Covid-19 mass testing facilities could end up the epidemic I rapidly

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4 years ago

Indeed, mass testing isn't really important, it doesn't make sense.

I provided small details but it is better to read the whole paper

"Everyone should be tested weekly. All households and care homes would return self-taken swabs from all residents together. In most homes all residents would test negative and they could resume normal life immediately. An identification card certifying date and result of latest test (positive, negative, negative contact of a positive case) might be useful for policing arrangements. By the time the first test is done there may be more than a million infected people who must be treated or remain quarantined at home or in care until all residents at the address test negative. That unavoidable crisis for the NHS would be ameliorated by earlier diagnosis and treatment, and hence reduced pressure on intensive care, and by having all staff as well as patients tested regularly. Contacts of positive people who test negative could choose continued home quarantine or, at little extra risk, choose to join a group of up to 10 test-negative contacts (usually with other family members). Subsequent weekly national testing, together with behavioural changes and efficient contact tracing, would find progressively fewer infections and might soon be extended to a month. This emergency system would only be needed for about 2 months but could be rapidly reintroduced to control any future epidemic caused by a new virus"

Godlee F. The burning building. Editor’s choice. BMJ2020;368:m1101doi:10.1136/bmj.m1101.

https://www.bmj.com/content/368/bmj.m1163.long

"Other countries have beat back the virus without such drastic measures. One example is South Korea, which has seen confirmed infections drop from 909 cases on 29 February to just 74 early this week. “South Korea is a democratic republic; we feel a lockdown is not a reasonable choice,” says Kim Woo-Joo, an infectious disease specialist at Korea University.

Instead, the key to success has been a large, well-organized testing program, combined with extensive efforts to isolate infected people and trace and quarantine their contacts. By 16 March, South Korea had tested more than 270,000 people, many at a network of dozens of drive-through testing stations, a strategy followed elsewhere that eases access to testing and prevents infected people from exposing others in waiting rooms."

--Countries test tactics in ‘war’ against COVID-19--

https://science.sciencemag.org/content/367/6484/1287.full

"South Korea’s knowledge and experience of the 2015 Middle East Respiratory Syndrome (MERS) allowed them to quickly react to the 2019 Novel Corona Virus or COVID-19. One of the lapses they have identified during the MERS outbreak was mass testing which resulted to a death toll of 38. This papers shows how South Korea’s mass testing allowed them to control the further increase in the number of new infections. Furthermore, it also allowed the early detection of outbreak in the city of Daegu after a period of 33 days from the start of testing."

Balilla, Jeffhraim, Assessment of COVID-19 Mass Testing: The Case of South Korea (March 18, 2020).

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3556346

"Many countries are taking measures stopping productive activities to slow down the spread of COVID-19. At times these measures have been criticized as being excessive and too costly. In this paper we make an attempt to understand the optimal response to an infectious disease. We find that the observed policies are very close to a simple welfare maximization problem of a planner who tries to stop the diffusion of the disease. These extreme measures seem optimal in spite of the high output cost that it may have in the short run, and for various curvatures of the welfare function. The desire for cost smoothing reduces the intensity of the optimal quarantine while extending it for longer, but it still amounts to reducing economic activity by at least 40%. We then study the possibility of either complementing or substituting the quarantine policy with random testing. We find that testing is a very close substitute of quarantine and can substantially reduce the need for indiscriminate quarantines."

Piguillem, Facundo and SHI, LIYAN, Optimal Covid-19 Quarantine and Testing Policies (April 2020). CEPR Discussion Paper No. DP14613. Available at SSRN: https://ssrn.com/abstract=3594243

"We show how group testing can be used in three applications to multiply the efficiency of tests against COVID-19: estimating virus prevalence, releasing group to the work force, and testing for individual infectious status. For an infection level around 2%, group testing could potentially allow to save 94% of tests in the first application, 95% in the second, and 85% in the third one."

---Gollier, Christian and Gossner, Olivier (2020) Group testing against Covid-19. Covid Economics, 2.---

http://eprints.lse.ac.uk/104228/

"Taiwan’s government learned from its 2003 SARS experience and established a public health response mechanism for enabling rapid actions for the next crisis. Well-trained and experienced teams of officials were quick to recognize the crisis and activated emergency management structures to address the emerging outbreak.

In a crisis, governments often make difficult decisions under uncertainty and time constraints. These decisions must be both culturally appropriate and sensitive to the population. Through early recognition of the crisis, daily briefings to the public, and simple health messaging, the government was able to reassure the public by delivering timely, accurate, and transparent information regarding the evolving epidemic. Taiwan is an example of how a society can respond quickly to a crisis and protect the interests of its citizens."

----C. Jason Wang, MD, PhD, Stanford University, 117 Encina Commons, CHP/PCOR, Stanford, CA 94305---

https://jamanetwork.com/journals/jama/article-abstract/2762689

"Our own NHS Trust at University College London Hospitals, London, UK, will soon be testing asymptomatic HCWs. In partnership with the Francis Crick Institute in London, UK, where COVID-19 testing will be performed, this initiative is an attempt to further limit nosocomial transmission. It could also alleviate a critical source of anxiety for HCWs.22 A healthy, COVID-19-free workforce that is not burned out will be an asset to the prolonged response to the COVID-19 crisis. As testing facilities increase in number and throughput in the coming weeks, testing should aim to accommodate weekly or fortnightly screening of HCWs working in high-risk areas.

There is a powerful case in support of mass testing of both symptomatic and asymptomatic HCWs to reduce the risk of nosocomial transmission. At the time of writing, the UK is capable of performing 18 000 tests per day,23 with the Health Secretary targeting a capacity of 100 000 tests per day by the end of April, 2020. Initially, the focus of testing was patients, with NHS England stating only 15% of available testing would be used to test NHS staff.24 Although this cap has been lifted, symptomatic HCWs, rather than asymptomatic HCWs, are currently prioritised in testing. This approach could mean that presymptomatic HCWs who are capable of transmitting the virus are not being tested; if they were tested and found to be COVID-19 positive, they could be advised to isolate and await the onset of symptoms or, if no symptoms develop, undergo repeat testing.

As countries seek to flatten the growth phase of COVID-19, we see a significant opportunity in expanding testing among HCWs; this will be critical when pursuing an exit strategy from strict lockdown measures that curb spread of the virus."

---- COVID-19: the case for health-care worker screening to prevent hospital transmission--

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30917-X/fulltext

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