Getty
Drs. Fauci and Birx, you are working tirelessly and heroically to fight Coronavirus. I and hundreds of millions of other Americans thank you for your efforts. If the President drags his feet on this as he’s done on most everything, resign and organize the governors to do this.
Dear Drs. Fauci and Birx,
You are working tirelessly and heroically to fight Coronavirus. I and hundreds of millions of other Americans thank you for your efforts. But I find myself totally perplexed as to why you are seemingly ignoring the obvious and sure way to eliminate the scourge of Covid-19 in just one month.
The solution is PRC group-household testing of all American households every week. Group testing was developed by economist Robert Dorfman during WWII to test for syphilis in army recruits. It’s used routinely to test blood donations. It’s also been used in PCR testing of animals. Its sensitivity has been tested successfully by Israeli scientists.
Testing all American households every week won’t just save the economy, which is literally on death’s door. It will save tens of thousands of lives. Compared to what you two are effectively sanctioning — each state opens up paying lip service to your guidelines — group testing is a godsend.
PCR group-household testing entails combining the samples of all household members. Given the new Rutgers University saliva test, all household members can spit into a single container and deliver or mail that container to a test-collection site with a filled out label detailing all contact information, including cell phones, of all household members.
Suppose at the testing facility, the samples from 62 households are mixed together and tested. Further, assume the combined sample tests negative. In this case, we can free up to 155 people (assuming 2.5 people per household) all with a single test! That’s a 155 to 1 efficiency factor relative to testing each person separately!
If a household tests negative, each household member would be notified to proceed to their local pharmacy to receive a green wristband coated to change to red after one week. After one week, everyone in the household would send a new sample to a testing facility.
This system is voluntary. But if you choose to have your household tested and receive your green wristband, you’ll be permitted by your employer to return to work, by your teachers and professors to return to school, and by proprietors to enter their restaurants, shops, cafes. You’ll also be allowed to frequent the beach, attend concerts, enter movie theaters, etc. Any household that tests positive will be required by the local board of health to quarantine in place for two weeks and then be tested. Households that don’t voluntarily get tested will be free to come and go as they wish. But without their green bracelets, they will have a hard time entering into workplaces and other establishments.
Is there something magical about the number 62? It’s the optimal number of households to be included in a single test according to a carefully worked out protocol developed by Cornell University Professor of Operations Research, Peter Frazier, and his colleagues. (Note, under Frazier’s protocol, the optimal group size changes by the week with the long-run optimal size stabilizing around 40.)
The protocol has two great advantages. In the process of doing the group-household testing, it identifies, with no extra tests, precisely those households that are positive. It also handles false negatives. The protocol assumes a very high — 30 percent — rate of false negatives. This is why weekly repeat testing is critical and should continue until we find an effective vaccine.
Why is 30 percent very high? First, because many of the false negatives may reflect inexperienced sample takers who didn’t properly swab the very back of subjects’ noses. With the saliva sample, there is far less chance of collecting an improper sample. Third, by combining the saliva of all family members in one sample, the chances that the entire household sample will test negative when at least one household member is positive is small. The reason is correlation. If one household member is infected, the chances are higher that other members are infected. Moreover, they may have enough viral load collectively, whereas individually they may not.
Professor Frazier’s protocol will release 96 percent of the American public back into the economy in just one month. Thereafter, this percentage rises.
How does PCR group-testing compare with antibody screening, now available, and antigen testing, which may become available? I’ve seen estimates, based on antibody testing, indicating that from 3 percent to 17 percent of the population has, by now, contracted Covid-19. If we can come up with an antibody test that’s highly reliable and that shows that the antibodies are protective against reinfection, such individuals would receive bracelets that permanently stay green or turn to red only after a few months. This would reduce the requisite number of tests needed to return 96 percent of the population to normal life within four weeks. We’d need roughly 5 million, not 6 million tests.
Can we produce 6 million tests per week? Yes! We’re now producing close to 2 million tests per week. Ramping up to 6 million tests per week should be easy. Our country built B-24 bombers in 53 minutes in WWII and cargo ships in four days. Germany will shortly be testing 4.5 million people per week. Scaled by our relative populations, that’s 18 million tests per week in the US.
The issue is not getting to a reasonable number of tests in short order. The question, Drs. Fauci and Brix, is whether you are going to make proper use of these tests. That means, to repeat, testing all households every week and providing green turning to red bracelets. This should be your constant mantra. If the President drags his feet on this as he’s done on most everything, resign and organize the governors to do this.
Full coverage and live updates on the Coronavirus