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How Coronavirus Testing Is Used to Reopen Society




Soon, Americans will be able to drive into the pharmacy’s parking lot and will be able to find a new coronavirus and be diagnosed within minutes without doctor’s instructions or delays. If it is positive, it will be immediately self-isolated. It also isolates the circle of friends and family you recently contacted.

Many Americans-probably only healthcare workers and their first responders-walked to pharmacies and hospitals to get antibodies and pin-up blood tests to tell if they were infected with coronavirus, Immunity. If tests show high levels of antibodies (proteins that the immune system produces to fight infection), they can get a certificate and return to work.

This is part of the picture they draw when infectious disease experts discuss the need for extensive testing to be performed before public health officials consider reopening workplaces, schools, and public spaces.

It is far from the reality of the United States today. Many technical, manufacturing and scientific obstacles need to be removed. However, steps have been taken to build this potential snapshot of our future. The expansion of diagnostic and antibody tests, also known as serologic tests or serologic tests, will play an important role in reaching them.

“This is a test that I want to give to many people in the end,” said Dr. Robert Siegel, a professor of microbiology and immunology at Stanford University. “If you have a situation where you are going to school, you may want to know what everyone at the school is and what their status is.”

A serology test is a blood test that detects whether a person’s immune system has produced antibodies that circulate in the bloodstream in response to an infection. The presence of antibodies does not necessarily mean that someone is immune. However, high levels of antibodies probably show some, even temporary, immunity. However, what is still unclear is the level of antibodies that someone must have to be immune to the coronavirus, or how long the immunity will last. Infectious disease experts say studies that attempt to answer these questions are either too small or have not yet been completed to reach broad conclusions.

Medical researchers test blood samples to see if they have already obtained and recovered from COVID-19 at the Clinical Virology Lab at Stanford University.

Some healthcare workers have already been tested for sera but are not seeking to get permission to return to work. At Stanford Medicine, which developed its own serology test, some healthcare workers who had COVID-19 performed serum tests to see if their blood had antibodies, You can volunteer to donate your own plasma to help with treatment. But to get back to work, you need to take a diagnostic test and get two negative tests in a row, says Dr. James Zehnder of Stanford University, who develops both types of tests. The goal is to make diagnostic and serological tests widely available to manage patients and communities at drive-through test sites.

There is increasing debate around the world about using antibody test results to bring people back to work. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Friday that the United States could issue a certificate of immunity-an idea that has been studied in Germany and is being considered in Italy and the United Kingdom It is.

“This is something under discussion,” Forch told CNN. “Under certain circumstances, I think it actually has some benefits.”

Dr. Charles Chiu, professor of laboratory medicine and infectious diseases at UCSF, said that a large population of people should have serologic tests to help determine the proportion of people infected, but testing everyone is not necesary to.

Local and national efforts are already underway. Stanford Medicine reported by Stanford Daily Serum test administered From early April in Santa Clara County up to 3,200 people use the results to try to determine what percentage of the population is infected. And on Friday, NIH announced that it would study the presence of antibodies and collect blood samples from 10,000 healthy volunteers to better understand the extent to which the virus spread.

Experts say that serological tests alone cannot overcome a pandemic. If the public sector resumes, diagnostic tests will need to increase significantly, as the coronavirus will almost certainly begin to spread again. Identifying and stopping these flares requires rapid diagnostic testing and contact tracking. California is trying to test 25,000 people a day, so far not enough —On average, about 9,500 people are tested per day, according to test results published by the Ministry of Public Health.

“Serology has a lot of hype. Dr. George Rutherford, professor of epidemiology at UCSF, says:” Serology is important if you are interested in what happened three weeks ago. Today If you are interested in the situation, you need to return to the (diagnostic) nasal swab. “

Reyes tests the patient's Refugio Rios for a coronavirus test.

Experts say that the FDA has quickly approved antibody tests, and many companies that create or attempt to create antibody tests are more likely to be screened out after more rigorous examination of the quality of the test. You.

“We can’t assume that this test will fix everything suddenly,” said Dr. Cyrus Shahpar, a Bay Area epidemiologist who had previously led the global rapid response at the CDC. “We are concerned that the FDA will pass everything without the normal review process, so the quality of the tests may be different.”

Dr. Reilly, professor of infectious disease at the University of California, Berkeley School of Public Health, said the United States effectively identified small outbreaks, quickly tested and quarantined those people, and then identified those who would be in immediate contact He said that extensive serologic testing may not be necessary if she could be isolated. .

“We don’t necessarily need to go that way,” he said, testing a wide range of people with serologic tests and issuing certificates to return to work. “Especially if you can identify who the risk group is currently, especially when it’s past its peak, it’s when you still have the opportunity to really study infected people. You target those populations. It doesn’t matter what the serologic test shows. “

Following the outbreak of SARS and MERS, Riley said extensive human serologic tests have not been performed and are not necessary to reduce the incidence of infections. He noted the ability of public health authorities to eradicate smallpox in the 1950s and 1970s by identifying small outbreaks and vaccinating people closest to sick individuals without extensive testing . Circle. The concept can be applied to COVID-19 without a vaccine by allowing people to sequester themselves.

“Because there is no vaccine here, what we can do is to separate,” he said. “So it works. This is a proven public health law. Testing is very important.”

However, serology can be used to learn more about the disease. According to Siegel, serologic tests were performed on people in Sierra Leone several decades ago after the outbreak of Lassa Fever. Testing has shown that the number of survivors of Lassa fever is far more than researchers expected and the disease is far less fatal than expected.

Catherine Ho and Mallory Mench are staff writers at the San Francisco Chronicle. Email: [email protected], [email protected] twitter: @Cat_Ho, Yutaro

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