OVERVIEW
COVID-19 test volumes have been trending well below the recommendations calling for 5 million to 20 million tests per day (click here for report) to adequately manage re-opening local economies. To understand the current trend in testing relative to high profile guidance, we spoke with a leading academic epidemiologist involved in COVID-19 testing, saliva based COVID-19 test development, detecting COVID-19 in sewage treatment plants, among other areas of research. We also touched pre-existing COVID-19 immunity, the #SecondWave, and the scientific underpinnings of social distancing and other epidemiological recommendations to prevent the spread of disease.
Our contact thought a #SecondWave was likely, and potentially already in motion based on data from Arizona, Florida, Texas, Iran, Poland, among other locations, even before seasonal upticks expected this Fall. While temperature taking was ineffective and likely not useful, high frequency testing on frequency of 3 days or weekly will be needed to control outbreaks. Contact tracing will be initiated by a positive test, but can be "quickly overwhelmed." Asymptomatic spread, if states have reopened too soon, will mean contact tracing will be late and behind case volume.
The implication for the genetic testing companies on our position monitor is significant, although the balance between the positive impact of COVID-19 testing under a #secondwave scenario will be offset by the negative impact to the core businesses.
Useful links
- Click here Arizona Data in the chart below and the key concern expressed by our contact
- Click here for pre-existing immunity paper published in CELL
- Click here for paper on sewage system COVID-19 detection
Field Notes
- We need a more sensitive test than we have now.
- To control infection spread we need individual level readings
- Epidemiologists are concerned about the impact of a sero test false positive may have on individual behavior
- Number one concern for epidemiology is behavior, people not following recommendations
- There is not much scientific data on the effectiveness of awareness, other recommendations made by Health Departments based on epidemiology
- Hand washing has been quantified, but much of the list of epidemiology recommendations has been less rigorously quantified
- Stigma, fear also play a role making recommendations difficult to study
- Epidemiology "unleashes" recommendation on public but uniform application is not possible, a controlled study difficult to impossible
- Positive COVID-19 tests precede hospitalization by several days or weeks given the progression of disease
- Expects a positive test trend, which we see in some locations, to result in rising hospitalization rates later
- Sewage studies - waste water can show COVID-19 1 to 2 weeks ahead of time
- COVID-19 RNA is "remarkably stable," it won't degrade in sample collection tube, or in waste water
- Schools and colleges are a problem for re-opening as are offices
- Contact tracing can be "quickly overwhelmed"
- Bluetooth tracing is interesting and looks useful in what's been shown
- Compliance is the key
- Fever and temperature detection is not useful, except as a reminder good reminder of the crisis
- Health Care workers are the most obvious population to test first on a regular basis
- Nasal swab is less sensitive than nasopharyngeal (to the back of the throat)
- Nasopharyngeal is 70-80% effective, but uncomfortable, likely to have lower compliance
- Abbott test not sensitive, "a disaster"
- Nasopharyngeal versus Nasal: Nasal is 80% as effective (56-64%) as taking a sample from the back of the nasal passage
- It is thought that children are pre-exposed to coronavirus and see much less disease as a result
- "Noise" in data from pre-COVID samples may be pre-exposure immunity to COVID-19
- Detection of COVID-19 reactivity presented in the data as they are developing a saliva based COVID-19 test
- Testing really needs to be done every 3 to 7 days based on disease progression
- DNA testing needed, not antibody, to be able to detect asymptomatic patients, spreaders
- Antibody positive does not confer immunity, "we are not sure if those antibodies stop colonization"
- The mutation rate is slow, helps with vaccine development
- Wearing a mask will likely help stop spread on elevator
- Risk of spread is with 15 minutes of exposure, or a cough, or some other direct exposure
- Expect a #SecondWave, we may already be seeing it in Iran, Poland, 13 US states where cases are rising
- Hoping to get saliva test paper published showing 0.5 to 1.0 ml sample adequate for a 300 micro liter test volume
- Test needs to be affordable and fast, it can't be putative for those who test positive
- For example, 100's of samples on a rapid test platform taking 15 minutes to show results will take too long to use for office entry
- Multiplexing potentially introduces error in a high throughput sequencing analysis, longer time to a result
- RT PCR can be completed in 2 hours, batch results, and manageable assuming we test overnight and inform test taker the next day before their commute
- Front line health care workers should be tested first
- Test where there is disease
