Systematic testing covid19

The plan is to systematically examine populations to identify any hidden outbreaks. The system proposes that the lock-down be lifted for anyone who is tested and found negative for the SARS-Cov-2. In brief, everyone must first be tested with a PCR test in order to work or move freely. The rationale is that diagnostic tests will be performed to those populations that are more likely to spread the disease, that is, those who provide essential services or those who need to visit shops or places in order to avail of goods and services.  In order for an individual to be able to return to normality, they will have to have been tested. If positive, they are placed in quarantine. In such a way, virus carriers and their contacts can be isolated without locking down the rest of the population.  

For the system to work, massive, concurrent testing has to be performed in each population group. For example, in order for a business to open, testing should be performed on all its employees. If negative, the employees can resume their duties in the business. Similarly, in order for the business to receive any clients, their test results should also be negative.     

Obviously, all essential workers (police force, bank employees, supermarket employees) are to be prioritised for testing.

Schools, universities, stadiums, churches, hotels, etc. will be open provided that all visitors have been tested.

Any business that opens will have its employees tested whilst only accepting visitors that have also been tested.

During the transition period, anyone who has not been tested will be allowed to move under the lock-down restrictions whilst also using protection measures, such as masks, disinfectants and gloves.

With this plan, we will respond in a proactive manner in the management of Covid-19, instead of in the passive manner with which we have responded so far. We will follow a system according to which, and based on the social and financial priorities, all cases and flare-ups will be isolated instead of locking-down the whole of society and economy. Instead of waiting to see how protection measures will function, we will take control of the situation, identify all hidden outbreaks and draw up realistic timelines with the aim of returning to normality.

There can be pilot trials of this system applied first to population groups that have been isolated, so it can be shown quickly whether the system is effective in controlling Covid-19 spread.

Given that testing will cover a substantial percentage of the general population, the question of the feasibility of having such a number of tests carried out, has a clear answer. Restrictive factors are the number of available kits to run identifications in the PCR devices and, secondly, PCR devices and genetics labs. 

What is a given for the present is clearly that there are not enough kits available. What is stopping us, however, from producing them? The answer is: absolutely nothing. The entire molecular genetics industry can adapt immediately. After all, there is no dependence on some rare raw material. To get a sense of the difficulty of the task, the kit today is priced at around 15 euros. These are basically DNA fragments with known code. They are manufactured in specialised centres continuously, given that they are subject to the principle of doubling.

However, if certain pilot populations are chosen, the plan can be implemented in full. If successful, a new industry of PCR reagents will be developed to follow this paradigm.

For PCR devices and staffed laboratories, reaching the target numbers is more feasible if public and private research laboratories are recruited for the next few months. The same goes for the provision of new devices. Finally, the microarrays-genetic chips technology can be implemented, in order for the speed of sample identification to increase.  

Theoretically speaking, the only weakness of the system is that a case might not be detected (i.e., false negative). However, the possibility of this happening is close to zero, given that after a lockdown of several weeks (2 to 6), it is highly unlikely that the virus is incubating. As long as the virus is not being detected, it is not being spread either, as the viral load is very low. If, on the other hand, someone has symptoms, they will have to maintain the usual quarantine rules and also get tested. It has to be noted that in the extreme situation where a case is not detected due to its asymptomatic character, we are not as concerned: this is a scenario of the lesser evil kind, because those cases are due to relatively harmless mutated strains. 

To date, identification with PCR in private laboratories costs approximately 100 euros, including taxes, profit, surplus value etc. whilst wholesale kit price is around 15 euros. We do not need to comment upon the returns of this system. Based on an average price of 50 dollars per testing, the expense for 300 million people equals 15 billion. That is, if the entire US population does the test, the total cost is less than the one-day quarantine for GDP.

In relation to Covid-19, the proposed system is infinitely more secure compared to the gradual lifting of measures. In the here-and-now, passive management (i.e. one that expects lifting of measures) cannot control the evolution of the pandemic and whether there will be any future cases, recurring flares or any possible accidents. In passive management, the lifting of measures correlates with the possibility of a second wave of the pandemic: the sooner the measures are lifted, the more the likelihood of a relapse there is. It has to be noted that a possible second wave may prove to be even worse for the economy than a sustained lockdown.

As the proposed system is applied, cases will be detected and isolated thereby prohibiting any flare from creating a second wave. 

The plan applied so far in Greece, encompasses herd immunity in its “arsenal”. However, herd immunity is now in doubt as the virus mutates and it is possible that immunity may not last. But even if immunity can be established, we have already experienced in a painful way many thousands of deaths due to the virus’ fatality rate. We can subsequently rule out herd immunity as a solution. If we accept that the advanced strains of the virus will be less dangerous, we still see no advantage between our proposed system and the one that might combine herd immunity, control measures, and repeated waves of the pandemic.      

 There is a lot of talk about treatment of the disease. Apart from the fact that none have been proven to be effective, the truth is that all antiviral drugs are toxic poisons, subjecting the individual to a regime which is effectively chemotherapy. In that respect, we have encountered completely unpredictable reactions of the virus. It’s possible that new strains of the virus, on the one hand, and the genetic particularities of people, on the other hand, will make the treatment of the disease difficult. Even if this is the case, it will be better to detect and isolate the cases with the proposed system, than to create a risk that endangers the cherished asset of public health.

SARS-Cov-2 is a retrovirus. As such, and also from what little else we know about this virus, it presents with new strains constantly, therefore making it difficult to expect prolonged immunity.

Similarly, and according to the opinion of many scientists, the creation of a vaccine is highly unlikely. But suppose a vaccine was developed. Does it have any advantages compared to the system proposed here? The answer is easy. Can we cope with further lockdowns for another 1-1.5 years? And even if we could cope, would it not be the case that so many vaccines would have to be produced so as to be equal to the number of identification tests that we propose today? It would have to be the same number with the cost for vaccines probably being higher. Never mind the highly problematic anti-vaccine movement. For PCR reagents, the code already exists and it is a piece of DNA. In contrast, the vaccine is a protein antigen, produced from DNA with genetic engineering and its code will be applied for the first time. We cannot pretend that it is impossible to run a massive number of tests whilst also claiming that it is possible to produce the corresponding number of vaccines.

If humanity acts to further develop the molecular genetics industry for tests today, it will be shielded from similar threats in the future. From now on, any dangerous virus will be identified en masse and cases will be isolated. Let us consider from what humanity would have been spared if there had been systematic testing in Wuhan. And the other way around: if there is going to be another virus with similarly significant transmissibility as SARS-Cov-2, what are we going to do? Apply more lockdowns?

How likely is it that humanity will have to deal with similar situations? SARS-Cov-2 passed from bats to humans, possibly through an intermediate host. Similarly, severe acute respiratory syndrome coronavirus (SARS-CoV) passed from animals to humans though its transmissibility was lower compared to SARS-Cov-2. As globalisation progresses, the chances of any epidemic spreading from country to country increase. Consequently, no one can rule out similar threats from other viruses in the future. No one can rule out the possibility of an error, an accident or even the case of intentional passing of animal viruses to humans. Systematic virus identification is our shield, but we need to isolate cases rather than the general population.

The implementation of the proposed system needs the help and support of digital governance. Call-centres with SMS and technologies such as smart-phone apps will give the passport to anyone who has been checked. 

George Panoutsakopoulos, Geneticist
+30 693 678 9298