Trust Me, I’m Looking Out For You
MEDICAL AND MENTAL HEALTH UPDATE
Wow! Thanks for the robust response to the story about my dear COVID patient on Monday night! She continues to do well. Your replies made me realize three things:
Days of Our Lives clearly still beats in the hearts of many,
We all need hope (and I have some to tell you about), and
You don’t need any more drama. It’s bad enough wondering if Gabi finally delivered that awful news to Jake. (Gosh how my heart aches for them both—especially RIGHT after the face transplant. Jeez). And THEN I left you with a medical cliffhanger on a Monday night...MAN! That was a low blow.
My patient's story is a perfect example: She felt fine; no symptoms. Wanted to visit a sick family member. Got a test “just to see.” A FULL WEEK later, the test came back positive. But during the week of waiting she potentially infected others and started a new cluster of infections.
What good is an expensive, hard-to-find test that tells you a result a week LATER?
What we need is to QUICKLY identify asymptomatic infected people, isolate them, and quarantine their contacts. This is absolutely CRITICAL to containing this disease.
What’s it gonna take? WIDESPREAD, REAL-TIME, and CHEAP TESTING.
And it’s possible. THIS is what gives me hope.
New developments in testing have the potential to help shut the virus down. These tests are called nucleic acid “LAMP” and rapid antigen tests. They are self-administered, inexpensive, and give results in minutes. We need the FDA to approve these tests and then get them to market ASAP. Bill Gates, are you listening??
Admittedly, the rapid tests are not as accurate as the gold-standard viral nasal swab tests (hence FDA’s hesitancy to approve). But the growth curve of the coronavirus (meaning the rate at which it replicates in the body) suggests that during the period of highest infectiousness, there is only a few HOURS of time during which the rapid test would be negative and the gold standard test positive. (Read THIS if you need convincing.)
We can use this lack of test perfection to our ADVANTAGE. We actually WANT a test that ONLY detects the highest levels of virus—because that’s exactly when people are most contagious!
And if you test people daily, you have much needed context: you can better identify WHEN someone turns positive, e.g. when they are most infectious.
In fact, the gold-standard test is almost TOO sensitive. These tests can PICK UP VIRUS FOR UP TO TWELVE WEEKS after initial infection! (Note that the vast majority of infected people are NOT contagious for more than 10 days; it’s simply that the nasal swab tests can DETECT non-transmissible viral “remnants” for up to 12 weeks. This is a crucial distinction.)
Recall from my patient’s COVID story, she tested positive with the gold-standard test, but without any prior test, how are we supposed to know when she was infected? Did the test pick up the viral debris from months ago? Or did it detect transmissible virus that could potentially infect another person? The answer to this question matters. But a lone test, whose results came back a week after it was administered, is useless in answering this question.
Essentially, when we use a LESS sensitive test, we better identify the window of contagiousness. And THAT IS GOOD! The rapid test would pick up people RIGHT before they become transmissible and positive on the more sensitive gold-standard nasal test.
So what does the rapid test look like in practice?
You spit into a small tube of saline solution, and insert a small piece of paper embedded with a strip of protein, and if you are infected with enough of the virus, the strip will change color within 15 minutes.
If positive, you would then need to self-isolate, call your doctor, and confirm a positive rapid test with the gold-standard test for accuracy.
According to economist Laurence Kotlikoff at BU and Michael Mina, MD, at Harvard Medical School, these tests could run for as low as $2 a day. I’m quite sure this cost analysis is debatable, but it seems to me like a good place to start.
The bottom line is this: in mid-July, with the virus soaring and asymptomatic spread everywhere, we need widespread surveillance of the population. We need to identify people who feel well but are unwittingly infected and spreading the virus.
And we don’t need a perfect test. We just need one that is GOOD ENOUGH and done FREQUENTLY and CHEAPLY so it is accessible to everyone.
Here’s an article published Monday by two Boston physicians lobbying for this very testing to SAFELY reopen schools. It’s well done.
So what can YOU do to make a difference?
Write to your congressman/woman. The FDA needs to approve these rapid tests ASAP, and then we need them distributed. Again to quote the late Rep. John Lewis, “When you see something that is not right, not fair, not just, you have to speak up. You have to say something; you have to do something.”
Trust science, even when it is imperfect. Perfect data in the wrong context is misleading; good data in the proper context gives it power.
Know that we will get out of this wicked mess. If not with daily rapid testing, it will be the vaccine (good news this week on vaccine candidates!), therapeutics, or maybe something we haven’t even thought of yet. Have hope. Keep moving forward. We cannot give up.
Continue calm vigilance with MOSHPIT to mitigate risk. These essential measures are WORKING well! Keep it up, people!
And tell me what happens with Jake and Gina. I sure hope they can work it out.
I will check in again soon. Until then, be well.
P.S. Here is the interview on school reopening that I did with parenting expert and Washington Post columnist Meghan Leahy last night. Among other things, we discussed the above testing as a potential game-changer for schools to reopen safely (once case rates are controlled and aggressive risk mitigation is in place).