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Cheap Mass Testing Is Vital for Pandemic Victory

A paramedic holds a blood sample
Jess Baddams, a paramedic, holds a blood sample as she poses for a photograph during an antibody testing program in Birmingham, England, on June 5, 2020. SIMON DAWSON-POOL/GETTY IMAGES

The development of COVID-19 vaccines in less than a year is an extraordinary achievement. But while trials suggest vaccines are highly effective in preventing sickness and death, they are unlikely to make us virus-proof. We don’t know yet whether they will prevent spread of the virus—the key to achieving herd immunity. The scale of the project, limited manufacturing capacity, and constraints of intellectual property issues mean it will be months before there is mass deployment of coronavirus vaccines in most countries, let alone protective coverage at the population level. In the meantime, the pandemic is getting worse.

While a high-tech approach has yielded success for vaccines, it has largely failed elsewhere. Despite billions invested in therapeutics, we lack effective drug treatment—let alone a single reliable cure. And despite the hype, there is no evidence that contact-tracing apps have moved the needle even in countries that kept infection rates very low through other means. In others, such as the UK, they have been an expensive fiasco. Effective testing is central to outbreak control, but PCR (polymerase chain reaction), the gold standard for testing, has failed in the first task of disease control—identifying and isolating the contagious. The world needs a lower-tech solution: rapid, cheap, and effective testing.

The human cost of the current approach is enormous. The United States is seeing record numbers of hospitalizations and deaths. Across the Europe Union, largely successful in slowing the first wave of COVID-19, many countries have been back in lockdown for at least two months. Even outlier Sweden introduced tighter restrictions. In East Asia, a resurgent winter virus threatens the hard-fought successes in Japan, South Korea, and others.

But it is the emergence of the highly contagious and fast-spreading B117 strain in the UK, and a similar strain from South Africa, that exemplify the catastrophic limitations of our current testing system.

But it is the emergence of the highly contagious and fast-spreading B117 strain in the UK, and a similar strain from South Africa, that exemplify the catastrophic limitations of our current testing system.

 Without a tool to easily detect

contagious people and meet the demands, border closures, travel restrictions, and lockdowns remain the only options to suppress infection and avert mass life-and-death decisions by already burnt-out medical staff at overstretched hospitals. These measures carry enormous economic and social costs. Shutdowns have destroyed hundreds of millions of jobs, upended education, spread poverty and hunger, and imposed a terrible toll of isolation, loneliness, and despair.

As we await mass vaccination, widespread testing offers a real alternative to the dismal choice between lockdowns and deaths. Even in a vaccine-led future, COVID-19 inoculation may not be a panacea. While vaccines will be lifesaving for many, especially the elderly, they are approved on the basis of their efficacy in preventing disease and death, not stopping spread. Since the latter is a higher immunological bar, even effective vaccines are likely to be significantly less successful in stopping spread. A strategy to give one dose to provide some clinical protection may be reasonable—but delaying a second dose may further compromise the ability to stop spread. Reinfections, increasingly reported, may mean that natural immunity has a short shelf life. Testing will remain essential.

And even when shortages are overcome, if the politicization of the virus and use of vaccines as political props leaves people too distrustful to get vaccinated, the goal of herd immunity— estimated at 60 to 70 percent of the population—may remain elusive.

Testing in a pandemic has several distinct requirements. First, identify the contagious for timely isolation and contact tracing. Second, confirm diagnosis of the clinically ill—particularly important for diseases that are mostly mild and present with non-specific symptoms. Third, test to determine the efficacy of vaccines in reducing spread—particularly important since nearly 50 percent of transmission is silent, and 20 percent of infected people are asymptomatic but may still spread the virus. Since the vaccine is designed to eliminate symptoms, frequent testing is the only way to figure this out. Finally, frequent testing helps to pick up mutations of the kind that have emerged in the UK.

PCR, the current test, is expensive—$50-$150 per  test—and requires laboratories, specialized equipment, and skilled scientists to conduct it, which restricts its capacity to meet increasing demand. These limitations can delay results for up to days.

A newly available testing strategy can rectify the current testing shortfall, provides the means to dramatically curb the number of new infections, and to open up greater use of PCR for sequencing as existing strains mutate and new variants emerge. Rapid antigen tests are ideal for decentralized testing, especially in communities and cities of moderate to high transmission, where contact tracing is severely limited or simply impossible.

source: foreignpolicy

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