Monday, July 20, 2020

Michael Mina: What if Covid Could be Arrested in 30 days?

Are you ready for a conspiracy theory?

What if there were an invention which could stop COVID 19 in its tracks in a month or two?

What would be the effect on our nation and the world?

Would this insure Donald Trump's re election, as the virus, "like a miracle" ceases to paralyze the nation, just as he promised, by, say, late October?

Listening to TWiV 640, Mad Dog was stunned. Here are the links, if you're interested, but you're not, because it takes an hour and you're too busy to take an hour right now. So the short and dirty summary follows.

https://www.microbe.tv/twiv/twiv-640/


Here, after all, was a trusted group of TWiV nerds who interview a Harvard infectious disease specialist at the School of Public Health who calmly, methodically lays out a solution to most of the problems of COVID 19 with a simple solution, relatively low cost, which clearly will work--a plan you do not need 4 years of medical school to understand.

It begins with Michael Mina, MD, PhD at the Harvard School of Public Health and his interview with the TWiV nerds. 
Dr. Michael Mina

It's very simple, but it requires a few leaps of faith:

1.1st LEAP:  There is a simple test for the RNA of SARS COV-2 which is a home test, like home pregnancy kits, which requires just a glob of saliva and a few minutes later you know whether or not you have the virus in sufficient quantity to be infectious to other people.

                      The test is imprinted on cardboard strips and can be manufactured in the millions at low cost at a variety of centers--universities, drug companies, all over the country and if logistical problems an be solved, every school child, every school, every university, every employee, waiter, air line,  could have these strips in hand and use them every day because they would cost only about $1 per strip.

2. 2nd LEAP: The government and business could organize and cooperate to the extent where these strips could be put into the hands of nearly every American.

3. 3rd LEAP: The profit motive could be abrogated to the extent that the government pays for the strips and nobody profits from them, apart for the general economy which could then safely send kids back to school, workers back to factories, airplane passengers back on airplanes, in short we could re open the economy, without masks and without fear of a new outbreak.



What could possibly go wrong with this rescue scenario?

1. Rigid government regulators at the FDA:  Such a system would have to be endorsed by the FDA, which would have to say these strips are reliable enough to trust and clinically useful. 
2. Companies (and Trump family members) who see a chance to profit handsomely from manufacturing these simple strips.

And here's the rub: The FDA has rules and current rules are meant to guide not public health, but clinical care of individual patients on wards and in doctor's offices. For these clinical settings you may want a test which does not miss viral disease particles--you want a "highly sensitive" test. 


But for the purposes of public health you do not need a highly sensitive test.
You can afford to miss people who have the virus--but not enough virus to transmit to others. Patients with low levels of virus are not a threat to the rest of us, to the public.
So if a patient has the virus at  low levels the saliva/stick test will miss it:  BUT THAT DOESN'T MATTER! That kid can still go to school because he won't infect anyone.
But the next day, when his virus load stokes up the saliva/stick test catches that and turns positive, he stays home. 

So sensitivity for the purposes of public health is irrelevant. All we care about is transmission to the group, not the individual, not whether the individual is early or late in his disease. You need one sort of test to treat an individual patient but another sort for defense of public health.

Imagine if all the school kids, employees, airline workers and passengers could wake up every day, test their saliva and those who are infectious stay home.






Wouldn't that be wonderful? Wouldn't that stop the pandemic in its tracks?
Well, maybe not dead in its tracks. We have people who won't wear masks--what makes you think they'd do the tests at home and if + would not go to work anyway?
But you could do them on kids at school, at airplane gates, at factories. You use thermometers, which granted takes only 2 seconds, but you could stagger arrivals and do tests which take 5 minutes. 

Now consider this: We have this test. It's sitting on a desk at the Harvard School of Public Health, and other places, but nothing is happening to get it mobilized. 

We have the saliva test bomb but we do not have the leadership to organize its deployment.

Now, let's think politically, just for fun. 
Suppose Trump administration officials are smart enough to learn about this and implement it by late August and by late October disease rates are vanishing. 
Who do you think wins  the election?

Or, suppose, Joe Biden comes on every network, every social media outlet and says, "I have a way to end this pandemic" the way Nixon had a secret plan to end the war in Vietnam?  Only, in this case, the plan is not secret. Joe gives it out and says Trump has been so inept he did not enact this simple solution.
Joe hammers Trump with this every day.
Videos explain it all with cartoons so everyone can get it. 
Who wins the election then?

But, as the virologists on TWiV lament: Nobody who counts is listening. They are all too busy on Facebook, Twitter and CNN.



Too bad, it could have worked. 

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