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While we're talking about the MLB and its #COVID19 cases, I want to take a min to talk about this important paper from @michaelmina_lab at Harvard. I think it's THE solution to having sports, schools, and everything else re-open before we come to a vaccine. Thread:
First, the paper: https://www.medrxiv.org/content/10.1101/2020.06.22.20136309v2
The premise is that gold-standard qPCR testing can detect on the order of 1000 viral RNA copies per mL (cp/mL), but people aren't infectious until they have millions, billions, or even trillions cp/mL. https://www.usatoday.com/story/news/health/2020/07/26/covid-testing-cheap-quick-home-rapid-test-needed-experts-say/5491744002/?fbclid=IwAR3kbShqCJNWKojnJtjdBrzwkJo5zPwlcsIH7U2quTfuMVSuHriaM6rHnvc
People with ~1000 copies/mL are technically infected with SARS-CoV-2, but they are either too early in the infection to be contagious or late enough in the infection that they've successfully fought it off and - you guessed it - are no longer contagious.
From a public health point of view, we really don't care about these individuals going out and about. (From a clinical perspective, it's still important to measure.) For SARS-CoV-2 containment, it ONLY matters if people are CONTAGIOUS.
What we need is rapid, cheap tests to tell us if someone has a high viral load. Paper strip, $1 tests have been developed that give results in 10 minutes, but aren't being used because of low sensitivity (they often read negative if people have these low, low cp/mL)
You could screen every child every morning before school, and if they test positive and are infectious, they stay home. These tests are extremely good at detecting patients with high viral load, but even if it misses one, if you test every day it's very unlikely to miss twice.
So why aren't we implementing this NOW? The FDA hasn't approved these tests... Due to the "low" sensitivity. They're still requiring sensitivity be much closer to that of the gold standard test, even though these data show that it's not the critical factor.
The FDA *JUST NOW* approved the extremely slow rtPCR test for asymptomatic individuals as a "screening" tool... which still requires a prescription, and will do nothing but worsen the rtPCR turnaround times we're already seeing from symptomatic testing.
So... what can we do? WRITE YOUR CONGRESSPEOPLE and tell them to push FDA approval for rapid surveillance infectiousness testing. Raise awareness about this. We need more people talking about it and to save countless lives, we need the @US_FDA to listen.
For more info: Michael Mina spoke about this on the This Week in Virology podcast (from the excellent @profvrr), an amazing resource if you want to keep up with the science of COVID-19. Here's a 17 minute summary video:
I am optimistic that we'll have a vaccine within by next spring, but that doesn't help the people that are getting infected and dying NOW. We need action.
