How to Reopen Businesses Safely with an Efficient COVID-19 Surveillance Strategy
Point of care rapid testing is part of the solution.
The Lockdown is Impacting Businesses
In March 2020, the world was shutting down. The new coronavirus was spreading faster than we could handle. The governments needed to buy time to prepare.
The fast spread took the world off guard. The quarantine was established. All activities had to stop for an undefined period of time. Businesses had to reorganize their strategies to limit financial loss. Unfortunately, employees had to be let go to prevent businesses from closing definitively.
Small Business Protection Program
Luckily, the US administration launched the paycheck protection program (PPP) to help businesses navigate such a situation. The deal was clear. The employers had to keep their employees on the payroll for several months or had to rehire them afterward as the case may be.
Otherwise, the loan would have to be reimbursed. I was lucky enough to find a job at a rising public company developing treatments of addictions and to keep it until now. However, many hard workers had to file for unemployment despite their effort to keep their job alive.
Coping with Unemployment
Unemployment and uncertainty of the future could be as deadly as the coronavirus SARS-CoV-2 itself. Permanent or temporary unemployment may lead to anxiety, stress, depression, or mental health challenges in general.
To cope with such a difficult time, human beings tend to find solace in alcohol or drugs like opioids for an ephemeral moment of stress relief, which is detrimental because of the high risk of addictions.
Returning to “normal” work activities as soon as possible is crucial to help the battle against mental health issues. Indeed, this back-to-normal can’t occur without monitoring and controlling the resurgence of the coronavirus. For this matter, a SARS-CoV-2 testing strategy is necessary to implement.
COVID-19 Rapid Testing Strategy
Testing is the only way to determine whether you are or have been infected by the SARS-Cov-2 virus. Since some of the COVID-19 symptoms, taken individually, can be confused with other seasonal pathologies like flu, making a differential diagnosis without testing for the specific virus becomes difficult.
A strategy to eradicate the virus, i.e., to end the pandemic, requires the population to be tested in mass. Countries like South Korea understood and applied mass testing early on after the entire world went on lockdown. This strategy enables them to progressively release the drastic preventive measures and return to work to keep the economy running.
South Korea was the country that flattened the curve the most rapidly and steadily amongst industrialized countries. The disciplined South Korean underwent nasal swabs as part of genetic — or PCR — tests to determine which persons were infected and isolate them for better treatment and prevent further viral transmission.
The challenge encountered during a pandemic time is to differentiate non-infected from infected individuals that need an extra amount of care. This can’t be done in an overloaded hospital. A surveillance filter has to occur to send to the hospital only individuals who need attention.
PCR tests are performed to detect viral RNA with high sensitivity, i.e., detecting a tiny RNA amount. PCR tests also exhibit high specificity, i.e., the detected RNA is actually from SARS-CoV-2, not from any other viruses.
Scientifically speaking, the specificity and sensitivity of the PCR method are highly satisfying. But in a pandemic, the question is not how little RNA can be detected but, do these minute amounts of RNA help to identify contagious individuals?
Low sensitivity tests performed at greater frequency would be more efficient.
Researchers looked at the viral load during the course of infection and how little viruses are required to be transmittable. Interestingly, they found out that viral load was peaking two days after symptoms onsets and dropped quickly thereafter.
Nevertheless, the viral load continued to be at a level high enough to be transmitted to surrounding individuals over a period of about 10 days. The study suggested that it is safe to return to work after 10 days for non-severe COVID-19 cases for economic purposes.
Photo by Ketut Subiyanto from Pexels
But here is the catch. From a testing point of view, these workers will still be positive to the PCR as it is an ultra-sensitive method. But, from a contagion point of view, these workers are not contagious anymore.
Thus, this testing paradox is first, hurting small businesses by having uncertainty on their number of employees, therefore on their ability to fulfill services that they are supposed to provide and, second, it overwhelmed people’s anxiety, already high, as it hides any silver lining on the horizon.
Indeed, clinical testing using PCR is extremely valuable and irreplaceable to confirm COVID-19 cases when symptoms occurred. It appears to be less useful in the COVID-19 surveillance strategy, where the testing frequency is crucial. I
t is too expensive, i.e., between $100 and $200, thus unaffordable for most recurrent use organizations.
Furthermore, the turn around time to get the results back is an even bigger issue. With an average of 3 days to confirm or infirm a case of SARS-CoV-2 infection, it is more than likely that it is not in phase with the virus's fast spread; therefore, it is not suitable to circumvent the viral propagation.
COVID-19 Antigen Testing
To build an efficient surveillance strategy, we need cheaper tests to allow high-frequency use without draining the bank accounts.
Those tests need to exhibit fast and reliable results. At first, let’s be honest, it’s a lot to ask for a test manufacturer. But the reality is that it is possible to have it all, and it’s actually already on its way to global distribution.
Antigen tests are lateral-flow cassettes that detect pieces of SARS-CoV-2, i.e., antigens from a blood sample or saliva. The results are available in less than 15min directly at the point of care.
Although antigen tests exhibit a lower sensitivity compared to PCR, in a surveillance strategy that will keep the economy running, this feature happens to be an advantage.
In a recent study published in the authoritative New England Journal of Medicine, scientists decided to rethink the testing strategy.
Low sensitivity tests performed at greater frequency would be more efficient in detecting and isolate contagious individuals while letting the “non-spreader” go back to work.
Back to Work in a Safely Manner
Indeed, preventive measures like social distancing, washing your hands, and wearing a face mask still apply. However, I deeply think that frequent and regular testing strategies using point-of-care low sensitivity antigen devices are worth the expense from the public health perspective and a global economy standpoint.
Doctor in Science | Entrepreneur | Writer | Founder of Open-Minded Elixir