Mass testing for antibodies.

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https://pharmaphorum.com/news/amazon-and-boots/

Interesting news on testing .

For information.

TWS

 oldie 01 Apr 2020
In reply to Chive Talkin\':

Its generally accepted that antibody testing will be a game changer. I'd certainly like one.

However a possible downside of a widely available test may be that those testing positive may assume that they are totally immune, possibly correctly but it is an assumption. They may feel entitled to break their social restrictions and start mixing with other friends and households leading to greater spreading of virions even if they are unaffected themselves. This in turn might encourage untested people to do the same. 

The response to this crisis is largely dependent on individual behaviour, which must be really hard to predict and control, especially in a democracy as opposed to a totalitarian system.

 colinakmc 01 Apr 2020
In reply to oldie:

I suspect we won’t have “normal” life returning and staying until there’s a vaccine freely available. And it’s too early to make complete sense of who’s most at risk so maybe everybody will need it, like polio/bcg. 

 dread-i 02 Apr 2020
In reply to Chive Talkin\':

Not quite the feel good story of the week, sadly.

It seems that our national testing strategy has not used the resources available. Too little too late, seems to be the order of the day. I read a story about the veterinary clinics offering their lab services, but it not being taken up. University labs have been slow being mobilized and there is a global shortage of the correct chemicals.

Whilst it would be good to do a 5 min test from amazon and then be able to go back to work, it probably wont happen any time soon. I suspect that some people who test negative for antibodies, will say, 'I've not got it, so I can go out.' The experience from other countries, as mentioned the the link, shows that some of the tests are only 30% accurate.

Prof Sharon Peacock, director of infections at Public Health England, told MPs that millions of home testing kits would be available, delivered by Amazon or bought in Boots, within days, not weeks.

<snip>

But within hours, Whitty seemed to quash the idea. He warned that antibody tests needed proper evaluation, which was being undertaken at Oxford University. “The key thing for us to do is evaluate. Are these tests accurate enough to be used by the general public?” he said at the prime minister’s press conference the same day.

https://www.theguardian.com/world/2020/apr/01/absolutely-wrong-how-uk-coron...

 Dave Garnett 02 Apr 2020
In reply to oldie:

> Its generally accepted that antibody testing will be a game changer.

That's a shame, because I don't see any sign that it's going to be available until it's largely irrelevant.

We've had a perfectly serviceable PCR test theoretically available for weeks.  Sadly, with this administration, there's a huge gulf between theoretically and actually.

3
 jethro kiernan 02 Apr 2020
In reply to Chive Talkin\':

The Downside with the antibody test is that it may reward slackness in as much as those who were a bit  Laissez-faire in their precautions and got corona early will be the first to be allowed back to work with passports. This could create a second blip as those who remain corona free realise they are going to be left behind in the bleak jobs market ahead and take the chance of getting infected to remain employable.

 Dave Garnett 02 Apr 2020
In reply to jethro kiernan:

> This could create a second blip as those who remain corona free realise they are going to be left behind in the bleak jobs market ahead and take the chance of getting infected to remain employable.

With a 20% chance of ending up in ITU you'd need to be an idiot to adopt this strategy, so you're probably right.

1
 DaveHK 02 Apr 2020
In reply to Dave Garnett:

> With a 20% chance of ending up in ITU you'd need to be an idiot to adopt this strategy, so you're probably right.

Do 20% of cases require ITU treatment? Sounds high to me but happy to be corrected.

1
 Red Rover 02 Apr 2020
In reply to DaveHK:

20 % need hospital 5 % need intensive care. Horrible figures even if you allow for dilution with un-detected mild cases. 

 jethro kiernan 02 Apr 2020
In reply to Red Rover:

With a quite high chance of permanent lung damage 😕

 jethro kiernan 02 Apr 2020
In reply to Dave Garnett:

> With a 20% chance of ending up in ITU you'd need to be an idiot to adopt this strategy, so you're probably right.

Or your a freelancer sole breadwinner staring down the barrel of bankruptcy and losing your house and being left behind permanently in the job market. 

 Red Rover 02 Apr 2020
In reply to jethro kiernan:

Still better than being on a ventilator! I'd rather be on the dole and drop out of the job market than end up in ICU with the virus. Ventilators do horrible damage to you even if you survive. I get your point though. It would be stupid to get the virus on purpose but some people would try it. 

 alicia 02 Apr 2020
In reply to Red Rover:

> 20 % need hospital 5 % need intensive care. Horrible figures even if you allow for dilution with un-detected mild cases. 

What's your source for this?  In the US the estimate is 12% hospitalization, and that's with an almost certain massive underreporting in mild cases (using S Korean data on asymptomatic infected).  

https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm?s_cid=mm6912e2_w

Not to mention that that 12% is across the board for all age groups.  If you're younger than 65, your chances are much smaller.

 Red Rover 02 Apr 2020
In reply to alicia:

OK my source was from the WHO report into Wuhan last month. Even the lower figures are still really bad though. 1 % would be bad when millions are catching it. With asymptomatic infected, does this just mean asymptomatic at time of testing, or they never got symptoms? This makes a big difference. 

Post edited at 12:34
 alicia 02 Apr 2020
In reply to Red Rover:

Maybe you're thinking of the percentage of cases requiring hospitalization for patients over 80 years old? That was indeed 20% in Wuhan.  However, for people under 30 years old, it was 1%.  So, across the board, it would have been quite a bit lower than 20%.

https://www.livescience.com/death-rate-lower-than-estimates.html

This paper discusses the reasoning behind the likelihood of a high number of undetected cases:

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30243-7/...

 Red Rover 02 Apr 2020
In reply to alicia:

Thanks.

 alicia 02 Apr 2020

In reply to:

This is why the use of antibody testing as a reentry plan makes me nervous.  On one hand, it does provide something of a clear roadmap for getting us out of a disastrous situation.  But on the other hand, if I were 30 years old, had never had the virus, and found myself faced with choosing between a 1% chance of hospitalization versus a 99% chance of bankruptcy from not being able to work, I'd probably take my chances with the virus.  (Fortunately I have a job that I was already working from home for, so I don't personally have to worry about this.)

I wonder what chance of hospitalization we take on a daily basis in "normal" times each day that we get into a car and drive to work...?

 LastBoyScout 02 Apr 2020
In reply to Chive Talkin\':

Try the government - seems to be lots of antieverybodies there.

4
 Dave Garnett 02 Apr 2020
In reply to alicia:

> So, across the board, it would have been quite a bit lower than 20%.

OK, yes, you're probably right but (a) nobody really knows the risk in a particular situation and (b) I still think the idea that anyone should catch it deliberately is mad.

There's a reason it's called herd immunity.  It's the whole population that counts, not any one individual.  I'll wait for a vaccine, thanks!

 Baz P 02 Apr 2020
In reply to alicia:

Whatever the chance of being hospitalised in normal times I doubt that there is always a 1 in 4 chance of dying as there is for people now on ventilators. 

2
Moley 02 Apr 2020
In reply to colinakmc:

> I suspect we won’t have “normal” life returning and staying until there’s a vaccine freely available. And it’s too early to make complete sense of who’s most at risk so maybe everybody will need it, like polio/bcg. 

https://www.hospimedica.com/covid-19/articles/294781485/researchers-just-da...

Possibly closer than we thought, or wishful thinking?

 Red Rover 02 Apr 2020
In reply to Moley:

Getting to Human trials is the easy bit. With people going flat out on it as a priority its probably at least 12 months until a vaccine is rolled out, 18 is likely. The coronavirus MERS-Cov appeared in 2012 and we are still at the human trials stage (OK it's not a priority as MERS-Cov is quite rare these days).

Post edited at 22:57
 wintertree 02 Apr 2020
In reply to Dave Garnett:

> (b) I still think the idea that anyone should catch it deliberately is mad.

That depends on if you think you’re going to catch it anyway.  If you think it’s unavoidable, the best time to catch it is as soon as possible, as healthcare is only getting more overloaded.  For example, see the senior government members...

Me: I’m acting as if airborne Ebola is circulating in the population.  

Moley 03 Apr 2020
In reply to Red Rover:

> Getting to Human trials is the easy bit. With people going flat out on it as a priority its probably at least 12 months until a vaccine is rolled out, 18 is likely. The coronavirus MERS-Cov appeared in 2012 and we are still at the human trials stage (OK it's not a priority as MERS-Cov is quite rare these days).

That was my understanding of the time frame, I posted this because it seems to contradict that - which surprised me but might be possible, unless I have misunderstood it?


“Given the urgent global need for a human coronavirus vaccine, we are doing everything we can to accelerate development. Our goal is to produce the vaccine during the next 8-10 weeks, and to achieve safety approval in 90 days,” said David Zigdon, CEO of MIGAL Galilee Research Institute. “This will be an oral vaccine, making it particularly accessible to the general public. We are currently in intensive discussions with potential partners that can help accelerate the in-human trials phase and expedite the completion final product development and regulatory activities.”

 Red Rover 03 Apr 2020
In reply to Moley:

OK fair enough. Hopefully it will be that fast. However, that's the CEO of the company developing it and he might be thinking about the share price.

 MG 03 Apr 2020
In reply to Baz P:

> Whatever the chance of being hospitalised in normal times I doubt that there is always a 1 in 4 chance of dying as there is for people now on ventilators. 

I think it's more 4 in 5 if you have coronavirus.

 HansStuttgart 03 Apr 2020
In reply to MG:

> I think it's more 4 in 5 if you have coronavirus.


survival rate of COVID patients in ICU: 66%

amount of COVID patients in ICU that need a ventilator: 85%

Therefore, chance of dying if you are on a ventilator <40% (probably close to 40% though)

data source: rki.de

 nufkin 03 Apr 2020
In reply to oldie:

>  leading to greater spreading of virions even if they are unaffected themselves

If (assuming an antibody test is accurate), wouldn't the presence of antibodies mean the virus would be unable to take hold and multiply in a positive individual? So no risk of spreading further. 
Or can one carry a virus at levels low enough to not alert the immune system, but high enough to be transmittable? 

 MG 03 Apr 2020
In reply to HansStuttgart:

OK - my numbers were from the USA (Cuomo's press conference) and also China in the following paper

"...mortality was 62% among critically ill patients with COVID-19 and 81% among those requiring mechanical ventilation"

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30633-4/...

 HansStuttgart 03 Apr 2020
In reply to MG:

wow, that's quite a large difference.

 oldie 03 Apr 2020
In reply to nufkin:

I'm not knowledgeable enough to give an authoritative reply.

But just having antibodies doesn't mean one has 100% protection, and they don't know enough about this virus yet. In fact I assume someone could have a bad illness, be producing antibodies, and still die. Incidentally the antibody tests presumably mean someone has had the disease or may still have it,

 Flinticus 03 Apr 2020
In reply to DaveHK:

> Do 20% of cases require ITU treatment? Sounds high to me but happy to be corrected.

You must remain sad as it is high. From the (US) CDC

https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm

No ICU admissions were reported among persons aged ≤19 years. Percentages of ICU admissions were lowest among adults aged 20–44 years (2%–4%) and highest among adults aged 75–84 years (11%–31%) (Table)

 Dave Garnett 03 Apr 2020
In reply to oldie:

> But just having antibodies doesn't mean one has 100% protection, and they don't know enough about this virus yet. In fact I assume someone could have a bad illness, be producing antibodies, and still die. Incidentally the antibody tests presumably mean someone has had the disease or may still have it,

I think the assumption would be that someone who had been ill a couple of weeks ago, was now free of signs of infection and was antibody positive would be virus free (for this sort of virus).  In an ideal world I suppose this would be demonstrated by a negative PCR test, but an antibody test probably wouldn't be consistently positive until 3-4 weeks after infection so in practice the two tests shouldn't overlap.  

 ian caton 04 Apr 2020
In reply to MG:

50% according to icnarc (intensive care audit outfit) 

 oldie 06 Apr 2020
In reply to Dave Garnett:

> That's a shame, because I don't see any sign that it's going to be available until it's largely irrelevant. <

Its worth noting that they can and are testing people for antibodies against the virus. It is presumably a reliable antibody test but comparatively time consuming and can't be done large scale. I think it is being carried out by Porton Down for research purposes....presumably sampling to find the % of the population who have antibody and are probably resistant. MH said on TV they would announce the results soon. Will be invaluable in planning future strategy.

 Dave Garnett 06 Apr 2020
In reply to oldie:

> Its worth noting that they can and are testing people for antibodies against the virus. It is presumably a reliable antibody test but comparatively time consuming and can't be done large scale. I think it is being carried out by Porton Down for research purposes....presumably sampling to find the % of the population who have antibody and are probably resistant. MH said on TV they would announce the results soon. Will be invaluable in planning future strategy.

I suspect (hope) that, at a research level, a lot of academic labs will have both PCR tests (really not at all difficult) and, by now, usable antibody tests (also not rocket science) but, as you say, not necessarily scaleable. 

Not that the government seems terribly interested what independent research labs are doing, nor in what homebrew hospital testing is happening.  The head of my old lab was on R4 last week responding to Matt Hancock's recent request by saying he'd offered their services to the DoH weeks ago and nobody ever got back to him.     


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