Most New Yorkers—and a huge part of the world—might agree today that there are few terrors worse than testing positive for Covid-19.
That reality struck us several weeks ago. We are brothers who live together in Manhattan’s East Village and cannot easily social distance from each other. Suraj started experiencing the symptoms of a Covid-19 infection including 101–102-degree fevers, shortness of breath, and body aches for several days. Fortunately, Viral is an ER physician whose ability to return to work is dependent on our household being Covid-free. Viral swabbed Suraj at home and safely sent the sealed sample to a lab in Brooklyn without coming into contact with anyone or clogging hospital waiting rooms. The test came back positive and allowed us to notify recent contacts to go beyond basic social distancing and strictly self quarantine. It also stopped two physicians in our household from going back to work and spreading the illness.
Fortunately, we have all fully recovered, and thanks to the confirmed result of a test, both of us will be able to donate our antibody-rich plasma this week and Viral will be safely working in the ER.
We were lucky to face this terror, because the only thing scarier than a positive test for Covid-19 is not being able to know whether you’ve contracted Covid-19.
As this pandemic becomes less abstract and more personal– when people’s own loved ones start to show symptoms—it’s only human that they will want certainty and safety. Around the world we have taken ourselves out of the equation for the sake of our global and public health. And that’s bad for public health.
We have no idea what the spread of this virus truly is thanks to costly under-testing at the start of this pandemic, but all of the evidence points to mass testing as the only way out of a perpetual cycle of social distancing and caseload spikes. Social distancing is buying us time, but without universal testing, this period of pause delays the inevitable. That’s why we're calling for a national mobilization to create a universal testing program for every American.
Such a program should categorize people in three ways: they had Covid-19, they have Covid-19, or they are still at risk for getting Covid-19. Green, Red, Yellow—that simple, no more uncertainty. It would use two types of tests to accomplish this categorization.
The Two Types of Tests for Covid-19
When testing for Covid-19, we can look at the presence of either (1) the actual viral antigen during infection or the (2) antibodies during the middle stage of infection and after. (For the sake of simplicity we are only going to talk broadly about the antibody test as one type of antibody.)
Covid-19 testing in the US currently is focused on antigen testing; a nasal swab is used to test for the presence of Covid-19 proteins in your mucus.
Such tests need to be made widely available in ways that do not clog our emergency rooms. Mobile testing for at risk seniors as well as rapid expansion of drive through testing facilities, or even self-administered home swab kits that can be securely sent to labs can help rapidly identify those who need to be on the strictest quarantine (Red).
We also need to increase the capacity to read these tests. South Korea reported its first Covid-19 case the same day as the USA, but had six times the testing capacity per capita. Fortunately, the science behind analyzing Covid-19 antigen tests is widely available—university labs, commercial labs, and the government all have the equipment needed to read them. They just need to be set up for testing and approved to analyze samples. That requires no medical breakthrough, just political leadership, which may be the taller order right now.
These antigen tests, however, can only tell providers if a person has an active Covid-19 infection or are asymptomatic carriers.
We also need to approve serological blood and/or ELISA antibody tests that can be rapidly deployed to detect disease immunity. In some cases these tests can be self-administered at home to test for immunity from Covid-19. This isn’t a fairy tale idea. Public Health England is attempting to make millions of 15-minute at-home testing kits available to the general public at pharmacies and via mail the moment one of the tests proves efficacious. The UK’s first options just recently failed, but the science behind antibody tests tell us it is a matter of when, not if one of these tests are successful. Dozens of similar tests are racing towards approval in the USA and other countries as well.
The goal is to make these tests available for 10 pounds per test at local drug stores: that would equate to around $4 billion to make a test kit available to every single person in the United States—a paltry sum compared to the $2 trillion disaster relief package Congress just passed. Similar tests to detect the presence of other viral antibodies are currently available in the U.S. for around $10. One can expect the COVID test to cost around the same amount.
We should be in the planning stages now so that we are prepared to send hundreds of millions of test kits, beginning with the hardest hit cities and first responders in them and then to the general public the minute they are approved. The CDC could create an online portal could for people to report their results so public health officials can get an accurate reading of the pandemic’s spread by zip code. There is little to no incentive to falsely report a result but uploading the results could come with mail-in verification if deemed necessary.
In sum, to be able to categorize all Americans as either red, yellow, or green, we’d need to follow three steps:
Continue with current social distancing guidance to buy time.
Provide self-administered, self-reported antibody testing to every American. Those who test positive can reenter daily public life with standard precautions.
Continue to improve access and speed of antigen testing so we can quickly and strictly quarantine those that have active disease and are contagious.
It’s Never Too Early To Plan and Prepare
The first antibody tests have just been approved by the FDA and others are closely behind. It’s not too early for the government to plan to get them developed at mass scale and get them distributed. Plants should be preparing to develop 300 million test kits now so that once the final spec is approved, there is no lag time to production. The USPS, the CDC, and the private sector, including pharmacies and hospital systems should be ready to deliver and collect data. In parallel, we need to set up emergency labs and test kits and test centers outside of hospitals for the antigen test in every state. Pre-planning is the order of the day, because each day’s delay will cost us unfathomable amounts of lives and dollars.
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In this limited circumstance, if the UK, German, or South Korean government approves a specific test or methodology for either the antigen and antibody test, the FDA should automatically grant approval to the same immediately. Those nations have had a head start on testing and there is no reason to delay delivery with a second look.
Although this type of mobilization is unprecedented, so was putting a man on the moon. Except here, we don’t need any technological or scientific breakthroughs: This is a leadership problem.
No one organization, delivery method, or type of test is going to solve this crisis. That’s why we need coordinated action from the federal government to undertake this massive logistical feat, with help from the military and private sector.
We look to leaders like Governor Andrew Cuomo, who swiftly cut through bureaucracy to expand New York’s testing capabilities, to call for this next level of aggressive action. And we look to leaders in the private sector in shipping, testing, and logistics expertise to help bring this project to fruition.
But this is not just a natural disaster, it is a national disaster. That’s why Congress and the president must act in the best interest of our heroes: our front line workers. Healthcare professionals, first responders, transit workers, grocery store employees, pharmacists, government personnel, members of the media, members of the military, and all who can not work from home need to be protected, and testing is how we protect them. If not for our heroes, then for our seniors; the keepers of humanity’s collective wisdom. They do not have the ability to fight this disease on their own, and for their sake we must fight for them.
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