A letter to the Premier of my province...
Hello Premier Ford,
Thank you for your leadership during this difficult time. I would like to take this opportunity to discuss an alternative approach to the COVID-19 pandemic that I believe would allow us to get the situation entirely under control until such a time that we are able to deploy an effective vaccine.
The approach is based on quick antigen tests of the type that can give results in 15 minutes or less. Some of these tests can show whether a person has COVID-19 even when they are asymptomatic. Health Canada is reviewing about ten of these at the moment, but has only approved one, and this one test has barely been deployed. I'll discuss the limitations of the tests and how to deal with them as I outline the proposed approach for dealing with the pandemic.
The basic idea for controlling COVID-19 and rendering it nothing but a nuisance is the simple fact that without constantly accessing new hosts, COVID-19 will burn out and disappear. The thousands of people who are newly infected every single day in Canada are the lifeblood of COVID-19.
Cut off the disease's access to new hosts, and it is finished and we can get back to normal.
To get this under control, I propose mass testing based on the use of the quick antigen tests mentioned above, coupled quarantine. Specially, it would start with testing every single person in the province over a three day period, and requiring mandatory and legally-enforced quarantine for anyone who is found to carry the disease. Two weeks after the first round of testing, we repeat the entire thing. Then we do it all again two weeks after that, ending three rounds of mass testing in a month and a half.
There should be virtually no COVID-19 left to deal with in Ontario after this as the disease will have had no way to spread.
While we would obviously keep long term care facilities and persons with underlying illnesses in lock down to safeguard them against even the remnants of the disease, everyone else could go back to normal.
Because there would be some COVID-19 left in the community after even this mass effort, and because some could come in from other jurisdictions, we would have to repeat the three days of testing every six weeks or so after the end of the first three rounds just to make sure that we keep the disease under control until we can access vaccines that can end the pandemic. Nonetheless, this proposal gets everyone back to work, and all children back to school. If we want to wrestle COVID-19 to the ground, the above proposal is how we can do it.
One significant concern with this proposal is the fact that these tests are not as effective as PCR tests (although, unlike those tests, they can detect the illness in asymptomatic people.) The sensitivity that Health Canada demands for antigen tests is 80%, and while many of these tests can best that result, they are generally inferior to PCR tests. The concern then is that if you test the entire population using these tests, and the tests are only 85% effective, for example, this means that 15% of the population will have results that do not accurately gauge whether or not they actually have COVID-19. If these people can continue to circulate in the general population, the disease will continue to spread.
The answer to this is rather simple. Don't give everyone one test...give them two.
If two tests are given and the known sensitivity of each test is 85%, should the tests give the same result, a simple probability calculation shows that the chances of that happening and the tests are mistaken are under 4%. Put another way, if two tests give the same result, the chances of a correct result are not 85%, they are over 96%.
This isn't a mystery - it is just math.
Given the reduced sensitivity of quick antigen tests, the proposal would therefore see two of these tests given to every person in Ontario over a three day period. If the tests both show the person has COVID-19, they will be subject to a mandatory and legally-enforceable two week quarantine. If the tests give the same results showing that the person does not have COVID-19, they can continue to go about their business with masks and social distancing. Finally, if the tests give two different results, the person must go for a PCR test - if positive for COVID-19 they must quarantine for two weeks, and if not, they can go about their business.
There are problems with the proposal.
The first is that it would require 75 million quick antigen tests for the first six week effort, and 25 million every six weeks after that until we got a vaccine. The tests allow for this proposal because they are quick and cheap, but Health Canada has been very slow to approve the ones that are available. Even if they are approved, it will take the companies that make these tests some time to get enough in hand to allow the above proposal to work.
The second issue is that such a proposal will take health care and other resources away from their important work during the days of testing - even organizing something like this will be a massive undertaking (Note - these tests cannot be administered at home, but require someone with at least some small degree of training.) Having said that, after the six weeks of testing, we would be in a situation much closer to normal, and we will be able to reap the benefits, including assigning extra staff to long-term care facilities, and even just allowing some health professionals to take a break. In short, while difficult to implement, the benefits from doing this would be massive.
This is only a proposal. I am not a health professional, and I know you have the benefit of informed and intelligent advice as we work to deal with this catastrophe. I would note, however, that if case counts matter, then what we are doing is simply not working.
If it is time for drastic action to wrestle this to the ground, you now have a plan.
Thank you for your attention to this matter,
Stay safe,
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