Testing became the buzz word in solving the COVID-19 epidemic. The logic behind testing is apparent to everyone. Only the number of tests is discussed. Ashish Jha, director of the Harvard Global Health Institute thinks that 500,000 tests a day is need for the foreseeable future. The U.S. Nationwide COVID-19 testing capacity steadily increased to 145,000 tests a day. The White House unveils coronavirus testing plan to expand testing which are viewed as critical to reopening the economy.
The Michigan state COVID-19 provides Confirmed COVID-19 Cases, but it is unclear what the case means (https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173—,00.html). More than likely, the number of tested positively. This information or better disinformation only fuels scare- mongering without a real assessment of the epidemiological importance of testing. Remarkably, during the briefing in Kent county in Michigan on April 29th, the Health department refused to answer the direct question about the number of hospitalizations and death cases.
As now became the standard of the public discourse, the approaches to this specifically medical epidemiological issue are divided along the political party line with the underlining background of public fear, politician’s ignorance, and corporate business interests. The uncertainty is only how less than 365 million to test. The solution is vacillating between the test performance in the bank’s lobby or drive- through or ATM. The tendency is in implementing all three options with looming ahead options by mail or even the drone’s involvement.
On the serious note, testing issue requires professional approach cleared from todays fear and politically motivated aggregation with the focus on rational actions in the current epidemic and in the future outbreaks. There some methodology issues which should be solved.
The presented serial of posts will reflect my personal approach. Otherwise why bother to write. It is based on the infectious epidemiologist experience, familiarity with diagnostic immunology, and anatomic pathology practice. Some bias, which stems on experience collected in different time and competely different situations, is inevitable. However, the classic epidemiology rules still apply.
The diagram presents main variants of testing during COVID-19 epidemic.Molecular test is carried out by Reverse Transcription Polymerase Chain Reaction (rRT-PCR) for the qualitative detection of nucleic acid from SARS-CoV-2 in upper and lower respiratory specimens. Serum test are in determination of antibodies in plasma to SARS-CoV-2 virus.
U.S. Food and Drug Administration (FDA) has issued the first emergency use authorization (EUA) for a COVID-19 Antigen test in May. Antigen test is a “hybrid” test by the diagnostic purpose is closer to the molecular test, a sort of molecular test light. It will be discussed in a special post later.
The next posts will discuss the testing options separately. There are many details which are not discussed although they are crucial for the test’s implementation and the desired outcome.