TWIV #640: Finally A Viable Solution!!

This comment is related to TWIV Episode #640.

https://www.microbe.tv/twiv/twiv-640/


I listened to it this morning during my walk. The first hour with Dr. Michael Minna was the key portion. I highly recommend listening to it. Even the hosts were completely blown away by what Michael Minna had to say.

This is honestly the first time that I have heard a solution that made me feel optimistic that we could get a handle on this thing. I have not been optimistic about vaccines because, as of today, nobody knows if a vaccine can guarantee any immunity longer than a few months.

The long story short answer is a less-sensitive $1 test strip that everyone can use daily before they leave their house. (Just spit in the sample case, and use the strip to find out if you're positive.) This sounds far fetched, but they apparently already exist and are super easy to make. The issue is that the FDA's approval mandate is for a test that is at least 80% as effective as a PCR. Michael Minna discussed why it is a complete waste to use sensitive and expensive tests to control the outbreak. You should not care if a patient still has some RNA in their system after they are no longer transmissible. He detailed how and why a significantly less sensitive test with a quicker response would be much more effective in controlling the outbreak.

And, they also mentioned that all the tests work just as well with spit as they do with swabbing your nasal passages and making people feel like you're doing a pap smear on their brains. The issue is that nobody wants to take the time and expense to officially qualify it.

I strongly recommend that you take the time to listen to at least the first hour of this episode. You can even save time by listening to it in 1.5x or 2x speed.

If reasonably accurate, it would be useful.

I question whether a strip would be $1, the big corporations have been singularly aggressive at profiting from any opportunity, there would have to be real competition in order to bring the price down to $1/strip regardless of how much it actually costs to produce.

Something like this could be especially used for schools with all kids testing before they go to school each morning. It wouldn't be perfect, but it could greatly reduce spread if sufficiently accurate and parents didn't just send their kids to school anyways.

Climber said:

If reasonably accurate, it would be useful.

I question whether a strip would be $1, the big corporations have been singularly aggressive at profiting from any opportunity, there would have to be real competition in order to bring the price down to $1/strip regardless of how much it actually costs to produce.

Something like this could be especially used for schools with all kids testing before they go to school each morning. It wouldn't be perfect, but it could greatly reduce spread if sufficiently accurate and parents didn't just send their kids to school anyways.

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Yeah, that's the thing. That's the conclusion from the podcast discussion. It only has to be reasonably accurate. Even if it gives you a false negative one day, it'll most likely show you positive the next day. Right now, people are getting tested every 2 weeks to a month, so sensitivity and accuracy is a lot more important.

The other challenge that Minna mentioned is that a lot of serological (antibody) tests are not good for contact tracing. It usually takes a couple weeks for antibodies to show up. By the time the antibody tests come back positive, it's too late to do any real effective contact tracing. The contact tracing efforts only go back a couple days, but the person would have been shedding virus for at least a week by then.

Regarding cost, it's just a matter of making sure that multiple dirt cheap tests are approved so that not one manufacturer can jack up the price.

But, yes, you understand the potential effectiveness of a daily test. Every kid can test themselves before they go to school. And, it will allow bars to open up again because you can have a bouncer at the door with test strips to test everyone before coming in the bar.

The change in the thinking comes with the idea that we don't need 100% accuracy as long as we have frequent cheap testing with fast results. In my head, this is much easier to achieve than putting all our hopes into someone developing a vaccine that will protect people for more than a few months. These test strips would be easier to manufacture and distribute than vaccines that have to be administered by a doctor. They just need to convince the FDA to change their thinking so that they can approve the cheaper and less sensitive tests.

But, in my head, this would absolutely work if they could get it done. There are significantly fewer unknowns with this plan than there are with a vaccine.

This was a very enlightening conversation and really does provide some hope for the management of SARS-CoV-02. I'm glad to see others are finding the podcasts useful. I'm learning a huge amount.

Dr_SLO said:

This was a very enlightening conversation and really does provide some hope for the management of SARS-CoV-02. I'm glad to see others are finding the podcasts useful. I'm learning a huge amount.

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Yeah, it totally upended everything I believed about pool testing too. I listened to it again during my walk this morning and picked up even more information. Man, this Michael Mina guy is brilliant!!!