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Testing half the population weekly with inexpensive, rapid-turnaround COVID-19 tests would drive the virus toward elimination within weeks—even if those tests are significantly less sensitive than gold-standard clinical tests, according to a new study published today by CU Boulder and Harvard University researchers.
Such a strategy could lead to "personalized stay-at-home orders" without shutting down restaurants, bars, retail stores and schools, the authors said.
"Our big picture finding is that, when it comes to public health, it's better to have a less sensitive test with results today than a more sensitive one with results tomorrow," said lead author Daniel Larremore, an assistant professor of computer science at CU Boulder. "Rather than telling everyone to stay home so you can be sure that one person who is sick doesn't spread it, we could give only the contagious people stay-at-home orders so everyone else can go about their lives."
[...] They then used mathematical modeling to forecast the impact of screening with different kinds of tests on three hypothetical scenarios: in 10,000 individuals; in a university-type setting of 20,000 people; and in a city of 8.4 million.
[...] When it came to curbing spread, they found that frequency and turnaround time are much more important than test sensitivity.
For instance, in one scenario in a large city, widespread twice-weekly testing with a rapid but less sensitive test reduced the degree of infectiousness, or R0 ("R naught"), of the virus by 80%. But twice-weekly testing with a more sensitive PCR (polymerase chain reaction) test, which takes up to 48 hours to return results, reduced infectiousness by only 58%. When the amount of testing was the same, the rapid test always reduced infectiousness better than the slower, more sensitive PCR test.
That's because about two-thirds of infected people have no symptoms and as they await their results, they continue to spread the virus.
"This paper is one of the first to show we should worry less about test sensitivity and, when it comes to public health, prioritize frequency and turnaround," said senior co-author Roy Parker, director of the BioFrontiers Institute and a Howard Hughes Medical Institute investigator.
Journal Reference:
Daniel B. Larremore, Bryan Wilder, Evan Lester, [et al]. Test sensitivity is secondary to frequency and turnaround time for COVID-19 screening. Science Advances, Nov. 20, 2020; DOI: 10.1126/sciadv.abd5393
(Score: 2) by legont on Sunday November 22 2020, @10:42PM (8 children)
Right now everyone who is for lockdown and such are assuming that science will find vaccines, drugs or both and soon. If so, China and vicinity will be huge winners as they avoided most of the costs and will just treat the whole population at once.
Suppose though if pessimists like myself are right and we will not get treatments any time soon. What will happen? Yes, exactly, the US dream will happen as sooner or later China will loose the control and the pandemic will run and the region will collapse.
Meantime the US, perhaps short of a million folks, will be sharp and ready. As well as Russia.
"Wealth is the relentless enemy of understanding" - John Kenneth Galbraith.
(Score: 0) by Anonymous Coward on Monday November 23 2020, @04:11AM
But you are making one huge and, in my opinion, unsupported assumption: that lockdowns work. It's an obvious and intuitive idea, but so are many things that are ultimately found to be incorrect. Various studies that have looked at the topic have found that internal lockdowns have been mostly ineffective. I'll look at this in three ways:
1) Some guys with doctorates and grandeloquent language saying [thelancet.com] the same thing. The one primary thing that predicts how well or how poorly a nation will fare against COVID is personal health. Obesity is the primary predictor of poor results and is directly predictive of on increased mortality, increasing hospitalization rates, etc. Obese people are very vulnerable to this virus (among countless other things) and the average obesity level of a nation is reliable predictor of how it will do against COVID. This is made even more interesting by the fact that lockdowns in the US have been substantially increasing our obesity problem due to increasingly sedentary lifestyles alongside greatly increased alcohol consumption. And the mortality rate of the virus is increasing. Go figure.
2) Increasingly obvious evidence. Sweden has had an aggregate death toll of 633/million after running on a response of basically 'do nothing'. They had no major lockdowns and life continued on pretty much business as usual. The US in the middle of the pack with a death toll of 792. And finally there is Spain which has not only had some of the most extreme lockdowns on this planet, but also has the 5th highest death rate at 911. There are obviously some countries that had lockdowns that did okay, and some countries that did not have lockdowns that did not do okay. The point I make is that the evidence shows with reasonable clarity that lockdowns do not really correlate with success, at all.
3) Anecdotal. A member in my family is immunocompromised due to an organ transplant. They are also a healthcare professional and did all they possible could to ensure a perfectly safe lockdown, even including sterilizing the packaging of foods and groceries to ensure no surface level contamination was possible, wearing eye protection very early on, etc. They still caught it, somehow. Interestingly enough they also recovered, more or less fully, after about a month without hospitalization being necessary.
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So you can put me into a third group. I propose not only are lockdowns ineffective, but I also believe that vaccines will also ultimately prove ineffective for reasons outside the scope of this post. And so the only solution will ultimately be to do as we have done for the countless plagues throughout history, many much worse than this: get on with it, ride it out, and come out stronger as a result. And to help avoid such outcomes in the future people need to gain some self discipline and stop eating so damned much, but we also need to start taking obesity more seriously. The 'body positive' movement, embraced by the media and by politicians, was one of the dumbest and most self destructive things possible.
(Score: 2) by RS3 on Monday November 23 2020, @06:27AM (6 children)
Yeah, it's tricky.
If you're quite healthy, and can mostly avoid people, and most everyone else gets immunized and pretty much stops COVID, you might get away without getting vaccinated.
It will all depend on how many people refuse / avoid vaccination, and how much those un-vaccinated people come into contact with each other.
If everyone else gets vaccinated, and 5% or so still get sick, you have a risk of catching it from them, and also spreading it to more of the 5% for whom the vaccine doesn't work.
The problem, as we all know, is the asymptomatic carrier / spreaders, which you could become if you don't get vaccinated.
Here's a question: if someone gets vaccinated and it works, can they still be a carrier / spreader?
(Score: 3, Informative) by Rich on Monday November 23 2020, @09:14AM (1 child)
If it works, there will basically be no spread. The dangerous spreading mostly occurs (according to C. Drosten, but cf new Chinese report) around asymptomatic infection days 4-5 and symptomatic days 6-7. After that, infectiousness drops off and is mostly gone by day 14. We can therefore assume that the high viral load that causes symptoms (body cleans out infected cells, maybe overreacts with cytokines) exists before symptoms in an asymptomatic state. If the vaccination avoids symptoms in all patients, it is a pretty safe assumption that the vaccine-induced antibodies don't cause the viral load to rise to dangerous levels in the first place. The same thing would hold for an anti-viral agent that catches the virus by its ACE2 affinity, or synthetic antibodies (but you'd need a huge lot of fast and sensitive testing to know when to apply those before it is too late, or administer them in advance). It would not hold for a medication that modulates the immune response in a way that it can clean up, but does not badly hurt the organism in the course.
(Score: 2) by RS3 on Monday November 23 2020, @02:06PM
Wow, that makes sense. A gem of useful information, thank you.
And of course, dovetail in the hygiene / habits of someone infected. At the start of the pandemic, medical experts talked about covering your mouth when coughing, especially using your elbow.
Best to quarantine, of course, but even then you can spread the germs onto everything in your environment, and possibly spread it depending if you live with people, or somehow come into contact, maybe mail / ship a package. A report came out some weeks ago that SARS-CoV-2 virus can survive on hard surfaces for up to 28 days, so even if infected person pretty much stops shedding, could still be carrier / spreader. I think, anyway, but maybe it's much lessened and almost negligible? Well, not negligible if someone could get infected from visiting someone who had COVID say 24 days prior.
Thanks again.
(Score: 3, Informative) by legont on Monday November 23 2020, @01:23PM (3 children)
I am not sure I got my point across. Yes, I do believe that lock-down works. However, it does not work forever. Sooner or later it will stop working and then one needs different ways to fight the disease.
If vaccines and/or drugs are found earlier, one definitely wins if the lock-down is total at the border and the internal life is going as usual from economy point of view. Everybody thinks China, but Thailand, the closest US ally over there, implemented even stronger measures.
If, on the other hand, the lock-downs fails earlier than vaccines are found, but later than competitors achieved herd immunity naturally, all bets are off. It would be especially true for China where a major crisis is coming anyway simply by pure economy reasons. Chinese would have enough trouble with it by itself and they know it. They might not be able to handle a pandemic at the same time. That's why they are so unusually aggressive.
"Wealth is the relentless enemy of understanding" - John Kenneth Galbraith.
(Score: 2) by RS3 on Monday November 23 2020, @02:39PM (2 children)
Thank you for furthering your great explanation. Actually I did understand and agree with what you wrote originally. It inspired some thoughts and I went in a somewhat different direction, thinking more about the mechanics and dynamics of the disease itself, and somewhat less from the geopolitical / economic view. But they all interact and interplay.
Due to the general climate here on SN, and the downmodding for anything that can even be remotely connected to politics, I prefer to stay out of political discussions. Politics is so complex, and I'm actually very cynical about anyone who desires to be in government no matter which label they choose. I just feel that the desire for power doesn't come from a good place, and it's difficult to find good leaders anyway. Our (USA) system doesn't choose the great leaders; rather we get to choose (vote) for the people who enter themselves in the competition. Sigh. I'll say this: I wish there was a way we could do away with political parties and just have government that represent us, the people. But I'm optimistic going forward. I think most of us in the US are very weary of the politics on top of pandemic, and we'll start compromising and working together.
All that said, in spite of what the news media says, we USA don't hate China at all. I personally think they're extremely clever, and play much dirtier game, for example all of the cheap products that break easily, are copies (knock-off) of expensive brands, child / forced labor, long hours, worker safety, environmental damages. I know their govt. does try to enforce many laws like worker and environment protection, but the country is so big it's difficult to do. Some of their government have a very competitive attitude, including disparaging the US as a "military threat". We have many allies in China's neighborhood, especially Taiwan, and that really bothers the CCP who want to annex Taiwan. Well, they don't consider Taiwan as sovereign, so there's the constant saber-rattling. But I haven't even touched the surface of global politics, and it's so complex that any summary would be too incomplete and a waste of time.
The only thing I'll add regarding China is there is some sentiment in the US that China wasn't forthcoming about SARS-CoV-2 initially and that allowed the carelessness of too much travel and spreading of the disease in the US and around the world. But I'm not sure they really knew enough about it themselves, and the whole world is still learning things about SARS-CoV-2. The more we (the world) share information and work together, the sooner we can get it under control and return to, well, whatever "normal" life is.
But again, you make good points and I agree, and I'm optimistic that enough strategic vaccination will all but stop SARS-CoV-2.
(Score: 2) by legont on Monday November 23 2020, @03:06PM (1 child)
There is an old and true scientific fact that history is ruled by numbers. Based on numbers, the US leadership is obviously over and the Chinese century has started already.
We have a choice here; actually, three choices. We can start a cold war which we will lose the same as Soviets did (that's what we recently won so many people believe we can do it again). We can work on a kill such as internal Chinese revolt and splitting of the country which could be triggered by economic crises or pandemic or both (that's the old British strategy). Finally, we can gracefully transfer the leadership and live happily on our extremely rich and beautiful island called North America and let them suckers sort their issues themselves.
I want the 3rd option and for as long as I live I will use whatever tools I have to persuade other people. I don't want no fucking war.
"Wealth is the relentless enemy of understanding" - John Kenneth Galbraith.
(Score: 2) by RS3 on Monday November 23 2020, @04:39PM
Option 3 for me and most of USA. I don't like saying or writing it, but some of the Chinese seem very competitive and determined to conquer the world. Not sure why. 20 years ago I worked with a Chinese national here (USA) on work visa. He was pretty introverted, but a couple of times he said "we (China) will conquer you". I wish the world could just live in peace, harmony, fair trade, sharing of ideas, education, etc. Too much competitiveness in the world, and not the "healthy" kind like Olympics or soccer or whatever, but rather military. No need for it. And sadly, very few people on earth want the aggression, but also sadly those people are the ones who desire and attain political power. And even more sadly, we've learned that if we want peace, we have to have big military. I'm trying to be optimistic though. At least the Middle East seems to be making strides in peace agreements. But we all know those don't always last long. But who knows. Maybe the "information age" is helping the young people learn how much destruction occurs due to all the aggression, and maybe they'll usher in more peaceful coexistence.