Coronavirus

At-Home Coronavirus Testing Kits Might Be the Key to Ending Our House Arrest

Developing them ought to be the top priority right now.

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This is the terrible predicament we face as coronavirus cases worldwide top 1 million: In order to avoid getting infected, we have to stay at home in a mass lockdown. But if we don't go out, we won't develop the "herd immunity"—the critical mass of recovered and immune people—that can limit the virus's spread. That means the minute we unlock and venture out, we risk getting attacked again.

So are we doomed to stay locked up—watching our economy go up in smoke—till a vaccine or treatment emerges months, perhaps years, from now? Or is there a way out in the interim?

There may be if mass home testing kits become available soon. That will allow near-universal and repeat testing, point out Sweden-based molecular biologists Jussi Taipale and Sten Linnarsson, which will be a game changer.

At this stage, it's pretty clear to everyone but denialists that COVID-19 is not a hoax. Rather, it spreads at an exponential rate. In epidemiological parlance that means its spread rate—R0, the number of people an infected person spreads in turn—is greater than one. Without intervention, in coronavirus's case, each infected person gives it to about two to four more people, each of whom gives it to two to four more till a vast chunk of the population is infected.

This wouldn't be so bad if every coronavirus victim could just pop analgesics and recover. But that's not the case. Although most people do get better on their own, about 20 percent of diagnosed cases develop severe respiratory problems—breathing difficulty, pneumonia, and worse—and need hospital stays and even ICUs. No country has enough health care infrastructure or medical professionals to deal with the surge of patients—not even the United States, as the horrific reports from swamped hospitals in New York City suggest.

Worse, the more the disease spreads and overwhelms a country's treatment capacity, the more lethal it gets. (It's not a coincidence that coronavirus's crude case fatality rate—i.e. the percentage of confirmed cases* who die—is 1.4 percent for Germany and 1.67 percent for South Korea, both of whom managed to contain it early, compared to 9.3 percent for Spain and a jaw-dropping 12.2 percent for Italy, who didn't.)

So the only way to avoid mass death is to stop mass infection.

Among the countries that have done the best job of containing the spread are South Korea and Taiwan. They started testing, tracing, and quarantining—TTQing—at the first hint of the disease. When anyone tested positive, they wouldn't just quarantine that person. They'd go back and trace everyone that patient had come in contact with over the past couple of weeks and quarantine them as well. This labor-intensive strategy becomes a losing game, however, after the disease spreads beyond a certain point because it becomes too hard to trace and isolate all contacts.

At that stage, which is where most countries that ignored the early warning signs, including America, regrettably are, there are two options: mitigation or suppression.

Mitigation involves slowing the spread of coronavirus through some social distancing to around R0 equals one. Why not below one? Because allowing the vast bulk of the population to gradually get exposed means that many people will develop immunity and the virus will be permanently defeated. Mitigation also avoids total economic annihilation. However, Taipale and Linnarsson point out that the trouble with this approach is not only that it is really hard to calibrate perfectly but it also risks increasing the total number of people infected.

Most countries have therefore opted for some version of suppression. China's authoritarian rulers implemented the most extreme suppression effort locking down 60 million people in the province of Hubei, the epicenter of the disease. America's approach doesn't go nearly as far, but with 38 states issuing stay-at-home orders, some till June, and the Trump administration under pressure to issue a national one, it is not exactly dithering either.

The upside of suppression, if implemented effectively, is that it dramatically stops the spread of the disease. That seems to have happened in China if the official figures can be believed—a big if. The downside is that suppression is maximally draconian and massively economically destructive. Even America's comparatively mild suppression effort has already resulted in 9.9 million Americans filing for unemployment benefits in two weeks. This means that the labor market is contracting at the rate of one Great Recession per 10 days, The Atlantic's Derek Thompson notes. At this stage, the question isn't whether America will avoid a prolonged recession but a depression. Worse, shelter-in-place orders that force Americans to stay away from each other thwart herd immunity. According to White House estimates, come June, the vast majority of Americans might still be susceptible.

This means that as soon as America relaxes, coronavirus could come back with a vengeance, especially in the fall when cooler weather might reactivate the virus. Should this happen, we may well end up in what George Mason University economist Tyler Cowen describes as an "epidemic yo-yo"—the worst-of-both-worlds scenario where we oscillate between locking down and opening, repeatedly assaulting the economy but never really conquering the disease.

A possible way out till we have a vaccine or a treatment is through near-universal and repeated testing that allows the U.S. to replace mass lockdown with targeted quarantining of infected individuals while others continue to work. This is not possible right now because the tests available require medical professionals to take a nasal swab and carefully transport it for analysis, a process that takes several days. This test is accurate but expensive and slow. It also strains not only hospital staff but pathology labs that are already running out of chemical agents for analysis.

But a home testing kit that isn't prohibitively expensive and gives unambiguous results within minutes like a home pregnancy test would change everything. It could use sputum —spit—or urine or feces (although sputum would probably give more accurate results because coronavirus RNA—genetic material—is more concentrated in it). Any test that can accurately detect 85 percent of coronavirus-positive cases and has an 80 percent compliance rate would be enough to reduce the R0 of coronavirus to under one without benching a vast swath of America's workforce. Scores of pharmaceutical companies around the world are currently working to develop these tests, Taipale noted in an email exchange, and they might become commercially available within a matter of months if not weeks. (Home coronavirus finger-prick blood tests are already close to being commercially rolled out in England. But their downside is that they aren't good at detecting early infection—when isolation is crucial—only later immunity.)

The duo suggests that the government could buy boxes of 50 tests and mass mail them to everyone for weekly testing for about a year. The boxes would have serial numbers that patients could use to collect a financial reward when they report their results, something that would ensure both compliance and tracking of the disease spread. Shelter-in-place orders could be restricted to any area showing a developing disease cluster.

This would arguably be a more defensible use of the $2 trillion that Congress used to fund its coronavirus relief package, which indiscriminately showers money on everyone and everything. But employers also have an inherent incentive in maintaining coronavirus-free workplaces and could fund their own home testing programs for employees, so there's probably a private sector solution as well.

One way or another, once home testing becomes available, it's likely to be embraced by Americans eager to leave their house arrest and safely get back to work—even as they wait for coronavirus's permanent defeat.

This piece originally appeared in The Week.

*The definition of case fatality rate has been corrected

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  1. Tests won’t make you safe. Truth is, you are never safe.

    1. “No country has enough health care infrastructure or medical professionals to deal with the surge of patients—not even the United States, as the horrific reports from swamped hospitals in New York City suggest.”

      This keeps being said, but is it true? Everything I read is that New York- ground zero of the American Epidemic- is managing just fine. They are stressed, but not completely overwhelmed.

      It needs to be repeated- Italy’s hospitals are overwhelmed whenever they have a bad flu season. The US isn’t in the same space.

      The reason our economy was curb stomped by the government was that people were out there insisting that the end times are upon us. There have been all these statements about how short we are on ventilators and beds, but the reality on the ground seems not to be the case…of course if the media would do their job and actually tell us how many free beds there are, it might help diffuse this nonsense.

      1. There are plenty of ventilators and beds for reality; but not enough for the apocalyptic scenarios foisted upon the public consciousness by the panic merchants in government, an unscrupulous media that parrots, rather than questions, government talking points, and a bevy of “reliable” epidemiological “models” that ended up being works of pure fiction.

      2. Only 1.9% of those who died in NYC didn’t have serious underlying health conditions….

        1. An acquittance of mine recently died from COVID-19. He was in ICU for two weeks, and on a ventilator for 48 hours before expiring.

          On the other hand, he was 86 and in a losing battle with leukemia for years. Prior to being infected, he was already preparing for the end and estimated that he had, at most, a few more months based on his doctor’s assessment.

          On the one hand, it obviously sucks. On the other, if this virus is overwhelmingly striking down those already knocking at death’s door, it is difficult to justify to destroying the financial stability of millions of people.

          Death is inevitable. Crippling poverty is not.

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  2. Let’s spend money on something that doesn’t exist.

    1. 1,970 Americans died yesterday. The number increases about 15% per day, in line with the models, doubling about every 5 days.

      1. About 1,000 of them in NY and NJ, with most of the rest also coming from defined areas (generally urban and poor). Sucks for them, and I have no problem with government (if it must exist and do something) dedicating some resources to helping stamp it out in those areas. But the rest of the nation should not be suffering for this, at all. This is not a national problem; it is a filthy urban area problem.

        1. I’d really like to see some numbers on how many people have been infected with COVID-19 after running to the emergency room with a case of the sniffles and a heavy helping of paranoia.

          You see line of people outside hospitals and I’d be willing to wager that a good amount of those people psyched themselves out over seasonal allergies and then ended up getting infected in the hospital.

      2. Yeah, no. Historical estimates from the model are still available online. If the models were accurate, we should have been at 5-8000 dead per day by now. We are not. The models are overestimating by a factor of 2-4.

        Note that this is an ‘apples to apples’ comparison. That is, it’s a comparison to the model runs that assumed levels of isolation about what we actually did. Even when taking that into account, the models run consistently high.

        1. They just relabeled the global climate warming change models – – – – – – – –

        2. Rossami, I don’t know what models you are referring to. Certainly there were many that made grossly inflated estimates early on. Recall that there was NO reliable data. But the current models used – at least by the Ohio Bd of Health – have been pretty accurate. They have a news conference every afternoon to update everyone. The expectation is about another 10 days of increase at the same rate, and then a very gradual slowdown. That would put the max rates as 5,000-6,000 per day. I hope that it is no more than that.

      3. So fucking what? 250,000 people die of medical mistakes every year in this country. Are you going to hide under the table and drink Purell over that? Life is risk. Start figuring out how to realistically weigh it so you can live life like a human being. For once.

        1. Goddamn this comment system. That was supposed to be a reply to BigT, not Rossami.

        2. I think most government bodies have over-reacted. The ‘stay home under penalty of fine/imprisonment’ is wrong. Governments should be providing guidelines – strict – for people and businesses to follow. Shaming and virtue signalling will take care of the rest.

          For example, they should tell restaurants that they cannot operate at more than X% of capacity, where X is determined by the ability to separate patrons by 6 feet or more. Perhaps 1 patron per 150 sq ft or somesuch.

          In Ohio, Gov DeWine is doing well. We have a ‘stay at home order’ that, according to my son-in-law lawyer has no enforcement penalty. That’s about right. People will play by the rules, as much as they can. Stores should have a max capacity that they can allow in at any one time that fits with the type of store. Again, some minimum sq footage might work. All these businesses have capacities for fire safety; start by saying 30% of that.

          Social pressure works well here in the Midwest. Maybe some of the coastal states need cattle prodding to behave.

    2. Sounds good. Shika Dalmia really has no idea whatsoever how a PCR-based virus identification test works. Note that she compares it to a pee-on-the-strip pregnancy test,which just looks for a specific hormone instead of the chain of DNA characteristic of a specific virus.
      Abbott Laboratories now has a COVID-19 test to be run on their ID NOW machine. I have no idea how much the machine costs, but I’m guessing two or three thousand dollars, maybe less — it’s a desktop box that looks like it would fit into a one-foot cube. I also have no idea how much the materials for the individual tests cost, but the price for one RSV (respiratory syntactical virus) kit for the ID NOW is $45.37.
      The test takes five minutes to return a positive result and 13 minutes for a negative result (because 13 minutes has to elapse for a small virus load to grow to a detectable level before there’s assurance that there is no virus.
      The important point is that the sample must be immediately put into the machine, meaning the machine, the tester and the patient have to be in one place. Sending samples taken in the home to be tested at a remote location requires that they be handled carefully, not allowed to dry out, etc.
      As of April 3, Abbott had shipped 190,000 tests, was making 50,000 tests a day and was expecting to be able to produce two million a month. Presumably other companies are striving to create their own tests. Not too shabby. Show me where command economies can do better.

    3. I could be wrong; but I was thinking I read an article right here at Reason that said at-home test kits were already made (maybe that had to shipped for testing). And that the FDA blocked the people from being able to buy them.

  3. Thus begins dalmia’s slide into becoming a right wing clinger. Not once in this article did she mention immigration, or india! She is caving to what all of you clings want! She needs to go back and focus on the important issues, like how the virus has made modi and trump more racist than ever! This is a sad day for us woke better. I guess there is one more clinger neck to stomp on now.

  4. It figures that Dalmia the non libertarian would be in favor of people having to prove they are healthy to leave the house, but not to enter the country. will we now do this for every flue season. Where’s your papers?. Of course we already allow the government to require papers if you want your kid to go to school, unless you are an illegal alien. so why not require it for everyone maybe a chip that constantly monitors and sends a note to an app that lets teh government know when we have a fever and need to be locked in our homes behind welded doors. I’ve though all along that teh whole corona thing was just a way of controlling all movement and even if its a conspiracy thats what is happening

    1. “It figures that Dalmia the non libertarian would be in favor of people having to prove they are healthy to leave the house, but not to enter the country…”

      Deserved repeating. It’s hilarious, isn’t it?

      Testing isn’t a cure. En masse, it helps epidemiologists figure out when this bug has burned out, but that’s it. And we can’t afford to have all of us cower in our homes until it does burn out.

      1. “”“It figures that Dalmia the non libertarian would be in favor of people having to prove they are healthy to leave the house, but not to enter the country…”””

        Definitely worth repeating.

      2. So you would let your kids hug Grams, without knowing they were infected? Some are calling this an ‘urban disease’, but that’s just silly. People in the ‘burbs are just farther apart. And smarter.

        1. Maybe Grams aught to be the one wearing a mask and washing her hands and if the kids come over, sit outside in the sun with them.

          1. What Don’t Look At Me said. If you’re vulnerable, stay isolated. It’ll be lot easier to allocate resources towards those who have to stay isolated, and maybe even find a cure for this thing, if the rest of us are allowed to be productive.

  5. But a home testing kit that isn’t prohibitively expensive and gives unambiguous results within minutes like a home pregnancy test would change everything.

    Like an honest politician and a unicorn, I have my doubts this will exist.

  6. The death rate for young, healthy people is very low. It looks like most of them that were infected never thought they had Covid-19. Rather than impinge on the liberties of the general public, let them all go about their business. Most will get the flu and almost every one of those will get over it.
    Herd immunity the old-fashioned way.
    Meanwhile, the old (like me) and those with health risks can self isolate voluntarily until the herd immunity reaches about 70%, when it will be safe to crawl out from under our rocks.

    1. Stop being so reasonable. You’re cutting into my panic.

  7. Problem here too. The Federal government of Canada failed its people.

    As did the WHO for the world. We now know Taiwan warned of the human-to-human transmission of the virus and the WHO didn’t notify the world. China then opted to try and cover it up. These two derelicts put the world in danger and must account when we’re done with this. I’m glad Trump is making noise about cutting funding to the WHO. The UN, for its part, then preposterously nominated China to the Human Rights tribunal! They put the world in jeopardy and get rewarded by the UN? Time to disband this despicable organization.

    Then Canada, despite this, decided it was ‘xenophobic’ to shut down airspace from places known to be the epicentre of the virus opting to play the ‘rational cop’ in January and February. They then decided to send equipment (including masks) to China. Either they knew about the virus and didn’t think much of it or they didn’t know about it; which makes them incompetent. Either way is not a good luck and put Canada in jeopardy. They kept the airports and border open until it was too late.

    As if this isn’t enough, they’re doubling down on their ideological nonsense as the Health Minister Patty Hajdu outrageously claimed the media was making up stories and that there was ‘no proof China lied’.

    The entire party should resign at this point. They failed Canadians.

    They wasted precious time where they could have prepared kits and begin the process of social distancing. Now we’re paying a heavy economic (and possibly a freedom) price because of their incompetence and gross negligence.

    As for Justin, his ‘leadership’ can be summarized thusly: He let events lead him. He wasn’t pro-active, he was reactive.

  8. Developing them ought to be the top priority right now.

    From the “Libertarians for Central Planning and House Arrest”.

    Us racist right wing extremists instead believe that staying in your house should be a voluntary personal decision, and that the development of test kits should be based on private investment and market forces.

    1. I’m doing just that, having a leaky heart, and some other issues, and being in my sixties. But I don’t want the kid that brings my groceries, or pizza, to bring COVID-19 with them, either.

      1. Then spray your stuff with Lysol and use your door as a mask.

        It won’t be forever. This’ll burn out soon enough. Wreck the economy in a misguided attempt to help the most potential patients, and you’ll end up with a threat you can’t get rid of with Lysol, or keep the door closed on.

  9. The boxes would have serial numbers that patients could use to collect a financial reward when they report their results, something that would ensure both compliance and tracking of the disease spread.

    People will falsely report just so they can get the reward and go back to work, particularly if they aren’t adversely affected by it.

    When their coworkers start showing signs, you’d have a hard time proving just who the rat bastard that lied was.

    1. Thats your objection???

    2. I’m reminded of a 1970’s requirement that you needed to send a sample of your dirt to the state capitol for determining if your land could sustain a septic tank and hence was a buildable lot.

      I know one guy who went to a gravel pit and obtained his sample from there. Enough said?

  10. Am antibody detection test was approved by the FDA on April 1st… google “Cellex-FDA”.

    CB

  11. I want my religious exemption. My religion is being not afraid of catching a cold.

  12. That’s crazy talk. Don’t you know the average American is too stupid to figure out how to use a q-tip?

    Then again, a lot of millennials don’t know how to change a light bulb, so I suppose not being able to use a q-tip wouldn’t really surprise me.

    1. yeah that’s a fucking shame.

    2. “Please don’t bury me down in the cold cold ground,
      I’d rather have them cut me up and pass me all around”

      Saw him twice. Great loss. My fav lyricist. Funny, touching, sassy.

  13. I really doubt that the US can test like two tiny nation states. Korea has 2 international airports. Taiwan has 4. The United States has 150. That is 150 places where people are entering this country from abroad. By the time we even knew that the cases were in this country, thousands of travelers had encountered the infected and gotten onto airplanes to regional airports.

    In Taiwan, one guy gets sick and the Government checks his cell phone records, and requires everyone in his house to get tested. Everyone whose cell phone says they were at the local store gets tested. Everyone who works on his floor and the floors above and below him gets tested. Now imagine trying to do that after finding just 100 infected people who traveled all over the US.

    Some things are just not scale able.

    1. I agree with this. The US is an example of a real scale problem, in addition to the fact that our federal structure makes it difficult give the (quickly diminishing) independence of the states.

    2. People *know* America is big but they can’t conceptualize how big in order to understand scale as you mention.

      It’s not helpful for compare a highly transient, heterogeneous and free country with a large population dispersed over a huge land mass to, say, Switzerland, Sweden or Korea on any level.

      1. Not as big as Canada!

  14. the Oldie Hawns were already inside all day doing nothing.

    >>>massively economically destructive

    was the goal.

  15. It’s not a hoax but it DOES NOT follow an exponential growth. No disease does. It can’t. Exponential curves never top out. Diseases, including this coronavirus, follow S-shaped logistics curves. Specifically, diseases follow Gompertz curves (a variant of the logistics curve where the increase and decay components are not necessarily identical).

    Once you admit that we have to analyze this as a logistics curve analysis, it becomes obvious that these isolation measures do nothing whatsoever to change the total number of people who will get sick. All they do is slow down the pace toward the upper asymptote of the curve.

    Yes, we should (mostly) get out and get back to work like Sweden did. Elderly and at-risk individuals should stay safe. And there may be arguments in favor of lockdowns in high-population-density areas like New York City. (Those arguments notably fail when applied to rural Wyoming.) Yes, some young people will get sick. Statistically, they are going to get sick regardless. All you’re doing is changing the timing.

    And the cost for this delay is mind-boggling. Not only are we crippling the economy, we are directly causing a host of other infirmities and deaths. Consider, for example, the many people who were just barely hanging on before this crisis and who are now cut off from their support structures. Consider the elderly who will fall and die alone because their loved ones are afraid to come visit. Consider the suicides and domestic violence that are directly correlated to economic disruption. The total death toll from the isolation measures is going to be far greater than the expected death toll from the virus.

    1. The disease does follow an exponential growth until the number of people who have had the disease and are immune grows to a significant number.

      It’s simple first order kinetics.

  16. “There may be if mass home testing kits become available soon.”

    There would be now if it weren’t for the FDA.

  17. I read the author’s name, but I guess the paragraphs about how this miracle test will be developed by illegals in a tent in the AZ desert fell off the web somehow.

  18. “In order to avoid getting infected, we have to stay at home in a mass lockdown.” No, we don’t, any more than we “have stay at home” to avoid the risk of a car accident or avoid hospitals to keep from becoming one of their 250,000 fatalities due to medical mistakes. Should no one ever go to hospitals because of the risk? What the fuck? “The upside of suppression”? Jesus titty fucking christ, I knew this woman was stupid, but I didn’t know she was this evil.

    1. “I knew this woman was stupid, but I didn’t know she was this evil.”

      New to Reason? Do some searches for her work around the election or concerning political violence at Berkeley and Portland. You’ll find plenty of her prior objectionable work to piss you off.

  19. The experts in the field of health must try harder to conquer Coronavirus, if Coranavirus stage 2 will tackle us again when people start to get out of the house and move as usual.

  20. Whatever options are pursued by government actors need to be consistent with respect for individual liberty and private property rights, and with respect for individual intelligence. Which means, government actions suppressing liberty are unacceptable.
    Eliminate government actions that are unacceptable, and what is left is what we have to work with. That really leaves only information and persuasion – then leave it up to us as free people to figure out the rest.
    Acting non-coercively, we will come up with the best solutions to overcome the virus with the minimum damage to individual rights to life, liberty, and property. Free people are smarter than slaves.

  21. Shikha, you are singing to the choir here on this issue.

    The tests EXIST, are cheap, availble.. but your sweetheart pals over at CDC refuse to allow them. dontchya remember how those bozos started out insisting on ONLY their tests, which were terribly inaccurate, could be used, anywhere in the US, AND that they HAD to be sent in to THEIR labs only for processing.. involving long delays. overloaded lab, lost and contaminated specimens…….

    GET those FedBozos out of the way. Private entities HAD test kits availalbe, were prepared to massivlyup production and get them in the hands of local medical providers who had local bio labs already capable of processing the tests. But Fauci and Birx said NO WAY. WE gotta keep control over the whole thing.
    They are STILL dragging their feet.
    Chloroquine is also HIGHLY effective against CV, is cheap, readily available and has a track record of high safety all round the world for four decades and more…. yet Fauci/Birx are again sandbagging THIS proven cure.
    You read enough about South Korea to present data above.. WHY did you not also present data about the incredible success with chloroquine and a certain antibiotic?

    Are you stumping for government here? Or what/

  22. It is great news to free people from home arrest.

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