What you need to do to resolve US testing problems and safely resume

• The United States must launch tests dramatically to give the confidence that most Americans can return to work safely. Coronavirus pandemic..
• The White House believes that 200,000 daily tests are sufficient, but independent experts and reports have requested 500,000 by mid-May. 30 million tests per day By autumn.
• The Trump administration can help by forcing billions to produce, stockpile, and distribute the required RT-PCR test supplies.
• However, if you do not have a strong incentive to take the test, Contact tracer, And if there is illness or exposure, stay in quarantine, and public health states that the level of testing does not matter.
• For more stories, visit the Business Insider home page..

Imagine a world where the United States is tested where it needs to be to reopen. Then imagine the world through the fictional character James.

Like the millions in the coronavirus outbreak, James is restless to leave Lockdown and return to the world he knew.

His employer fired him in early March. Exciting payments and public support programs have nourished and highlighted his family. They needed to run out of savings to cover food and rent.

But today, James starts a new job with maintenance staff at a nearby hospital. Wings for selective surgery are reopened and his cleaning is paramount for safety.

James takes a bus to the hospital. There, a nurse in protective gear stands outside the check-in tent. Measure his temperature and ask a series of questions about his health. I had a mild cold last week, but I’m fine now.

He waved to his seat in the tent and filled a small vial with saliva. A few weeks ago, the nurse had pushed a cotton swab down his nose and sent a runny nose to the lab.

But today, toaster-sized machines print results in less than 15 minutes. This is a plus for SARS-CoV-2.

James receives the report and is given a folder. Included is a printed description, a two-week voucher for the hotel room, a contact tracking center phone number, and a $ 50 check. The first $ 700 will be received for 14 days during self-quarantine. It is on Other paid, Enough to convince him not to risk the exposure of his family. The contact tracer will later arrange a COVID-19 test for his family and the state will provide assistance while James is absent.

Two weeks later, James returns to the hospital. Two new palm-sized plastic wafer tests are available. The same nurse asks him to spit on one person’s well, then squeezes a few drops of blood from the finger prick into another’s well. In a few minutes, the first test suggests he is not currently infected. The other shows that he has enough antibodies to protect against reinfection.

The nurse turns him to the front door of the hospital. Laughing at James: He finally got back to work.

Testing is the key to safe resumption

Such a fictional ideal scenario may be realistic — if the United States could get that action together. But now many states simply Pretend to be safe again During a pandemic.

To be fair, there are many things we still don’t know about reaching a place where people can safely return to work together. But the interests are immeasurable. If not done correctly, Deadly secondary surge COVID-19 cases The misery of the blockade..

One thing all public health officials agree on is testing, and much more. That’s because the test is a kind of superhuman ability that allows invisible murderers to be monitored, tracked, and executed within a particular population. Knowing who is sick is the first step in fighting the spread of the virus and restoring the country.

If all goes well across the United States, all other measures to responsibly resume the country’s economy are a vital foundation.

To understand how to safely exit lockdowns and expand economic activity through proper testing, it is important to know how hard the United States stumbled At the present moment..

Why are the US tests still inadequate since the beginning of the pandemic?

So far, during the pandemic, testing in the United States has taken a long time to launch and is not well controlled.

White House Negative reaction, In addition to Official email and document cachePresident Donald Trump and his administration Didn’t listen enough To Or act Urgent call for action from top experts as outbreaks from China spread worldwide.

Efforts to quickly scale up testing, Contact tracking, Isolation, and proactive guidelines Late Or Silenced.. Dr. Anthony Fauci, Director of National Institute of Allergy and Infectious Diseases, Called test situation “Failure” by the government during a parliamentary hearing on March 12.

Lack of federal leadership during the crisis has gone States that understand the test For myself without time resource, Or Funds.. Lack of coordination also sparked Expensive bid war Even between counties between states and supplies.

Despite playing cards Claim that the US is “dominant” For testing, Federal lawsuit Is required.

Still, a series of questions remain about how the United States should strengthen its testing and what will happen to the future of this important element of the pandemic struggle.

How many tests do you need?

Some non-profit organizations with significant brain trust have published details Roadmap for resumption American economy. Such documents throw out various daily test numbers, but everyone agrees with the 200,000 tests per day that the United States is currently conducting, and the White House Seems to believe it is enough, Don’t cut it

Safe and effective for the incomplete and pandemic world we live in now The vaccine is at least a year away (If any So far displayed) And there is no slam dunk on the horizon, Dr. Ashisher Some colleagues at Harvard Global Health Institute said last month that 500,000 tests daily by mid-May It is a national bottom price for resuming with some confidence and control.

“So what we really want to do is have ideals,” Jha, Director of Global Health Institute, told Business Insider in late April. “And what I’ve been arguing about is what I’ve defended, but it’s not really ideal. It’s not that great either. It’s pretty good, but it worked.”

In a more ideal world where the United States could start resuming a larger part of the economy, the number of daily tests would be even higher. Estimated daily test capacity required from 750,000 — as planned American Business Association And Johns Hopkins University — 2 million tests daily in June, 100 million tests per day by fall — Amazing and logical range Harvard University Plans..

Jha confirmed that a low number of tests, 500,000, assumed that lockdown would reduce the number of new coronavirus cases to a total of 50,000 per day. Currently, there are approximately 20,000 to 30,000 confirmed cases per day in the United States. CDC data, But studies on asymptomatic carriers have 5 to 20 times higher.. If the state reopens prematurely, expected subsequent surges could easily underrun 500,000 tests per day.

So the exact number of daily tests we need is controversial, but the US needs to significantly increase the number of tests per day in order to be confident of safely resuming the country. Clearly there is.

However, there is no universal test. When monitoring and controlling coronaviruses, type and its placement are very important in keeping with the state’s economic opening, making it a tricky but important factor in US testing problems.

What kind of testing do you need?

To see where and when COVID-19 will expand, the US will need several different types of tests. Each has its own piece of testing and each has some drawbacks.

The first and most important type of test, called RT-PCR, is the type of test that requires at least 500,000 per day to monitor disease in the United States, and it mainly functions to detect active infections. To do.

These tests are the types most people are familiar with. Healthcare workers wear full personal protective equipment, push a long swab into someone’s nose, and wait for test results for several days.

For economic restart to work, this model of COVID-19 detection needs to be larger, more efficient, and more results returned in hours or minutes instead of days. Thankfully, and despite the delay, the private industry already has some momentum.

For example, Abbott’s ID NOW COVID-19 test can produce results Within 13 minutes Using tabletop machine. Instead of waiting a few days at home, people can test on the day they appear and come back to work. Saliva-based sampling method, one Received emergency approval from FDA By mid-April, all aspects of RT-PCR testing can be sped up and simplified.

The second type of test is Now available to consumersLook for particles of the immune system, called antibodies or immunoglobulins.

The body produces these particles during an active infection, but they do not appear until after a few days. The earliest type of antibody that emerges, called immunoglobulin M (IgM), attaches to and tags the surface of viruses, causing immune cells to swallow infected tissues. Next comes the late-stage antibodies called IgG and IgA, which help prevent new infections.

Labs are currently processing their sera looking for such antibodies, resulting in delayed results. However, handheld tests for meaningful levels of antibodies Began to appear In the United States, plastic and paper slabs are much cheaper and easier to mass produce. Instead of requiring blood collection and delivery services, all you need is a few drops of blood, some liquid reagents, and about 15 minutes.

The downside of IgM testing is that such antibodies usually take a week to become visible after infection and tend to disappear. On the other hand, longer-lasting IgG appears at detectable levels weeks after the infection begins.

Also, antibody testing is not as sensitive as RT-PCR. Generate false negatives, Or a result that actually had an antibody but did not have the antibody.

“I don’t think antibody testing is the key to identifying infected people and protecting them from uninfected people,” Jha said. “By that time you had a virus that could detect it for 5 or 6 days [with a RT-PCR test]”

The third type of test that can be of great help is Antigen test.. Such tests superficially react with a spike-like protein, called an antigen, that covers the surface of coronavirus in a small sample of body fluids.

Antigen testing can be a crude tool for early detection, as the replication of the virus releases proteins everywhere in the body. You also need to provide simple, near-instantaneous results like antibody tests. The modest materials also facilitate mass production and deployment.

However, like antibody tests, antigen tests usually have sensitivity issues that can lead to many false-negative results. They are also difficult to develop, because their production requires an intimate biochemical understanding of the virus. The FDA has begun reviewing the first possible tests such as: E25Bio’s.. Quidel Corp. Received emergency approval From FDA on Saturday.

All of these tests have problems, so you need to use them together to create an effective strategy.

RT-PCR tests use widely available technology and are time and resource consuming. Onsite testing is not scalable and can take months to build, qualify, and install a lab machine that can handle hundreds of specimens at a time, according to executives in the diagnostics industry. Given that reality, Jha said the RT-PCR tests used early in resumption should change as more people return to work or school.

“The problem is that when 500,000 people enter the fall [daily tests]”We will be crushed,” he said. “And those who claim tens of millions [of tests per day]? The PCR technology we use cannot do that. It requires a completely different technical approach. “

That’s where the other two tests come in.

Assuming science is proven, a mass-produced antigen test would be a crude detector of active infection. You can also use two different cheap tests at the same time Improve confidence in results.. If there are positive or inconclusive hits, a more accurate RT-PCR test will follow. People with negative consequences can return to work.

Assuming that immunological studies demonstrate that coronavirus-specific IgG actually confers permanent protection, mass-produced antibody tests work similarly. Those who test positive for a certain level of antibody will get an immune passport and will be able to travel and work until the time of the retest.

“It’s not really a reality yet. It doesn’t exist. But everyone is trying to figure this out. That’s why I’m optimistic,” said the top medical industry in late April. The consultant told Business Insider.

Who will take the test on resumption? And how do we make enough?

Once the United States has performed the desired level of daily testing and has improved the quality of the required tests, the next step is to understand how to create and distribute the tests.

The first problem to solve is to create tests and documentation to manage them. As the scale of resumption grows, the already incredible demand for swabs, vials, liquid reagents, and other supplies needed to run tests increases.

Jar said the Trump administration would be the best way to solve material problems Defense Production Act More aggressively, it forces companies to produce the billions of test supplies they need.

He emphasized that manufacturing such supplies is almost nothing compared to the trillions of dollars the government may spend in its efforts to stimulate the economy.

“We shouldn’t penny pinch with a cotton swab. [ingredients] And vial. It will still be fine now. Make a billion of each of these. One billion dollars sounds like a big deal, but it’s not. In the US, 50 cents is $ 500 million, “said Jha. And that’s trivial. “

Jha and other public health experts also stressed that the government should not worry about overdoing it.

“If you’re still dependent on PCR, you don’t want to talk about swabs in the fall, so make a billion or two billion swabs and put them in your warehouse. That’s fine. I need it now. I’ll use it. ” “If not, they will be passed on to people to clean their ears later.”

Two industry insiders interviewed by Business Insider said most test supply chain problems should be resolved in about a month. In a global society that is returning from work and returning to work, it is difficult to identify a more accurate quote, including the work we supply to our staff and factories.

Similarly, resuming the US economy itself is a means to strengthen testing. Output and innovation can expand as people return to all core industries that supply test supplies from raw materials and factory production.

Assuming the production of test supplies continues to increase, the following questions are: Who will take these tests?

1 White paper In connection with Harvard’s plans, there is a need for a national pandemic test board and the launch of “30 megalabs across the country” to tackle about 1 million tests daily. It allows US labor force Take the test at least once a week. But there seems to be essentially no federal willingness to enact such ideas.

At this point, it doesn’t make sense to test everyone in the United States, at least for the first few months of resumption.

Rather Dr. Joshua Scharfstein, Deputy Dean of Johns Hopkins Bloomberg School of Public Health, and others advocate targeted RT-PCR testing during reinstatement for high-priority populations. Such sites include hospitals, clinics, prisons, homeless shelters, nursing homes, and other places where high-risk people meet or where social distance rules are not met.

As more testing capabilities become available online, the combination of RT-PCR, antibody, and antigen testing will allow more industries to thaw and bring people back to work.

However, even if this test is performed, until an effective vaccine or frontline treatment is given, If they can put up — Use of social distances, face masks or shields, and other precautions will continue.

But without quarantine, like paid leave, testing efforts may be useless.

The United States can manufacture, deploy, and manage all required tests. But without a well-established public health protocol, experts say it was the cause of the loss.

“It has to be a“ test plus ”: what action does a test lead to? Testing alone cannot control the virus, “Scharstein told Business Insider in late April. “Even if we tested everyone 20 times a day, literally, if we didn’t do anything else financially, we wouldn’t be able to control the disease without doing anything other than testing it domestically. Just watch it. . “

The key moments that must occur after a positive test for active infection are Contact tracer, Or a worker who walks a person infected with the virus over the past two weeks’ life and finds potential for human exposure. Contact potentially exposed people and encourage them to be tested.

“If you don’t want to bring the whole economy to a halt again, you need a strategy to identify infected people and evacuate them into place so that those who aren’t infected can start their daily work and live.” Said. “That’s the strategy. Keep infected and uninfected people away from each other.”

At least 100,000 to 180,000 contact tracers may be needed to effectively implement the type of tracking needed to open the economy. People hired for the role So far.

Separation is required after testing and tracing. This would prevent people from being tested at all without incentives.

One of the best ways to motivate people to undergo tests and self-quarantine is to pay them. As such, Scharfstein and others want people to pay at least $ 50 a day for isolation.

Now that you have infected or exposed people (and Not just documented citizensFrom infection to others, including families who were dependent on the quarantined person.

Sherfstein also added, “We need to help quarantined people in their quarantines. If they need food, they need to get food. If they need to move to a hotel, I need to move. ”

Jha explained his point using a fictitious example of a Uber driver.

“If you’re an Uber driver, that’s a real problem, so we need to take you to the hotel, we need to make sure you can get food to you. 2 You will lose your weekly income. ” “If we don’t do that, especially if it’s asymptomatic, it can be very tempting, like” screw it in. I’m going to keep working. ”

The importance of such amplified aid is no exaggeration to say the least. Even if perfect tests were developed and made widely available, if they were not supported, the United States would be at risk of a second wave that could cost lives and trillions of dollars.

“The need to shut down again would be prohibitively expensive in the long run,” said Jar. “Don’t shut down anymore. Make sure you’re in the same place you found a month and a half ago.”