WEBVTT - We Can Still Pass This Test 0:00:00.120 --> 0:00:02.720 Hi, I'm Carol Masser and I'm Jason Kelly. It's time 0:00:02.720 --> 0:00:04.920 for this week's cover story. Well, Carol, we're still at 0:00:04.920 --> 0:00:08.560 the earliest months away from a working, widely available vaccine. 0:00:08.640 --> 0:00:12.080 Until then, rapid COVID night teen tests could help close 0:00:12.080 --> 0:00:15.160 the gap between normalcy and where we are right now. Yeah, 0:00:15.200 --> 0:00:18.079 it's pretty simple, Jason. If Americans want to safely send 0:00:18.160 --> 0:00:21.000 kids to school, go to a restaurant, travel somewhere, or 0:00:21.079 --> 0:00:24.200 even host a holiday party, well, the United States needs 0:00:24.200 --> 0:00:28.280 to test a lot more people and a lot faster. Faster, 0:00:28.600 --> 0:00:31.800 cheaper testing which several companies are working on, may not 0:00:31.920 --> 0:00:34.360 flag every new case of COVID, but that shouldn't mean 0:00:34.400 --> 0:00:37.599 we should settle for the status quo that's right. At 0:00:37.600 --> 0:00:40.320 the minimum, a new approach to testing might allow us 0:00:40.360 --> 0:00:44.120 to enjoy a semblance of our normal lives. Coronavirus testing 0:00:44.159 --> 0:00:46.960 could even become a habit. If not like brushing your teeth, 0:00:47.000 --> 0:00:50.199 then at least like flossing. Check it out. If your 0:00:50.240 --> 0:00:53.400 preferred climate as business friendly, check out Ohio with zero 0:00:53.400 --> 0:00:56.000 presents taxes on corporate income, R and D investments, and 0:00:56.040 --> 0:00:58.720 good sold out of state, Ohio was better for business 0:00:58.960 --> 0:01:02.040 because Ohio was a built for followers. They're building for 0:01:02.200 --> 0:01:06.520 leaders Ohios for leaders dot com. We can still pass 0:01:06.600 --> 0:01:10.400 this test with the seasons changing and a vaccine a 0:01:10.480 --> 0:01:14.720 ways off. The US needs to dramatically improve its infrastructure 0:01:14.720 --> 0:01:19.399 for rapid COVID testing. It's got options by Drake Bennett 0:01:19.440 --> 0:01:24.520 and Michelle fay Cortes. As undergraduates returned to the University 0:01:24.520 --> 0:01:27.520 of Arizona for the fall semester, many of the new 0:01:27.560 --> 0:01:31.840 precautions were hard to miss. Plexiglass dividers were affixed in 0:01:31.880 --> 0:01:35.720 front of lecterns and between lab benches. Giant tents were 0:01:35.720 --> 0:01:38.640 set up so students arriving early for a class could 0:01:38.640 --> 0:01:42.880 wait outdoors, sheltered from the punishing sun. Roving teams of 0:01:42.920 --> 0:01:47.039 student health ambassadors tooled around in golf carts, handing out 0:01:47.080 --> 0:01:50.160 masks and politely chiding their peers for standing less than 0:01:50.160 --> 0:01:53.400 six ft apart. But the first thing students had to 0:01:53.440 --> 0:01:56.240 do was visit one of the university gyms for a 0:01:56.360 --> 0:02:00.280 rapid stars cove to test. The results took an hour 0:02:00.960 --> 0:02:03.880 negative and you could move into your residence hall right away. 0:02:04.320 --> 0:02:07.280 Positive and you were sent to a special isolation dorm 0:02:07.600 --> 0:02:10.480 where you spent the next ten days taking classes online. 0:02:11.480 --> 0:02:14.800 Many of these safety measures emerged from discussions headed by 0:02:14.919 --> 0:02:18.000 Richard Carmona, a former U S Surgeon General who is 0:02:18.000 --> 0:02:21.840 a professor of public health at the university. Carmona's medical 0:02:21.880 --> 0:02:24.960 career stretches back to the Vietnam War, where he served 0:02:25.000 --> 0:02:27.720 as a Special Forces medic after dropping out of high school. 0:02:28.360 --> 0:02:31.880 Over the years, he's developed an expertise in emergency preparedness 0:02:31.919 --> 0:02:36.040 and disaster response. As news of the novel coronavirus began 0:02:36.120 --> 0:02:39.399 making its way out of China last winter, the university's 0:02:39.440 --> 0:02:42.800 president asked Carmona to form a working group and propose 0:02:42.840 --> 0:02:46.600 ways to keep the institution functioning during a pandemic. The 0:02:46.680 --> 0:02:49.200 question was what were the metrics were going to look 0:02:49.240 --> 0:02:50.799 at and how are we going to be able to 0:02:50.840 --> 0:02:54.920 make a reasonable determination that this is somewhat safe. Carmona says, 0:02:55.480 --> 0:02:58.640 we didn't have a playbook for this. Nobody had a playbook. 0:03:00.000 --> 0:03:02.720 In early spring, the team reached out to Ian Pepper, 0:03:03.160 --> 0:03:06.960 an environmental microbiologist on the faculty who had experience with 0:03:07.040 --> 0:03:11.480 wastewater testing. It used to be called sewage surveillance, says Pepper. 0:03:12.000 --> 0:03:16.480 Now the preferred term seems to be wastewater based epidemiology. 0:03:16.600 --> 0:03:20.200 The technique traditionally has been used in population level studies 0:03:20.240 --> 0:03:24.800 of illegal drug use or viral infections. Carmona's team, however, 0:03:25.160 --> 0:03:28.160 wanted to go upstream from the treatment plant to determine 0:03:28.200 --> 0:03:31.360 not just if the coronavirus was on campus, but where 0:03:32.080 --> 0:03:35.920 the sampling would provide an early warning system. People ill 0:03:35.960 --> 0:03:38.720 with COVID nineteen can start shedding the virus in their 0:03:38.760 --> 0:03:42.560 stool as many as seven days before showing symptoms. That 0:03:42.640 --> 0:03:46.760 gives you seven precious days for intervention, Pepper says. Over 0:03:46.800 --> 0:03:51.240 the summer, Carmona poured over university blueprints with the facilities department, 0:03:51.640 --> 0:03:54.920 tracing decades old sewage pipes back to the dorms they drain, 0:03:55.440 --> 0:03:59.200 while Pepper worked on filtering samples and identifying trace amounts 0:03:59.200 --> 0:04:02.560 of the virus. By the time students returned in August, 0:04:02.680 --> 0:04:05.640 the program was in place each morning at eight thirty, 0:04:05.880 --> 0:04:08.400 an hour chosen to give residence a chance to visit 0:04:08.400 --> 0:04:12.000 the bathroom. A faculty engineer working with an underground assistant 0:04:12.040 --> 0:04:14.800 would make the rounds at each stop, prying off a 0:04:14.840 --> 0:04:18.520 manhole cover and lowering an open nalgene water bottle at 0:04:18.520 --> 0:04:21.120 the end of a long aluminum pole into the river 0:04:21.200 --> 0:04:24.400 of waste below. The pair would place the samples in 0:04:24.440 --> 0:04:27.120 a cooler and drive them back to the lab, where 0:04:27.120 --> 0:04:29.839 Pepper's crew would turn around the results by the afternoon. 0:04:30.480 --> 0:04:33.440 On Tuesday, August twenty fifth, a week and a half 0:04:33.480 --> 0:04:37.000 after students started to return, Pepper got his first positive 0:04:37.400 --> 0:04:40.400 from the pipe, leaving a dorm called Lichens Hall. The 0:04:40.480 --> 0:04:43.920 next day, all three hundred and eleven Lichens residents took 0:04:43.960 --> 0:04:48.240 COVID tests. Two students, both without symptoms, came back positive 0:04:48.279 --> 0:04:51.359 and were relocated to the isolation dorm. Thanks to the 0:04:51.360 --> 0:04:55.960 head start, no other residence would contract the virus. Since then, 0:04:56.120 --> 0:04:59.040 the university has stemmed outbreaks in at least eight other 0:04:59.120 --> 0:05:03.359 dorms using the same method. Pepper is scaling up his lab, 0:05:03.720 --> 0:05:06.560 training more teams of samplers, and expanding the effort to 0:05:06.600 --> 0:05:10.560 off campus apartments and Greek houses. He's fielding requests from 0:05:10.600 --> 0:05:14.320 around the world for help setting up similar programs. Carmona, 0:05:14.400 --> 0:05:17.000 for his part, is careful not to get ahead of himself. 0:05:17.480 --> 0:05:20.640 It's a tool that's just evolving, he says, But we 0:05:20.720 --> 0:05:25.240 see value. Ever since the novel coronavirus began circulating in 0:05:25.279 --> 0:05:28.279 the US, the country's response has been crippled by a 0:05:28.320 --> 0:05:31.400 failure to see the spread in anything close to real time. 0:05:32.080 --> 0:05:35.120 Half a year after the first wave of US lockdowns, 0:05:35.160 --> 0:05:38.080 with more than two hundred thousand Americans dead from COVID, 0:05:38.480 --> 0:05:42.520 we're still playing catch up. The Trump Administration's botched rollout 0:05:42.520 --> 0:05:45.479 of its first tests and the supply chain shortages that 0:05:45.560 --> 0:05:50.880 followed helped the disease spread unchecked. Today, processing bottlenecks still 0:05:50.920 --> 0:05:54.520 render many test results worthless by the time people get them. 0:05:54.560 --> 0:05:57.719 This blindness has left public health officials only the crudest 0:05:57.720 --> 0:06:01.520 measures of containment, such as braw add social distancing mandates 0:06:01.640 --> 0:06:06.120 and lockdowns. It's turned the loosening of restrictions on restaurants, 0:06:06.200 --> 0:06:10.480 sports offices, gems, and schools into terrifying leaps of faith, 0:06:11.040 --> 0:06:14.360 and it has surely killed people. The testing we are 0:06:14.400 --> 0:06:17.719 doing today is mostly just keeping score for the virus. 0:06:17.880 --> 0:06:22.480 Since William Hannage, an epidemiology professor at Harvard, even that 0:06:22.560 --> 0:06:25.360 grim framing gives the u S system too much credit. 0:06:25.839 --> 0:06:29.279 The Centers for Disease Control and Preventions sampling of Americans 0:06:29.279 --> 0:06:32.640 with stars COVE two antibodies shows that the true number 0:06:32.680 --> 0:06:35.320 of infections is as many as seven times higher than 0:06:35.360 --> 0:06:39.520 the official count. Over time, though, the problem of testing 0:06:39.560 --> 0:06:44.080 has attracted new focus, new thinking, and new money. Experimental 0:06:44.160 --> 0:06:48.440 viral screening technologies have taken big steps forward, and researchers 0:06:48.480 --> 0:06:52.040 have found ways to retool existing procedures. Some of that 0:06:52.080 --> 0:06:54.440 work isn't likely to pay off in time to change 0:06:54.440 --> 0:06:57.800 the course of the pandemic, but some of it already has, 0:06:58.000 --> 0:07:02.200 and the outbreak's global scale has rd epidemiologists and policymakers 0:07:02.480 --> 0:07:05.720 to seek better answers to fundamental questions about the management 0:07:05.760 --> 0:07:09.080 of a modern plague, not only how to test, but 0:07:09.200 --> 0:07:14.240 whom to test and why. Those debates are particularly vital now. 0:07:14.880 --> 0:07:17.920 The number of new US COVID cases, which peaked this 0:07:17.960 --> 0:07:22.280 summer before dropping significantly, is climbing again. The c d 0:07:22.320 --> 0:07:25.400 c's seven day moving average rose from thirty four thousand, 0:07:25.480 --> 0:07:29.400 three D seventy one on September twelve to forty four thousand, 0:07:29.400 --> 0:07:34.680 three D seven on September Colder weather and classroom reopenings 0:07:34.800 --> 0:07:37.240 threatened an explosion of cases at a time when the 0:07:37.240 --> 0:07:41.280 public has tired of social distancing's heavy costs, and we're 0:07:41.360 --> 0:07:44.920 still at the earliest months away from a working, widely 0:07:44.960 --> 0:07:49.600 available vaccine. Until then testing can help close the gap 0:07:49.680 --> 0:07:53.280 between normalcy and where we are. If Americans want to 0:07:53.320 --> 0:07:56.720 safely send kids to school, eat in a cafe, go 0:07:56.800 --> 0:07:59.560 to a basketball game, or get on a plane, the 0:07:59.680 --> 0:08:04.400 US needs to test a lot more people, a lot faster, faster, cheaper. 0:08:04.440 --> 0:08:07.480 Testing may not flag every new case of COVID, but 0:08:07.560 --> 0:08:10.720 that shouldn't mean settling for the current level of blindness 0:08:10.760 --> 0:08:14.880 with its tortuous drip of preventable deaths. Even world class 0:08:14.880 --> 0:08:17.480 testing won't rid us of the virus, but it can 0:08:17.560 --> 0:08:22.600 allow us to live our lives in the meanwhile. Well 0:08:22.640 --> 0:08:25.520 before this year, the US had ample warning about the 0:08:25.520 --> 0:08:29.520 health care system's vulnerability to a pandemic. An industry long 0:08:29.640 --> 0:08:32.960 kept as lean as possible, lacked the personnel and hospital 0:08:33.000 --> 0:08:36.480 beds needed to respond to a national crisis, let alone 0:08:36.520 --> 0:08:40.880 the protective gear and ventilators. The coronavirus requires. Testing was 0:08:40.920 --> 0:08:44.200 the one thing the US had supposedly handled. The c 0:08:44.360 --> 0:08:48.080 DCS early warning system for epidemics, based on reports from 0:08:48.080 --> 0:08:51.520 medical professionals all over the country, was designed to spot 0:08:51.600 --> 0:08:54.760 new diseases in time to head off bigger problems, and 0:08:54.800 --> 0:08:58.120 the technology to create tests for new viral diseases is 0:08:58.160 --> 0:09:01.520 so straightforward. It can really be done in a few days. 0:09:02.360 --> 0:09:05.800 When the time came, though, the apparatus worked against itself. 0:09:06.440 --> 0:09:10.480 After its Chinese counterparts published stars Cove two's genetic sequence 0:09:10.520 --> 0:09:14.360 on January eleven, the CDC did indeed create its own 0:09:14.360 --> 0:09:17.679 test in a matter of days, but because of regulatory 0:09:17.720 --> 0:09:21.680 requirements and limited access to the relevant viral samples, the 0:09:21.760 --> 0:09:25.000 agency's Atlanta headquarters was the only place it could be done. 0:09:25.559 --> 0:09:29.199 In early February, the CDC produced tests that state labs 0:09:29.240 --> 0:09:32.160 around the country could use, but they were faulty and 0:09:32.240 --> 0:09:36.800 returned in conclusive results. Public and private clinical labs rushed 0:09:36.840 --> 0:09:39.160 to fill the void, only to be stymied by the 0:09:39.160 --> 0:09:42.640 Food and Drug Administration, which demanded extensive data and a 0:09:42.720 --> 0:09:48.280 regulatory submission before authorizing alternatives. By early March, the US 0:09:48.360 --> 0:09:51.280 was struggling to run one thousand tests a day, while 0:09:51.320 --> 0:09:54.199 South Korea, which confirmed its first case the same day 0:09:54.240 --> 0:09:57.840 the US did, was running ten thousand. By the end 0:09:57.840 --> 0:10:02.040 of that month, lab giants, ab Labs, hal Logic Lab, Corps, 0:10:02.120 --> 0:10:05.360 Quest Diagnostics, and Roche had rolled out US tests of 0:10:05.360 --> 0:10:08.160 their own, but at one to a hundred and fifty 0:10:08.160 --> 0:10:11.600 dollars apiece, they were expensive and labs were short on 0:10:11.679 --> 0:10:15.719 technicians trained to run them. Long complex supply chains led 0:10:15.760 --> 0:10:19.520 to further shortages from the swabs needed to gather nasopharyngeal 0:10:19.600 --> 0:10:23.480 samples to the reagents used to process the tests. The 0:10:23.559 --> 0:10:26.800 tests in use at the time were molecular diagnostics known 0:10:26.840 --> 0:10:31.520 as polymerase chain reaction tests, performed by medical professionals and 0:10:31.600 --> 0:10:35.959 processed in specialized labs. PCR tests identify segments of a 0:10:36.040 --> 0:10:39.720 virus's genetic material in secretions swabbed from the back of 0:10:39.760 --> 0:10:43.800 a patient's throat or nose. The process starts with enzymes 0:10:43.840 --> 0:10:46.840 being added to the sample, which is then repeatedly heated 0:10:46.880 --> 0:10:50.040 and cooled to create billions of copies of the viral genome. 0:10:50.600 --> 0:10:54.960 Special probe molecules bind to the copy genetic material, releasing 0:10:54.960 --> 0:11:00.480 fluorescing nanoparticles whose globe signals the virus's presence. Used everything 0:11:00.520 --> 0:11:04.840 from food safety to DNA profiling. PCR tests take several 0:11:04.840 --> 0:11:08.480 hours and are extremely sensitive. If the virus is present 0:11:08.520 --> 0:11:12.680 in a sample, even in infinitesimal amounts, PCR will find 0:11:12.720 --> 0:11:15.560 it to public health officials. In the early days of 0:11:15.559 --> 0:11:19.840 the pandemic, reliability seemed like the most important quality, but 0:11:19.960 --> 0:11:23.520 the hospitals, dodgers offices, and pop up testing facilities where 0:11:23.559 --> 0:11:26.640 PCR tests are given often don't have the equipment to 0:11:26.679 --> 0:11:30.480 process the results on site. The thermo cycler that incubates 0:11:30.520 --> 0:11:33.600 the samples costs at least a hundred thousand dollars, so 0:11:33.640 --> 0:11:37.200 the swabs are usually sent out. That's resulted in massive 0:11:37.240 --> 0:11:43.160 backlogs and severely limited the tests usefulness. There are alternatives. One. 0:11:43.360 --> 0:11:46.760 A lateral flow test is a disposable strip of cellulose 0:11:46.840 --> 0:11:50.800 or woven fiber picture a home pregnancy test. Instead of 0:11:50.840 --> 0:11:54.960 looking for viral DNA or RNA, it identifies proteins called 0:11:55.000 --> 0:11:59.040 antigens that protrude from the virus capsule. It exploits the 0:11:59.120 --> 0:12:02.880 lock and key relationship between those molecules and the antibodies 0:12:02.920 --> 0:12:06.920 the human immune system makes to identify them. Lateral flow 0:12:07.000 --> 0:12:09.920 tests can be done on nasal swabs, but some are 0:12:09.920 --> 0:12:13.520 in development to work with saliva. The sample is deposited 0:12:13.559 --> 0:12:16.760 at one end, doused with liquid, and then spreads through 0:12:16.760 --> 0:12:20.560 the fiber by capillary action, like a spill infusing a sponge. 0:12:21.240 --> 0:12:24.599 As it advances, the solution flows over antibodies embedded in 0:12:24.640 --> 0:12:28.160 the fiber with nanoparticles of gold or dye grafted onto 0:12:28.240 --> 0:12:31.520 them as tags. If the virus is present in the sample, 0:12:31.880 --> 0:12:34.360 the antibodies latch on and are carried along until the 0:12:34.440 --> 0:12:38.079 virus antibody pair encounters a second set of antibodies anchored 0:12:38.120 --> 0:12:42.199 in a line. Those two grab onto the target viruses, 0:12:42.480 --> 0:12:45.680 activating the tags on the antibodies that hitch deride earlier. 0:12:46.120 --> 0:12:49.560 As more virus rich liquid reaches the line, the tags, 0:12:49.679 --> 0:12:53.599 like millions of microscopic pixels, form the telltale stripe of 0:12:53.640 --> 0:12:56.760 a positive result. The whole process can take as little 0:12:56.760 --> 0:13:01.240 as fifteen minutes or Assure Technologies has long sold lateral 0:13:01.280 --> 0:13:05.520 flow tests for habititis C and HIV. In twenties seventeen, 0:13:05.600 --> 0:13:09.640 it created the only FDA approved ebola antigen test. The 0:13:09.720 --> 0:13:13.400 company is based in Bethlehem, Pennsylvania, but sells many of 0:13:13.440 --> 0:13:16.840 its fast, cheap, over the counter diagnostics in sub Saharan 0:13:16.880 --> 0:13:21.160 African nations that lack the medical infrastructure for PCR testing. 0:13:21.800 --> 0:13:24.120 At the beginning of this year, with the U S 0:13:24.120 --> 0:13:28.559 struggling to create reliable tests and its most advanced labs overwhelmed, 0:13:29.000 --> 0:13:33.040 chief executive Officer Stephen Tang saw the parallels we have 0:13:33.120 --> 0:13:36.600 to repatriate our experience from low and middle income countries. 0:13:36.720 --> 0:13:39.680 He says, you have a test that is rapid, that 0:13:39.760 --> 0:13:42.760 you can take by yourself, that doesn't require an instrument 0:13:42.760 --> 0:13:46.040 to read or a medical professional to administer. What we 0:13:46.080 --> 0:13:49.320 have learned from experience is that people will test themselves 0:13:49.360 --> 0:13:52.800 more frequently in the privacy of their own homes. Tang 0:13:52.880 --> 0:13:56.320 plans to build on the company's HIV test platform to 0:13:56.400 --> 0:13:58.679 bring an at home COVID test to market before the 0:13:58.760 --> 0:14:01.920 end of the year. While the HIV test costs forty 0:14:02.000 --> 0:14:04.840 to fifty dollars in a U S pharmacy, the company 0:14:04.880 --> 0:14:09.439 promises its coronavirus test will be cheaper. Other strip test 0:14:09.520 --> 0:14:14.680 makers have also prioritized the pandemic. Eive Bio, a startup 0:14:14.679 --> 0:14:17.280 born in an m I T lab two years ago, 0:14:17.520 --> 0:14:21.120 has temporarily shifted its focus from epidemic fever viruses such 0:14:21.160 --> 0:14:25.040 as dingey and zica with COVID. There have been maybe 0:14:25.040 --> 0:14:30.640 fifty million infections worldwide, says CEO Bobby Brooke Herrera. Dinge 0:14:30.680 --> 0:14:35.320 causes four hundred million every single year. Like Tang, Herrera 0:14:35.400 --> 0:14:38.280 has been trying to apply lessons from countries with threadbare 0:14:38.360 --> 0:14:41.880 public health systems to those like the US he's in 0:14:41.920 --> 0:14:46.000 discussions with US regulators to authorize a coronavirus strip test 0:14:46.360 --> 0:14:49.280 made to be processed in a lab. Once it reaches 0:14:49.320 --> 0:14:53.200 the market, he says a home version will be next established. 0:14:53.240 --> 0:14:56.880 Testing companies are already bringing lateral flow tests to market. 0:14:57.520 --> 0:15:01.040 On August, Abbott Laboratory Is announced that the f d 0:15:01.200 --> 0:15:04.560 A had awarded it an emergency use authorization for bin as, 0:15:04.680 --> 0:15:09.600 now a fifteen minute disposable antigen test priced at five dollars, 0:15:09.800 --> 0:15:12.560 A so called point of care test, it must be 0:15:12.600 --> 0:15:15.560 given by a health professional, but since it requires no 0:15:15.680 --> 0:15:19.240 lab equipment, an unlimited number can be conducted and processed 0:15:19.280 --> 0:15:23.160 at any given time. Abbott is already producing fifty million 0:15:23.200 --> 0:15:29.000 of them a month. A test's accuracy is a matter 0:15:29.040 --> 0:15:33.920 of sensitivity, how often it correctly spots a disease, and specificity, 0:15:34.280 --> 0:15:37.600 how often it correctly rules the disease out. A test 0:15:37.640 --> 0:15:40.640 with low sensitivity will miss a lot of cases. A 0:15:40.720 --> 0:15:43.680 test with low specificity will mistakenly tell people they have 0:15:43.720 --> 0:15:47.000 a disease when they don't. Lateral flow tests are neither 0:15:47.080 --> 0:15:51.360 as sensitive nor as specific as PCR tests. They're more 0:15:51.400 --> 0:15:54.600 likely to miss an infection during the incubation period as 0:15:54.640 --> 0:15:58.120 the invader has just started replicating, or weeks in when 0:15:58.160 --> 0:16:01.160 the body's immune response has managed to eliminate many of 0:16:01.200 --> 0:16:05.960 the virus particles. Lateral flow tests lower sensitivity has hampered 0:16:05.960 --> 0:16:09.040 efforts to bring them to market. There are concerns that 0:16:09.160 --> 0:16:12.560 tests done at home, where people swab their own noses 0:16:12.600 --> 0:16:15.880 instead of having a professional du it or at least supervise, 0:16:16.280 --> 0:16:20.200 could further lessen the sensitivity. Herrera says he doubts E 0:16:20.320 --> 0:16:23.440 twenty five bios at home test will be approved without 0:16:23.440 --> 0:16:27.560 a change in expectations from the FDA, which requires accuracy 0:16:27.640 --> 0:16:31.160 levels difficult for him to achieve outside a lab or. 0:16:31.200 --> 0:16:35.080 Asher says it's confident it concluded the bar. Some companies 0:16:35.120 --> 0:16:40.360 are trying to address this shortcoming technologically. Mammoth Biosciences, working 0:16:40.400 --> 0:16:43.360 with a microbiologist named Charles Chew at the University of 0:16:43.400 --> 0:16:47.520 California at San Francisco, is using the DNA splicing technology 0:16:47.560 --> 0:16:51.760 Crisper to improve the accuracy of strip tests. Crisper's potential 0:16:51.840 --> 0:16:55.280 for precise gene editing rests on its use of sequences 0:16:55.280 --> 0:16:59.520 of guide RNA that zero in on target genes. Chew 0:16:59.680 --> 0:17:02.360 and a meth are turning that search engine property to 0:17:02.400 --> 0:17:05.840 the task of finding the telltale genome of SARS cove two. 0:17:06.880 --> 0:17:10.520 The effort is taking two parallel paths. One that the 0:17:10.560 --> 0:17:13.520 FDA cleared this summer runs on the same equipment as 0:17:13.600 --> 0:17:17.320 PCR tests, but it copies the viral genetic material without 0:17:17.320 --> 0:17:20.960 the time consuming heating cycles. The other, in development with 0:17:21.000 --> 0:17:24.920 Glaxo Smith Klein manages to replicate this approach with the 0:17:24.960 --> 0:17:28.760 attendant sensitivity in a self contained and disposable kit. Not 0:17:28.960 --> 0:17:32.840 unlike a lateral flow test. You're getting the same accuracy 0:17:32.960 --> 0:17:35.200 as in the lab, but it's much easier to use, 0:17:35.440 --> 0:17:39.959 says CEO Trevor Martin. Another school of thought, though, holds 0:17:40.000 --> 0:17:43.280 that worries about the sensitivity of strip tests missed the point. 0:17:43.800 --> 0:17:46.120 The way we've been approaching testing so far in this 0:17:46.160 --> 0:17:48.920 epidemic is to try to shove a public health need 0:17:48.960 --> 0:17:53.480 through a diagnostic pathway, says Michael Mina, the Harvard epidemiologist 0:17:53.520 --> 0:17:56.879 who is the leading proponent of this idea. Mina argues 0:17:56.920 --> 0:18:00.560 that we should essentially test everyone, all the time, everywhere. 0:18:01.200 --> 0:18:04.120 It's a form of what public health experts call surveillance 0:18:04.600 --> 0:18:08.879 rather than diagnostic testing. In this model, speed and ubiquity 0:18:08.920 --> 0:18:12.399 are all that matter, Mina likes to talk about what 0:18:12.440 --> 0:18:16.000 would happen if we had one dollar self administered saliva tests. 0:18:16.440 --> 0:18:19.199 Restaurants and bars would have cups of strips on the 0:18:19.240 --> 0:18:22.520 major dast end by the toothpicks and the mints. Theaters 0:18:22.560 --> 0:18:25.320 would have them at the door. Air travelers would be 0:18:25.320 --> 0:18:28.880 tested at their departure gate before boarding. The International Air 0:18:28.920 --> 0:18:32.520 Transport Association recently announced its determination to put a system 0:18:32.600 --> 0:18:36.040 like this in place. Coronavirus testing would become a habit. 0:18:36.520 --> 0:18:39.600 If not like brushing our teeth, then at least like flossing. 0:18:40.280 --> 0:18:43.720 These tests would be much more reliable than temperature checks, 0:18:43.720 --> 0:18:47.119 which can miss carriers with mild or non existent symptoms. 0:18:47.920 --> 0:18:50.399 At a large enough scale and a high enough frequency, 0:18:50.720 --> 0:18:53.520 the thinking goes, testing is all you need to do. 0:18:54.160 --> 0:18:57.200 Tests at the entrance to offices and schools would visibly 0:18:57.320 --> 0:19:00.879 ensure the safety of those spaces encourage people to return 0:19:00.920 --> 0:19:05.440 to them. People who test positive could immediately isolate themselves, 0:19:05.480 --> 0:19:09.040 breaking the chain of transmission. In this world, a strip 0:19:09.080 --> 0:19:12.840 test's relative insensitivity would be less of an issue. Positives 0:19:12.840 --> 0:19:15.359 could be double checked to make sure they're correct, and 0:19:15.400 --> 0:19:17.600 false negatives would be caught. A day or two later 0:19:17.680 --> 0:19:20.800 by the next test, still early in the disease course. 0:19:21.560 --> 0:19:24.679 Mina goes so far is to characterize lower sensitivity as 0:19:24.680 --> 0:19:27.800 an asset because a PCR test taken in the late 0:19:27.840 --> 0:19:31.520 stages of COVID nineteen will still show positive even if 0:19:31.560 --> 0:19:34.240 the patient is well past the contagious stage and no 0:19:34.320 --> 0:19:38.560 longer needs to be isolated. In that sense, he argues, 0:19:38.720 --> 0:19:41.760 strip tests can better gauge in individual's risks to the 0:19:41.760 --> 0:19:44.520 broader population. I don't want to see these kinds of 0:19:44.560 --> 0:19:47.560 tests being promoted as passports to party or to go 0:19:47.600 --> 0:19:51.320 out to dinner. That misses the big picture. The epidemiologist says, 0:19:51.920 --> 0:19:55.639 these aren't passports. These are actually the intervention lack of 0:19:55.720 --> 0:20:01.240 vaccine to suppress population spread. According to his Budeling, testing 0:20:01.359 --> 0:20:04.480 just half the population every three days would bring COVID 0:20:04.560 --> 0:20:08.320 under control within weeks. To make this a reality, the 0:20:08.400 --> 0:20:11.720 FDA would need to relax its testing standards down from 0:20:11.840 --> 0:20:15.679 PCR level sensitivity, and someone would need to manufacture and 0:20:15.720 --> 0:20:19.240 pay for the untold billions of tests. Mina believes it 0:20:19.280 --> 0:20:22.800 should be Congress. This is a national emergency, he says, 0:20:23.359 --> 0:20:26.200 and a fifty billion dollar or one billion dollar price 0:20:26.240 --> 0:20:29.359 tag to stop the virus is easily worth it, given 0:20:29.400 --> 0:20:32.000 that the US has already spent three trillion dollars in 0:20:32.080 --> 0:20:36.000 COVID related stimulus money and its economy has lost trillions more. 0:20:37.119 --> 0:20:39.680 At least one of the two men running for president 0:20:39.840 --> 0:20:43.440 has unequivocally committed to more testing. The first point in 0:20:43.520 --> 0:20:47.120 Joe Biden's seven point COVID plan is to ensure all 0:20:47.160 --> 0:20:51.280 Americans have access to regular, reliable, and free testing. The 0:20:51.320 --> 0:20:54.679 plan mentions at home and instant tests and proposes a 0:20:54.720 --> 0:20:58.200 testing board modeled on Franklin D. Roosevelt's War Production Board, 0:20:58.720 --> 0:21:01.960 which oversaw the Manu facture of weapons and supplies that 0:21:02.040 --> 0:21:06.280 helped win World War Two. President Trump has publicly called 0:21:06.320 --> 0:21:10.359 for less testing, and his CDC recently said asymptomatic people 0:21:10.359 --> 0:21:13.119 who've had contact with a sick person don't need to 0:21:13.160 --> 0:21:17.520 be tested. Most public health experts strongly disagree, and the 0:21:17.560 --> 0:21:20.960 agency has since reversed that guidance. On the other hand, 0:21:21.200 --> 0:21:24.840 the day after ABBOT unveiled its lateral flow kits, the 0:21:24.960 --> 0:21:27.960 U S Department of Health and Human Services announced a 0:21:28.000 --> 0:21:31.400 deal to buy and deploy one fifty million of them, 0:21:31.440 --> 0:21:34.040 and the agency is already distributing a different type of 0:21:34.080 --> 0:21:37.720 antigen tests to nursing homes across the country. Of course, 0:21:37.880 --> 0:21:40.080 all of this is a fraction of what Mina's plan 0:21:40.160 --> 0:21:44.840 would require. Among his fellow epidemiologists and public health experts, 0:21:45.080 --> 0:21:49.280 Mina's plan does have skeptics. Without reimbursement, the price of 0:21:49.280 --> 0:21:51.760 even very cheap tests might be a challenge for some 0:21:51.880 --> 0:21:55.760 families and organizations. New York City School system has more 0:21:55.800 --> 0:21:59.440 than one million students. The production of billions of new 0:21:59.480 --> 0:22:03.080 tests could create supply chain problems of its own, and 0:22:03.160 --> 0:22:06.119 the millions of false positives and negatives that would be 0:22:06.119 --> 0:22:10.480 produced at that scale could further undermine American's shaky confidence 0:22:10.480 --> 0:22:13.600 in their public health system, a dangerous prospect in a 0:22:13.640 --> 0:22:18.080 country where large numbers already refused to wear masks. There's 0:22:18.119 --> 0:22:21.440 also no mechanism to compel people who test positive at 0:22:21.440 --> 0:22:24.680 home to stay there, especially if they're living paycheck to 0:22:24.720 --> 0:22:28.359 paycheck without paid sick leave. It's our failure to act 0:22:28.400 --> 0:22:30.920 on the test results we have that has been the problem, 0:22:31.200 --> 0:22:35.200 these skeptics, argue. As Henage, Mina's colleague at Harvard, points 0:22:35.200 --> 0:22:39.240 out South Korea succeeded in corralling the virus by relentlessly 0:22:39.280 --> 0:22:42.200 tracking down those put at risk by each discovered case, 0:22:42.800 --> 0:22:46.960 not by reinventing testing. All of these extraordinarily smart people 0:22:47.000 --> 0:22:50.959 are coming up with extraordinarily smart things, Hennage says, and 0:22:51.000 --> 0:22:56.000 we haven't done the basic things right. Whether or not 0:22:56.200 --> 0:22:59.119 MINA can sell the idea of regular tests for all 0:22:59.440 --> 0:23:03.600 the imports of faster, more widespread surveillance testing has become clear. 0:23:04.240 --> 0:23:06.800 Such a model could use strip tests if they can 0:23:06.840 --> 0:23:09.480 be scaled up, or it could rely on methods such 0:23:09.520 --> 0:23:13.720 as pooling combining multiple samples to increase the throughput of labs. 0:23:14.320 --> 0:23:18.399 Hann Edge is particularly excited about the potential of wastewater. A. 0:23:18.520 --> 0:23:21.320 Shish Jaw, a physician and the dean of the Brown 0:23:21.400 --> 0:23:24.600 University School of Public Health, is among the scholars who 0:23:24.640 --> 0:23:27.440 have tried to calculate how many tests the country actually 0:23:27.480 --> 0:23:30.800 needs early in the pandemic. His team came up with 0:23:30.840 --> 0:23:33.359 a range of five hundred thousand to six hundred thousand 0:23:33.400 --> 0:23:37.520 per day. Those estimates, though assumed that positive results would 0:23:37.560 --> 0:23:41.880 be followed by South Korea style contact tracing. So far, 0:23:42.119 --> 0:23:45.400 such programs have largely failed in the US, and Jaw 0:23:45.560 --> 0:23:49.520 is reassessing. I have increasingly come to believe that a 0:23:49.600 --> 0:23:52.880 large army of contact tracers may not work in our country, 0:23:52.960 --> 0:23:56.199 he says, and that will need large scale surveillance testing 0:23:56.240 --> 0:23:58.640 as a strategy for building a high degree of safety 0:23:58.720 --> 0:24:02.280 into a lot of our activity these Jaw's new approach 0:24:02.440 --> 0:24:05.760 focuses less on how many tests the nation needs than 0:24:05.840 --> 0:24:09.200 on where they're needed. Nursing homes and hospitals are places 0:24:09.200 --> 0:24:11.800 where people should be tested all the time, he argues. 0:24:12.160 --> 0:24:16.240 With meat packing plants, prisons and schools close behind, you 0:24:16.240 --> 0:24:18.280 could make the case for any place where you can 0:24:18.280 --> 0:24:22.080 get large numbers of people gathering indoors for extended periods. 0:24:22.119 --> 0:24:25.119