Covid-19 Early Detection Surveillance
Covid-19 is a virus that has the ability to spread silently and quickly through asymptomatic and pre-symptomatic spread. As we look to open up the economy and move away from a shelter in place model of life, how can we use limited and expensive testing in a meaningful way to protect us?
The solution is to combine pooled screening (a variant on pooled testing) with frequent repeated testing to convert our testing approach from a reactive model where we test those who are symptomatic to an early detection model where initial cases are identified quickly in the pre-symptomatic and asymptomatic stages.
With pooled screening, the group size is larger than that for pooled testing, slightly less sensitive, and negative screen results are not reported as negative test results to the individuals in the group screen. This trade-off allows for more broad and more frequent screening which ultimately improves the sensitivity of the overall early detection system. Additionally, the use of a screen rather than a test presents less regulatory hurdles for CLIA labs.
For a facility, using a pooled screen of size 16 and testing twice a week, we can achieve the following level of broad, inexpensive, and early detection:
- 3 days : Average time to detect new contagious case in facility
- 56:1 : Uses one test per day for every 56 people under surveillance
- Under $5 : Cost per person per day for early detection
Here is a more detailed write-up of the early detection system:
Covid-19 early detection surveillance on a 280 person facility using 5 tests a day
To get from here to there requires no new science but it does require a shift in thinking, coordination among the pieces, and a recognition that early detection surveillance is a tool that we should implement to protect our vulnerable populations. The submitted video covers these issues in more detail.
Implementing an early detection system broadly would provide a cornerstone for controlling the spread of COVID-19 throughout the country. It is an inexpensive model (under $5 a day per person) that could be replicated all over the country. Local labs capable of running 1000 tests a day could be providing ongoing surveillance for 56,000 local community members. It could provide early detection in places like nursing homes, jails, factories, and schools.
Currently, the US is running a little over 400,000 tests a day. If 1/4 of those were devoted to the early detection model, it would provide ongoing early detection surveillance for 5.6 million people.
Our goal is to get early detection surveillance going at a large scale in the United States. The road we envision is as follows:
Phase 1. Pursue two parallel tracks centered on providing information and education to the appropriate stakeholders and helping to shepherd through a modest size implementation (nursing home, campus building, campus, K-12 school, kids summer camp).
Track 1. Local implementation at a lab and a site.
Track 2. Getting general awareness and policy awareness of what is possible with a goal of driving movement from the top.
Amplify the implementation accomplished in phase 1 along with providing thorough information for duplicating the result to allow large scale implementation.
Things are currently in phase 1. Here is an incomplete and unordered list of progress:
- Partnered with Stanford who are in the process of submitting an EUA for pooled testing.
- Established relationship with the California testing task force who has been supportive.
- Created a website that will be a hub for information: https://sites.google.com/view/covid-19-early-detection
- Performed the mathematical analysis to quantify the effectiveness of an early detection surveillance system as a function of screen sensitivity and frequency of testing.
- Building a network of interested stakeholders (public health, research, education).
- Starting an information campaign to universities with their own testing facilities.
We plan to continue beyond the hackathon to achieve the goal of widespread implementation of early detection surveillance. If you’d like to get involved or are interested in finding out more, visit our website (above) or contact us as email@example.com
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