To prevent the furious coronavirus epidemic, which is recently spreading at a rate of about 60,000 new instances per day, the United States can do one of two things.
Or you can block everyone altogether. Or everyone can do it all the time.
The blocking technique works because if other inflamed people can’t get close to other non-inflamed people, the chain of transmission is disrupted, even if we don’t know who is inflamed.
The verification technique works because it allows us to identify other inflamed people and isolate them from other inflamed people without forcing everyone to stay home.
The problem, however, is that after suffering a primary national stagnation this spring, and suffered the economic consequences with little to show, Americans have no appetite even for specific, localized aftermath.
That leaves evidence.
Unfortunately, the most recent knowledge now shows that evidence is declining in much of the United States. According to Johns Hopkins University, the average number of COVID-19 tests consistent with the consistent form of another 1,000 people has decreased during the following week in 30 states – more than part of the country. Nationally, the average number of tests fell by 8.75% during the same consistent period, from 822,470 on July 29 to 750,517 on August 4.
And although some of the states where the tests failed were affected by Hurricane Isaias, the maximum was not. Most are states, 22 in total, where a higher percentage of COVID-19 tests test positive, indicating that they do not show a wide enough network to track (and control) their epidemics.
In short, while President Trump is correct in saying that the United States has conducted more tests than any other country, it is not testing enough, given the scale of the epidemic. And the evidence he’s doing, for reasons we’re going to explain, attending as much as he should.
The good news is that there may be an undeniable solution: new tests that prioritize speed over sensitivity.
Storms aside, the main reason U.S. testing is going down instead of up is because the type of testing we’re doing — PCR (polymerase chain reaction) — seems to have reached its limit. PCR tests are the gold standard for diagnosing COVID-19, and rightly so: They correctly identify more than 98 percent of positive cases.
But they are also slower and slower. As the virus spreads, more and more potentially exposed Americans are not easy to control, forcing defeated U.S. labs to compete with other countries for the materials needed to process so many samples. The labs ran out. As a result, crippling delays have delayed the effects of checks for so long that they are worthless.
According to a new national survey conducted through researchers from Harvard University, Northeastern University, NorthwestEr’s University and Rutgers University, Americans evaluated for COVID-19 in July reported that they waited an average of 4 days to get their results. About 10% of other people said they waited 10 days or more.
However, public fitness experts say the results, which take more than 24 to 48 hours to arrive, disagree with the verification goal. By the time other people get a positive result, they may have already inflamed others. By the time they get a negative result, they may have swelled up through others.
Americans seem to perceive the message. “Long wait times and long response times mean other people are just giving up,” Ashish Jha, director of Harvard’s Global Health Institute, tweeted Tuesday.
The collapse of turnover in the United States has revealed, in short, its fatal flaw. Costly and bulky PCR controls are appropriate when an epidemic is relatively small; In this situation, you can invest in slower and more laborious control that will not lose any positive cases, because you need to prevent the virus from spreading before it is too late.
But when it is too late, when more than 4.8 million infections have been reported and only about 160,000 more people have died, PCR infrastructure cannot remain active.
That’s why experts like Michael Mina, assistant professor of epidemiology at Harvard Medical School and Harvard T.H. Chan School of Public Health, we recommend it and start again.
“We want to replace the total situation of what people need to check for,” Mina recently explained.
Imagine a $1 paper check at home that’s as simple to distribute and use as a pregnancy check. Imagine getting up in the morning, adding saliva or mucus to a chemical tube, waiting 15 minutes, dipping a strip of paper into the tube and reading its effects, instantly.
Now believe that every single user in the United States does this every single day.
So-called immediate antigenic controls are not science fiction. In fact, they already exist. Two of these checks, carried out through BD and Quidel, obtained an emergency authorization from the F.D.A., or still require tools to operate. (The governors of seven states this week announced a joint offer to acquire a total of 3.5 million of those antigen controls.) Another $1 antigen control has been implemented in Senegal. And U.S. corporations like E25Bio and Sherlock Biosciences have developed housing controls as reasonable and simple as those described above.
These are not the same antibody tests you may have heard of, which stumble upon antivirus ingredients in the blood of others that have been swollen in the past (and can be immunized). Rapid antigenic testing is designed to trip over active infections in progress.
So why the U.S. government Does it not produce antigenic mass tests and distribute them to all? The biggest impediment so far has been what reports tend to call “precision.” But “sensitivity” is a better way to think about it.
PCR tests make thousands of copies of the virus’s RNA and may trip over it to very low degrees. Antigen tests are based on a molecule that binds to the picos of coronavirus proteins; at very low levels of infection, there might not be enough viral remains in a sputum pattern to cause a positive result.
The concern is that if we rely on antigenic testing, we lose many cases. But this concern would possibly be unfounded for two reasons.
The first is that we are already missing tons of instances. According to CDC antibody data, our existing PCR formula checks only other people to trip over about 10% of the total number of infections. “If everyone took an antigen check, even if we only knew 50% of the positives, we would still identify 50% of all infections in the country,” Jha explained. This is “five times more than 10% of the instances we’re probably identifying, because we’re reviewing very few people.”
The time is that the amount of coronavirus in the picture increases exponentially in the first few days of infection. Initially, the incubation period, no control would be sensitive enough to trip over it. About 3 to five days later, a PCR test captured it. After another 8 to 24 hours, according to Mina, a quick antigen analysis would show a positive result.
It’s not about whether an antigen check would run into an infection. That’s when
That’s a very important distinction. Assume that PCR verification verifies a positive result on the fourth day and the antigenic check delivers a positive result on the fifth day. As you can see the most productive experts, the fourth and fifth day are before or near the beginning of the window, that other people can transmit the virus to others. But if the user taking control of PCR does not notice that it is positive before the eighth day or even the 14th day, while the user taking the antigenic control notices it on the fifth day, antigenic control is much more useful to stop it. spread of the virus even if it is less sensitive.
What if your viral load is too low on the fifth day for antigenic control to be detected? His infection probably wouldn’t be very communicable yet. Then, the next check you pass, the seventh day, I’d pick it up. And the user who performed the PCR check would not yet have its results.
“The vast majority of PCR positive tests we currently collect in this country are actually finding people long after they have ceased to be infectious,” Mina recently explained. “All we’re doing with all of this testing is clogging up the testing infrastructure, and essentially finding people for whom we can’t even act because they are done transmitting.”
Current FDA rules state that any new coronavirus checkup that competes for emergency approval will have to be almost as effective as a PCR checkup. But as autumn approaches, and in colder weather, increased domestic activity, a return to school, and the possibility of even greater waves of infection, it may be time to reconsider those regulations.
Rapid antigenic testing has its challenges. A fair distribution on a giant scale would likely require billions of dollars of government investment; Easy and affordable house trials will only paint if everyone takes them to a conscience.
But experts say they’re starting to make more sense than the quo.
“If you had made me this consultation a few months ago, I would have said we only did the PCR tests,” Susan Butler-Wu, clinical microbiologist at the University of Southern California, told New York Times on Wednesday. “But we are so far away in this country. It’s a mess. It’s time for the kitchen sink.”
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