The answer is testing!

Imagine that you aren’t allowed entry to your favourite activity without passing a rapid Covid-19 test.  Passing, of course, means failing, meaning you are negative for Covid-19.  But if all who are allowed entry have failed the test, then no one engaged in the activity is an active spreader of the disease.

 

If this were to be done, then we could allow cruise ships, we could allow parliament to sit, we could allow all our commercial activities to resume.  We could return to life in some form of normal.

 

Why do we not allow this?  Because we want all testing to meet the gold standard.  The consequence, however, is that our economy and society are grinding to a stop.

 

Any testing has false positives and false negatives.  Provided the rate of the false results is the same in one form of testing compared to another, we can have the same confidence that we have limited the spread of the disease.

 

This is the case of the rapid tests that are available.  They are as reliable as the PCR tests, yet cheaper.  They can be administered by anybody, and do not require a professional specialist.  They can be done at home.  They are rapid, the results are known in a matter of minutes not days.  They test for a different product of the virus.  Instead of looking for the active agent itself, the RNA of the virus, they look for the product of the virus, a protein.  The detection of the protein ensures we look for the contagious members of our community.   By removing them from further contact, we are isolating the source of contagion.

 

The logistics of doing the testing are different.  For a cruise ship, for example, no one would be allowed on board without passing the test.  Special units would be set up on shore.  A triage room would be required, where crew, passengers and visitors, wait for the test to mature, suitably masked and distanced.  Once cleared, then boarding can happen, and masks can be dispensed with!  Periodic onboard testing and other measures will still be required, as well as different procedures at ports of call.  Life can return to normal, since no one on board is a carrier.  The same for getting access to parliament.  The triage is done on entry.  A delay of perhaps 15 minutes is added to the day.  But once inside, no worries about transmissibility can exist.

 

Save for the false negatives.  But that’s the case anyway!  So that worrying about them doesn’t make you any safer.  The same triage would happen every time you re-enter the facility.  If you fail the triage, then access would have to be denied.  But so you should be anyway.  But there’s no need to complain about the process.  Get on with what you have to do.

The question is how to get out of the Covid-19 pandemic quickly.  The answer has to include massive rapid testing.  Let’s do it.  Let’s introduce a massive program of instant rapid testing wherever we need people to gather, wherever we want life to return to normal.  Let’s do the testing.

The Name of the Devil is Sub-Optimization

The name of the devil is sub-optimization, somebody famous once said. Through sub-optimization we are failing to solve the crisis of the corona virus pandemic. We are more worried about the effectiveness of the masks we use, than about contact tracing; more worried about flattening the curve, than squashing it; more worried about the effectiveness of testing rather than just getting testing done. Some are more worried about paying a fine than in limiting the spread of the virus. 

Covid19 is unprecedented. The way we are going it is potentially civilization ending. 

 

Covid19 is without doubt an extreme challenge. We have no cure, or even a simple treatment other than oxygen. It transmits very easily. It is killing close to 3% of those who contract it. We have no vaccine, or at least till recently did not. In Canada it has infected close to 2% of the population—750,000 cases in a population of some 37 million, killing about 18 thousand. It is stretching our medical services to the limit.

 

So, we need to get to general immunity as fast as we can. We need to do that with minimal loss of life and minimal economic disruption. We are doing neither.

 

We have had enormous disruption in our daily lives. A year of everybody’s lives lost because assemblies are denied. How absurd to deny usage of outdoor activities when that is exactly what is required for healthy development, physical as well as mental. These constraints are basically out of proportion to the threat we are facing. We have optimized the response without clear regard to the consequences.

 

What I want to understand is why we are confined when open exposure is required to develop immunity in the absence of a vaccine. Without that immunity, natural or inoculated, we are not going to escape this pandemic. The history of other corona viruses is that they stick around for a very long time. Many common colds are caused by corona viruses. We live with them and accept the consequences of their existence in our societies. Covid19 will similarly be around for a long time. I doubt very much we will be able to eradicate it as we have done with smallpox, but are failing with measles.

 

What I want to understand is why we are denying use of simpler testing which is widely available but sitting idle in government warehouses. We can do the full PCR test and have a very high degree of confidence in the results. Or we can do testing for other than the RNA targeted by the PCR tests. We can test for the antibodies the body produces in reaction to the virus, and we can test for the proteins produced by the virus. It is these latter tests, simpler but less accurate than the PCR tests, that we are not applying, because we insist on the gold standard of testing.

 

But just a minute, our goal is to reduce the penetration of the virus in the community. A testing regime would identify those in the population who are infected or who have been infected by the virus. We are not going to eliminate it by testing but we do make progress. This is where sub-optimization is hurting us most. We should be using these other viral protein tests, and not sitting on them.

 

My concern is the statistics here. If a percentage of simple tests is positive, those positives are then directed through a more rigorous test. If a higher proportion of the rigorous tests is positive, then we can rely on the simpler tests and we have reduced the incidence of the virus in the population.

 

The point is that the simpler tests work as a triage to limit the number of people we need to take more seriously, we reduce the costs of the more rigorous tests. This is another example of going for perfection when good is every bit as effective.

 

If we had a way of requiring people to carry proof of a successful recent negative Covid test, then we would have no qualms about allowing large gatherings. About allowing access to our stores and shopping centres, exercise and entertainment facilities. We would police people on entry, but not deny them entry otherwise. Without the proof, they would have to be turned away, and encouraged to take a test, perhaps even on the spot. There will be some inconvenience, but our businesses could resume and we could enjoy gathering crowds.  

 

Contact tracing is required of any person showing the symptoms of Covid19. But we are not doing it. There have been too many cases and the staff handling the tracing are swamped by the demand. Not only that, but our freedom loving populations are not responding to the calls from our contact tracers.  

 

We need a massive program of testing. We need a massive implementation of contact tracing. We need to control gatherings subject to successful testing. If a test is positive we need confirmation of the presence of the virus, and then enforced isolation for 14 days. A fine for breaking isolation, but not for a gathering of Covid tested negatives.

 

So let’s make sure we wear masks, get vaccinated, introduce both a mandatory testing regime, and an effective contact tracing scheme. Sub-optimal, but better than perfection. And we can get back to some kind of a normal life.