Covid-19: A Way Out Before a Vaccine

Contrary to the brainless boasting about “saving lives” heard from the Republican National Convention this week, we in the United States lead the world with 180,000 deaths from Covid-19. Brazil, with similarly abysmal national leadership and coordination, runs second with nearly 120,000 dead.  (You can slice and dice the numbers without a paywall at )

Fall and winter are coming. Most of us will have to spend more time indoors. There is ample evidence that the virus spreads not only in droplets (most of which fall to the ground within 6 feet), but also as aerosols, particles that float on currents of air. We will return to buildings that often lack ventilation systems to clear indoor air.  Since 20-40% of the people infected and shedding virus with every breath, song, shout, or cough never experience symptoms, that shared indoor air will sometimes contain virus. (Temperature checks might catch the rare person “powering through” their symptoms, but will miss all of those without symptoms) 

To be sure, the current downturn in the numbers is modestly encouraging. A great many sensible people are practicing some level of social distancing, wearing masks, and engaging primarily in outdoor activities. Viral spread and Covid deaths would be far worse without these sensible behaviors. Meanwhile, the economy is teetering (regardless of the stock market) and a safe, effective, and available vaccine in which enough people have enough confidence to actually receive it is at least many months away. No amount of wishful thinking or premature “all-clears” are going to convince the majority of our citizens to go out and engage in all the economically important activities in which they used to participate. 

A Way Out

Imagine a test that would tell you in a few minutes at home or on the way into a movie theater or a work place, a test that would detect clinically relevant amounts of virus in a small sample of spit or snot. “Clinically relevant” means enough virus to make it likely that you might actually spread the virus. (The current PCR based tests for viral RNA are so sensitive that they can detect clinically irrelevant amounts of virus and even viral RNA remnants that are no longer infective at all. Furthermore, PCR-tests are laboratory-based, relatively expensive, and, with a few exceptions, they are relatively slow, i.e. 2-14 days to yield results. In even two days your viral shedding status may have changed.)

Imagine this test is really cheap, widely available, and widely accepted, pushed by a massive educational campaign by the national government. Imagine that the national government spent a few billion dollars to further develop such a test and to ramp up production, the kind of government involvement appropriate to war time investment. (Recall that a few billion is a pittance compared to the trillions already spent to try to help companies and citizens to hold their lives and businesses together.)

Combine such widespread testing, isolating and further testing of people with positive results with continued social distancing and mask wear, then diligently trace the declining cases. It is a way out–a way back to a more normal life. 

We are close to approval of such rapid test-strip type tests. If we had national leadership that worked as one instead of floating contradictory information and adding to confusion, if we had national leadership and news media that could offer a consistent message about what testing was even being talked about, we could get this done and we could start crawling out of the hole we’re in–before there is a vaccine. 

This will not work without scientifically literate leadership, without leadership that speaks with one clear, honest voice. Remember that when you cast your ballot.

Further recommended reading and listening:

A fascinating podcast on Fresh Air entitled Why We Need Widespread Rapid COVID Testing from August 27, an interview with Alexis Madrigal, journalist with The Atlantic Magazine. (47 minute listen)

Alexis Madrigal’s print article The Plan That Could Give Us Our Lives Back in The Atlantic from August 14, 2020. 

For more detail on the various types of test for Covid-19, my article Testing – Fast and Slow, also from August 14. (It covers a lot of the same basic ground as the Atlantic article but might assumes less science background–and I wasn’t aware of some of the tests Madrigal discusses.) 

Finally, concerning Covid more in general, I’d like to recommend an almost daily email “Update on an Epidemic” written by a Seattle based physician, Betsy Brown, M.D. I found this one Kids: camps and schools particularly interesting.

Keep to the high ground,

P.S. On technical note. Once the spread of the disease is down to a point where contact tracing can be used to find and isolate new cases the utility of the rapid test we’re talking about here will drop off. In a population with very few infected people the number of people flagged incorrectly as positive (false positives) will overwhelm the number of true positives detected. (This is based on Bayes’ Theorem.) At that point the contact tracers can take over. When that point is reached depends on the specificity of the test.