Amsterdam, 7 May 2020, Johan Pieter Verwey, Co-founder Nostics
This article will try to explain why we need testing to get out of the pandemic and what different types of tests are out there. With the reality of the impact of the coronavirus setting in among all people around the globe, the next challenge is coming to grips with how to get through the pandemic. One of the key-words has become ‘testing’. Testing will put us back on track, get all of us out of a very sticky situation. But why is this the case? And is it? The answer is both yes and no. Testing is not the solution but without testing, getting out of this ordeal will be much more challenging and will take forever.
Why perform tests at all? Let’s take away some misconceptions that are prevalent in the media and in daily discussions about the COVID-19 virus.
· A vaccine will take many, many months to be ready. Even if it works immunizing the whole world will take years. And in reality we have to consider this may never happen.
· It is very unlikely that the virus will just ‘go away’. It will affect our communities, our healthcare systems and our economies for the years to come.
· A cure is extremely important. This will reduce the morbidity rate and reduce the pressure on ICU’s and healthcare professionals.
· Psychology plays a major role in pandemics. Even with a cure in place and a declining hospitalization rate, fears will not subside easily and hamper the re-opening of our global economy.
· Only trust and confidence in each other will get us back to normal. Testing can play a major role here.
So, knowing this, when and why should we tests be administered?
1) In case people are ill, we need to know if they are carrying the SARS-CoV-2 virus, which causes COVID-19. We need to know this to protect the healthcare professionals caring for patients, to protect the people around them and to make decisions about quarantine measures;
2) To re-open the economy, allow people in airplanes, public venues and safely interact in large crowds, we need to know for who it is safe to do this;
3) To truly understand the status of the virus in the population, we need data. Lots of data, that will provide a solid basis for policy makers to make sound decisions about the social distancing and the economy.
Without testing the world will lack the confidence and certainty to move beyond the pandemic, even if the threat has subsides. Which, by the way, will most likely take several months, if not years. So, testing is important. But what types of tests are actually out there? With so much media attention focused in diagnostics, it is often hard to understand the difference between the different tests and methods. So, let’s discuss them all briefly:
Virus detection tests.
These tests, predominantly genetic tests, use a saliva from a throat or nose swab from a test subject and look if there is viral DNA or NRA present in the sample. This is done through a rather complicated process called polymerase chain reaction, where minute amounts of genetic material are multiplied and then detected. This allows for a positive or negative diagnosis.
Viral antibody tests
Antibody tests don’t detect the presence of viral material in the body. These tests use human blood samples to screen for antibodies that are present after a person has been ill. The body’s immune system builds up protection against the virus in the form of antibodies, that are specific to that particular virus. Once detected we know two things: 1) the test subject has had the disease and 2) at this point the test subject is no longer contagious or carrying the virus. How long this ‘immunity’ lasts is unclear but several months is expected.
It is important to understand that these are two very different types of tests. One says something about the presence of the virus, the other only something about the presence of antibodies. Ideally, we would like one test that tells us both, but currently that test does not exist. Not yet….
When people are discussing COVID-19 tests, always consider the type of test they are talking about. They are both important, but for different reasons and useful at different times.
If we would be able to provide every citizen in a country with an antibody test right now, this would provide some insight from a policy perspective, but would hardly help the economy forward. The simple reason is that only 5-15% of most populations carry antibodies. Therefore we can be sure that 85-95% of the tests will turn out negative; the vast majority of the population. Not helping with the re-opening of the economy at all.
If instead, we could do a mass virus test on the entire population, we would be able to demonstrate who would be negative for the virus at the moment of testing. Immediately allowing these people to interact freely, to travel and to get back to work. Allowing us to stop social distancing. Testing will however need to continue until the virus is either curable or has lost its virulence.
In the end we will have to accept that, if we want to go back to normalcy soon, testing is imperative. It is the only way confidence can be restored and the economy can be reopened.
The cost of not-testing will greatly outweigh the cost of mass testing the population. Even if that means testing every citizen every 7-10 days, which will cost billions every month, will dwarf the costs of a depression that will result from a prolonged pandemic.
Luckily more, new and faster tests are hitting the market every week. Now it’s up to the policymakers to create the financial incentives and (legal) infrastructure to test on a mass scale. It is our only way out of this unprecedented situation.