UKH

I'm sure all of us will be interested in the UKC scientists' take on this proposal. It sounds like a brilliantly simple solution. What has been missed?

https://giftarticle.ft.com/giftarticle/actions/redeem/23ba52c7-d87d-4c97-b4...

I can't read the article due to the paywall but I'm guessing it's testing, testing, testing? We have a woefully low level of testing the UK I don't see how we could ever use the South Korean tactics which have allowed them to carry on with some normal life.

An accurate antibody test would be a game-changer though as, once immune, you could go back to work and travel etc. 

I think that scale of PCR is a bit optimistic and then some, both from a viewpoint of total installed capacity and from the logistics.  Cross contamination causes problems given the way PCR exponentially multiples sample DNA (in this case derived from viral RNA) and so you can’t just magically scale a lab up that much.

8 days ago the Navy collected 7 qPCR machines from Newcastle uni for a central testing lab, I gather ThermoFisher installed and recommissioned them almost immediately.  I’d imagine - but don’t know - that other uni, commercial and forensic labs are loaning their kit too.  If I had to pull a number out of my rear I’d say perhaps 100,000 tests per day could go ahead eventually.  For reason unknown to me there’s no sign of this new testing capability coming online yet.  Another poster, KathrynRC I think, suggested it might be used to validate less reliable antigen tests.

I’m not convinced that testing everyone repeatedly is a very good use of resources - rapid, targeted testing combined with thermal camera based fever detection and home temperature measurement is effective in Singapore.  I’ve been doing a daily home temperature log for 18 days.  You can add in heart rate detection - most phones with a camera and flash can do it through measuring finger colour change, most smart watches etc.  

I’m sure some people would love a government scheme that collects swabs with genetic and narcotic information on every individual every week...

Edit: if the author’s hunch about machine capacity is better than mine, I doubt the staff capacity is there for indefinite, flat out operation and I don’t know if production of the essential “primers” could scale.

The theory is simple the practice not so much.

The cost and bureaucracy about sending those out every week would be massive and prone to failure.

You also need to know who lives where. I have significant doubts the electoral roll is up to the job (quick google shows the electoral commission reckon there were about 9m incorrect records) and would fail once back at uni.

I don't think it'll work without retaining some social distancing - if you're testing weekly it's not enough. If you have a 'superspreader' who infects dozens of people in a short period of time (nightclub, pub, school, bus driver etc.) you simply can't contact-trace fast enough to control it.  If you test someone on Monday and they're infected on Tuesday they have 6 days to become infective themselves and spread it before they get re-tested.  Our government here have been doing contact tracing as the vast majority of our cases were imported. They reckon on average each person has 20 'contacts', but they have one with 73 (a doctor allegedly!). Super-spreaders can have way more.  We now have the virus spreading in the community, but we also now have a testing machine on island so it'll be interesting to see what happens with testing - as we've been sending samples to the UK for testing we've only tested those with symptoms who have travelled until the last couple of days.

Then you have the 'importing cases' issue. We've made everyone coming into the island self-isolate for 14 days, but that's not stopped it from spreading - people 'self-isolating have been seen in the community, and their families had no controls either.  As Mark Hadley's graphs show, you can control case rises resulting from importations, but only with distancing/lockdowns.  People can still enter the island, but literally the only people travelling are those intending to stay for a long duration - business travel has stopped.

Worked for me, but now doesn't . In a nutshell, it's test EVERYBODY once a week and quarantine those with it.

Well that would be nice! Seems unrealistic for antigen tests though as we are only doing a few thousand per day. Antibody tests though are likely to be about £5 each and they tell you if you had the disease and are therefore immune and can presumably go back to normal life (or be drafted onto a farm to get the harvest in).

The antigen test seems important to me - if you know you’ve had it you can get back into society and the economy. 

Although that may have its own problems. Since you will have people who havent had it who will see those out and about and so weaken the stay at home line.

As long as the accuracy is high enough. Somebody will have to calculate what is acceptable for the number of people who are wrongly told they're immune and go on to be infected. Also, will it lead to some kind of tesion as some people are allowed to go climbing and some aren't? 

Quite - it would have to be part of an exit strategy in a few weeks minimum. We need to bear in mind that the current strategy isn’t “nobody must get coronavirus “ it’s “too many people mustn’t get it at once and vulnerable people must be protected”. The measures in place are also having a dramatic economic effect which is easy to ignore if it’s not affecting you, but has to be weighed against the public health measures currently in place (which I support). 

Also, it’s not clear to me that the virus’ RNA is stable enough to survive the 24-36 hour lag of postal sample delivery (a much tougher problem than sending test kits out by post).    The virus doesn’t last long on many surfaces, I don’t know if that’s due to failure of the capsid, proteins or RNA.  Hopefully an actual biologist can chime in...

Also not sure sending lots of this stuff - that I am sure is soon to be classified as a bio terrorism agent - through the post is the best idea in the world...

I think the capsid breaks and the RNA lingers on for quite some time after; they have found the RNA in the sewers in some places.

You'd need to be given something like a green photo-id badge if the test said you were immune so it was obvious who was allowed to be out,

The other problem is that people might get coerced to become infected so as to get a badge that would let them work.

On the other hand, if testing identifies people who are immune and employers use them to carry out the jobs which involve most person to person contact you could get something like herd immunity with a far smaller fraction of the population being infected.

Has the idea of herd immunity through infection been abandoned? Blowed if I know.

It seems to rely a lot on people doing stuff by themselves. Because the whole testing + having the discipline to go into isolation cannot be done by the health service at this scale. Especially because for containment you need to have both the positively tested person to be in quarantaine, but also the persons this person had contact with in the week before the test.

One of the problems will be false positives. Because the actual amount of people with the disease is very small, the amount of false positives will be much larger than the amount of real cases. The false positives can be solved by more testing. I don't think people can be trusted with "do the test until you find a negative and then you're free to go". So I think all people tested positive should be retested by the healthservice. This easily becomes a workload of 100000 persons for the NHS to test per week. And they have something better to do.

I think the amount of people who have had it is too small for this to have an impact.

Not judging by the British cabinet!

We don’t really know I guess until we start testing. I’m hoping that many more people have had it than we think. 

nah,

I'd have a big green "Immunoid" on my forehead

Desperate people will start licking supermarket touch screens to get themselves infected so they can recover and get on with life again, while spreading the virus around in the mean time and maybe clogging up an overstretched NHS of they don't shake it off as easily as they hoped! I'd fancy my chances with it and the thought did cross my mind as soon as I heard about antibody tests that I could make sure I had antibodies! (I wouldn't, I'm not that desperate, but if it was my first thought then it will be for plenty of others who are desperate!)

I see where you're coming from. Even if the immune weren't allowed special privilages it would be nice to go shopping for nice bits of food whenever you wanted without thinking about the risk, and you wouldn't have to constantly wash you hands. You could stroll around without really bothering about avoiding people as you can't spread it if you're immune (but it might stress people out if they don't know you're immune).

If the more pessimistic models are accurate though the immune might be drafted into helping out in hospitals or farms though and they'll wish they were sat at home.

Or you shatter society into many segments.  Each segment has social distancing but not lockdown.  The only contact allowed between segments is the recovered/immune.  This massively slashes the progress of the virus.  

Yes, I think an antibody test will still be a good thing, but I don't think it can allow special privileges. However, if I knew I had antibodies, I could go and sit in my parents house with them rather than my dying father coming out to sit at a distance out in the garden due to use having someone living with us who recently flew many times to get to us! There would be advantages even if it is not coming out of lockdown due to it

This is Britain under a Tory government.  They'd outsource the testing to Crapita and charge for it - fork out or you don't get the badge that lets you work.

I keep banging on about the quarantine badge thing but as soon as you have a badge with an e-ink display and network connection you give yourself the ability to design and experiment with quarantine regulations in a far more flexible way than can be done with no badge or a printed badge.

Segmenting is one of the things a system like that could do.   For example give everyone a set day of the week when they were allowed to go food shopping.  That way you couldn't get cross infection between 'Monday' and 'Tuesday' people at the shops and there would always be 7 days for symptoms to appear between one visit to the shop and the next.

I hope the weather is as dry and warm as possible for you so that the benefits of your "garden visits" can be maximised.

Thanks. By the weekend it will be 2 weeks since our traveller arrived, so probably safe to go back into their house again after that. They bought an incinerator for the garden so we have some heat out there. Dad still doesn't last long though, it is too cold for him really

There are a few presumptions in the thread that catching it once offers lifelong immunity?! 

https://www.newscientist.com/article/mg24532754-600-can-you-catch-the-coron...