Beat Covid Without a Vaccine

Beat Covid Without a Vaccine, with "frequent rapid at-home testing" write Larry Kotlikoff and Michael Mina in the Oct 2 WSJ. I've made this point many times before, as have Larry, Michael, and many others (Paul Romer especially) but this one is well written and concise, and the issue is so important it bears a bit of repetition and efforts to package the message. 

How would you like the recession to be over in a month? Here's the ticket. A vaccine is a technology for stopping the spread of a virus.  Frequent rapid at-home testing is a technology for spreading the virus. And it is one we have now, if only the government will let us use it. 

"At least one such test, Abbott Labs ’ BinaxNOW, is already being produced for the government....

... each is simple enough to be self-administered. With the BinaxNow test, you swab the front of your nose, insert the swab into one side of a small card, add saline to the other side, close the card, and see if the reader on the front lights up green or red. A phone app records a negative result for use as a digital passport."

No doctor visit, no referral, no insurance, no lab, no do you fit the criteria. Just test and see if you're sick. 

"Asking those presumed to be infectious to stay home would cut transmission chains, ending Covid outbreaks within weeks. Each transmission stopped may prevent hundreds more. .... Like vaccines, the tests don’t have to be perfect. It’s enough to drop the virus’s reproductive number (the average number of people each infected person infects) below 1."

The tests don't have to be perfect and what we do with them doesn't have to be perfect. We don't need intrusive contact tracing, government imposed isolation, and so on. So long as a bit more than half of the people who are infected stay home and don't infect one other person (on average -- it's really about super spreaders) the pandemic ends. 

"Cornell University’s quick defeat of its Covid cluster shows the power of frequent testing. Cornell tests all undergraduates twice a week and quarantines those who are positive. After an unauthorized party, Cornell had 60 positive cases a week before starting surveillance testing. It now has about three a week."

How fast can it work? 

Our models show outbreaks can be driven down in weeks even if only half a community uses rapid tests every four days. Fifteen million tests a day could stop outbreaks across the U.S. 

How to get this going? Here I think Mina and Kotlikoff are a bit too polite and a lot too dirigiste: 

Based on data from symptomatic Covid patients, the Food and Drug Administration has approved BinaxNOW for use in a doctor’s office or clinic. This will help, but such “point of care” tests are too cumbersome to use on the scale needed to reopen the economy.

Rapid tests need to be tested with asymptomatic infected patients. If they work as well, particularly on those with high viral load, the FDA will be closer to approving them for home use. The agency is highly focused on bringing safe and effective Covid testing into the home. 

I do not see evidence for the latter two sentences. Let us rewrite these paragraphs. "Lacking what it considers enough data, The Food and Drug Administration continues to ban the sale and use of BinaxNOW outside doctor's offices or clinics, destroying its value for stopping the pandemic. A test is not a drug, and cannot cause any medical harm to individual who takes it. By what right does the FDA ban me from learning about what's going on in my own body, in a way that cannot possibly harm me, even if like all information that knowledge is sometimes false? The FDA must allow its home use immediately, with big warning labels about false positive and negative rates, while collecting data on its efficacy for asymptomatic people. We have an economy-destroying pandemic going on, and cannot wait for perfect knowledge of these tests an all classes of people. If the FDA refuses, the politically accountable administration should over-ride its refusal by executive order." 

Likewise, offering an analogy to B-24 bombers, 

The administration should organize a Manhattan Project, run by the Defense Department, to produce and provide free at-home rapid tests to all Americans, starting in hot spots.

Where is the market failure here? Let's work on the FDA allowing home tests before we jump to the conclusion that they need to be produced by the defense department and paid for (at about triple market prices) by taxpayers. There are multiple competing tests by extremely competent private companies.  How about (heavens) start by allowing the companies to sell them to the public at whatever price they want and (heavens) make a profit by doing so; the quicker they ramp up production the more profit they make before competitors come in and drive the price to $5? If we then need a subsidy to get people to buy them, give people money to buy them. The Manhattan project produced three nuclear bombs at immense cost, not 300 million simple low-cost easy-to use tests. I cannot think of a worse metaphor. The Soviet Union had Manhattan projects too, and could never produce toilet paper. 

Covid-19 is ravaging the land, but there’s a clear way to fight back quickly and safely.

President Trump: Here is one last chance to do something big, daring and effective.  Force the FDA to allow the sale of these tests. Stop the pandemic. Senator, presumably president elect Biden: Here is one first chance to do something big, daring, competent, and obviously nonpartisan. Same advice. 

 

from The Grumpy Economist https://ift.tt/2SkdNTD