this vision. An ideal test would be licking a piece of paper with a strip of protein. The strip would turn green if you tested negative and red if you tested positive. Your response to red would be to a) immediately quarantine, b) inform your doctor, and c) have a standard PCR test (the standard test now being used across the country) to confirm the finding. You’d leave quarantine when your daily test became and stayed negative for several days.
Such rapid, immediate, and inexpensive ($1 to $5) tests are under development by a handful of companies and individual researchers. But to capture and kill COVID-19 before hundreds of thousands more Americans die or are sickened, the Administration needs to do four crucial things.
The first is initiate a Manhattan Project to develop rapid home COVID-19 tests. The administration is pouring money into developing viable vaccines. It must do the same with rapid, home COVID-19 tests.
Second, once developed, the administration needs to mail or otherwise supply, free of charge, an ongoing supply of these tests to all Americans.
Third, the administration needs to initiate a Test for America campaign to convince the public that testing for COVID-19 every day is their patriotic duty as well as being vital to their own health and livelihood.
Fourth, and most important, the administration must direct the Food and Drug Administration’s (FDA) to approve tests and associated protocols that achieve real-time detection of the virus. The FDA is focusing almost exclusively on diagnosis and essentially ignoring or inhibiting, through its rules, detection. Ironically, detection can dramatically improve diagnosis since those with red strips would be directed to get the “gold standard” PCR test.
Diagnosing those who have the disease can help the infected and protect healthcare workers, but it’s a strategy for treating the sick, not saving the healthy. Real-time detection is the product of three testing features — accuracy, frequency, and speed.
The PCR test entails a healthcare specialist inserting a long, somewhat uncomfortable swab, deep in your nose. The swab is sent to a lab, where it stays for days before being analyzed, after which the results and a $50 to $100 bill are sent your way. In the meantime, you may have spread the disease believing you were healthy. You may also have become seriously ill still not knowing the cause.
This PCR test does a tremendous job detecting COVID-19, even in those with very low levels of viral load (number of viral molecules), but it’s does an absolutely terrible job in fighting the epidemic. It’s unpleasant, expensive, inconvenient, and slow. No wonder nine of ten people infected with COVID-19 never get tested. Multiply PCR’s high accuracy rate by its extremely low (zero for most people) frequency and extremely low speed and you get extremely low real-time detection. You can’t detect, let alone defeat, an enemy flying blind. But that’s exactly what we’re doing relying exclusively on PCR.
It’s time to fight this war with a super weapon, not continue to rely on a test that obviously has failed in what should be the FDA’s and CDC’s central mission — detect, isolate, and, thereby, destroy our ferocious enemy, COVID-19.
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