COVID 19 Breakthrough Idea: Do Not Make the Perfect the Enemy of the Good

The Phantom has been trying to get the attention of his elected representatives from his state senator to his state reps to his US Senators and Representative about the idea from Michael Mina, MD, PhD from the Harvard School of Public Health, a simple idea with enormous implications.

Michael Mina, MD, PhD

The idea is that you can do an "instant" test, on saliva, at home, or at school or at an airport and it can tell you, for about $1, whether you are carrying the SARS CO-2 virus in enough viral load to make you infectious to others.

Apparently, the test is like a home pregnancy kit test in its practical execution, but it can be made much more cheaply and it could be made as a "paper test" a cardboard strip coated with monoclonal antibodies to detect antigens (virus particles). 

This may not be useful in trying to manage an individual patient in the Emergency Room who has fever, cough and you are trying to decide if he has COVID19, because it's not a very sensitive test, it will miss some people who have the virus, but that doesn't matter at all if you are simply trying to figure out if a school kid has enough virus to be infectious to others.

This "insensitive" test is potentially enormously useful in public health, where all you care about is if a patient at a given moment infectious to others.  

Patients are likely infectious for only a few days or even hours, when the virus load is very high and all you need is a test that tells you if the student is infectious that day, or if the airline passenger is infectious for that plane ride.

All this depends on a new understanding of COVID19: When you first get the virus, it takes 24-72 hours for the virus to replicate in your nose or throat and around day 3-7 you finally make millions of virus particles and for that brief interval, you can, unknowingly in many cases of presymptomatic or asymptomatic people, be infectious to others. But after that, although you may "shed" virus particles for weeks to even months, these are just the wreckage of virus, bits and pieces, which cannot infect anyone else.

So it's good the test misses those viral particles. This is a test for infectivity (infectiousness) not infection.

This test can be made at local universities, local companies and it could be produced in the millions.

The test actually gives you results in 10 minutes.

As some have noted, getting people to do home testing when you cannot get people to even wear masks may limit the usefulness of this test.

But let us not make the perfect the enemy of the good.

It's good enough if we have all students checked at home and spot checked at school, and it's good enough, maybe to make airplane rides or to eat in a restaurants or to go to work at the factory or the office.

Here is Medcram's version of the This Week in Virology #642 podcast where it's discussed:

https://www.youtube.com/watch?v=h7Sv_pS8MgQ&feature=youtu.be

In this age of Twitter and ascendant marketing, we need a good slogan so people who are all worried about who has the infection, how many people may be undiagnosed, we might roll out a simple Clinton-esque phrase:

"IT'S INFECTIOUSNESS, STUPID!"