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We can choose to have i) perfect reporting of a relatively small number of infrequently used tests that have slow turnaround times, OR ii) we can have imperfect reporting of a LOT of rapid tests Choice (ii) will provide MORE data, not less, to public health authorities 8/
With nearly half of the country testing themselves weekly, incredibly... we do not need to rely on contact tracing... which is largely to figure out who to test and isolate (And it generally isn't working great). Here the frequent rapid at-home tests ARE the intervention 9/
The tests ARE the intervention because they let people know they are infected WHEN they are infectious. And then people isolate for 10 days... or since that's burdensome for many... at LEAST until they have been negative for 48 hours... often < 10d. 10/
Some will say "Some people may not isolate"... yes... that's true - Some won't But some won't with PCR/Test/Trace/Isolate as well. We don't handcuff people home Here, this is more personal. They are testing themselves and SEE they are positive. Most POSITIVES will isolate 11/
This is NOT an "Entry Screen"... this is a "Public Health Screen" The goal is NOT to stop every case. The goal is to stop every outbreak. Slow it down, get R << 1, and let the outbreak die out. So far we've been trying to stop outbreaks by focusing on stopping cases.. 12/
We need to shift our focus - away from thinking of this as a lot of medical problems, to thinking about this as one big public health problem If we focus on stopping OUTBREAKS and not individual cases, we realize the full power of frequent rapid at home testing... 13/
In this program, it is not a big deal if the test misses someone - remember, 50% of people are choosing not to participate at all!! Here, the goal is to suppress the outbreaks by driving R <<1. So that in weeks outbreaks have dropped dramatically and everyone becomes safer 14/
We see a TREMENDOUS example of the power of frequent rapid tests in Slovakia
Slovakia is testing ~50% ppl 1x/wk
In the first week alone the incidence of #COVID19 dropped ~50%!
We CAN do this in the US too!!
It takes a plan, strategy, coordination, and funding.
15/
Also -we must ensure income for anyone who needs to isolate. This is an absolute must. We must have a LOT of high quality messaging - on web/tv/radio - like wartime messaging to make sure everyone understands the purpose, goals, how to test, etc We can do this! 16/16
Finally - to clarify - this is the plan I envision. I HOPE the Biden team will take it and run with it - or some version of it.
Also - Here is what would happen if we implemented this program! (Note, we mistakenly labeled this "surveillance" but it should be "screening". This comes from a soon to be formally published pre-print: https://www.medrxiv.org/content/10.1101/2020.06.22.20136309v3.full.pdf …pic.twitter.com/w4sqdDh17c
Here, we evaluated the economic return on investment of this plan had we started in June - Dec 2020. The version described above is shown in panel C Costs (all included) $28B Would have increased GDP by $395B! Would have saved >100,000 lives in 2020! https://www.medrxiv.org/content/10.1101/2020.10.22.20217984v2.full.pdf …pic.twitter.com/VhGTajljzS
Here is a news report on the efforts in Slovakia to drop incidence by 50% through widescale testing of their population in a short amount of time.https://www.usnews.com/news/world/articles/2020-11-09/slovakia-says-covid-double-testing-cut-number-of-infections-by-more-than-half …
And here is a paper we wrote describing why, for a program like this, we needn't worry about low analytical sensitivity and instead must prioritize sensitivity to detect infectious people....https://www.nejm.org/doi/full/10.1056/NEJMp2025631 …
If worrying that rapid tests miss a lot of people at start of infection - This paper tracked regular people over time to see if they turn positive. Note incredibly fast upswing in virus titers! Frequency, not sensitivity at the limit of PCR is needed. https://www.medrxiv.org/content/10.1101/2020.10.21.20217042v1.full.pdf …pic.twitter.com/z8gFCLgSEk
In other words, the time difference is minimal between when ppl 1st turn PCR pos and when they turn rapid antigen positive. It is MUCH better to prioritize frequency and turnaround time over PCR type sensitivity b/c within hours of PCR turning pos, the viral load is sky high.
Oh. Also recognize that that plot of virus titers is a log scale. Every 3.3 Ct values is a 10-fold change. So 40-30 is a 1000x increase in virus titers.
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