Coronavirus (Covid 19) testing (Debate)

Wed 1 Apr 2020, 12:05

Hi Kris

Anyone who is on the NHS list will either have received a letter or a text from their GP letting them know and this is probably what that is referring to.

Tue 31 Mar 2020, 14:04

I do believe mass testing and contact tracing will have to happen for two reasons. 1. NHS may be struggling. 2. The cost of mass testing and contact tracing may well be a lot less than the £ 300 Billion bail out package - which we as tax payers will have to pay for in the future. The cost to the economy because of the lockdown will be immense, many companies will go bankrupt and people without savings will struggle.

Anthony Costello was on the Today programme this morning saying that testing could be scaled up to German levels using existing test facilities. 

I'm Swedish so I watch the situation there very carefully. There is no formal lockdown however pretty much all of my friends who can work from home do so. Restaurants aren't closed but trade is down perhaps 90% - and everybody sits outside if they can. High schools and uni's are closed but not schools for children 7-16 years of age, because they are worried essential jobs won't be performed if parents have to stay at home. However the Swedish government is drawing up lists of essential jobs as we speak.  

Tue 31 Mar 2020, 12:30 (last edited on Tue 31 Mar 2020, 12:31)

Hello again and thank you Liz for informative reply. Someone has mentioned to me about “a shielding text message”; are you able to state what exactly this is and who should receive it?  Is it linked in any way to food parcels?

Kris

Tue 31 Mar 2020, 11:14

The UK did do contact tracing in the early days of the outbreak, but eventually the outbreaks exceeded the amount of testing capacity that the UK had. A lot of people returned from things like skiing holidays in Italy and other locations with infections. It's simply not possible to suddenly scale up live virus testing. South Korea had a lot of capacity which they'd built up as they were concerned about MERS. The capacity available seems to have varied a lot by country. Germany clearly had a lot more than most western countries.

Also, the Chinese are going for a type of automated contact tracing using apps on phones which is very intrusive. Without using it, people will be banned from travelling. It's the sort of controls that are difficult to enforce in a western democracy. I've been tracking the stats in several countries in Europe as well as the USA and the pattern is similar. Yes, there are differences, and where the health systems get overwhelmed it gets very serious indeed, but the pattern is common.

Incidentally, Sweden will be an informative test case, as they have kept their schools and restaurants open with relatively loose controls. However, what might help them is they have the largest proportion of single occupant households in the world.

Tue 31 Mar 2020, 10:32 (last edited on Tue 31 Mar 2020, 10:33)

Hello, Please can anyone give information about "shielding"?

Thanks

Kris

Hi Kris, yes I can.  This is the term that is being used to describe the programme to protect the 1.5 million people in the UK who are most vulnerable to coronavirus because of underlying health issues.  They have been identified by NHS England and they are receiving packages of food and medicine from hubs that have been set up around the country.  We have a couple of hubs in Oxfordshire, and we estimate that they are assisting about 18,000 people. The shielding programme is being co-ordinated by councils using staff and volunteers.

Mon 30 Mar 2020, 18:56 (last edited on Tue 31 Mar 2020, 11:09)

I am not a health professional. However herd immunity sounds to me being the a result of successful vaccination. I was concerned when I first heard it as a strategy to contain an unknown entity where immunity is at present unproven as far as I understand it. 

Looks like we have moved on from that strategy. However other countries like the Asian tigers and esp Taiwan has managed to contain the virus spread without lock down. My forecast is that unless we are very lucky with the present strategy we will have to move to mass testing and contact tracing. Something that should have been done in January. 

I remember how fast SARS spread in 2003, so I've been hiding under the desk since late January.

Stay safe now!

Mon 30 Mar 2020, 17:24

Thank you Steve for a cogent and measured explanation of the science!

Mon 30 Mar 2020, 15:57 (last edited on Mon 30 Mar 2020, 22:22)

"Surely “herd immunity” is a euphemism for euthanasia "

No, and it's a paranoid and misleading interpretation. Herd immunity is a concept that has been around for many years in epidemiology. It's well a well respected and useful idea and actually protects some of the weakest once reached.

Herd immunity…

Long post - click to read full text

Mon 30 Mar 2020, 11:18

Surely “herd immunity” is a euphemism for euthanasia or survival of the fittest. 

Mon 30 Mar 2020, 10:55

Hello, Please can anyone give information about "shielding"?

Thanks

Kris

Mon 30 Mar 2020, 10:31 (last edited on Mon 30 Mar 2020, 13:13)

Thanks Katie.

Sorry, just one more question following on from your helpful answer.  What is "herd immunity" and does it "work"?

Mon 30 Mar 2020, 10:01

Hi Hannen. No, only the person that had the infection could have immunity. Your body has to be exposed to the virus in order for an antibody response to be generated by the immune system. The person that remained healthy was most likely not infected and therefore could not generate an immune response.

Mon 30 Mar 2020, 09:23

Hi Katie.

A married couple living together.  (Not me and my Wife!).  One tests positive, and is poorly, but recovers.  The other tests negative and remains healthy.  Would they both have immunity?

Thanks, Hannen.

Sun 29 Mar 2020, 17:56

Hi Hannen. Is there a specific / question topic that you want to understand?

Sun 29 Mar 2020, 17:30

Thank you Katie.  Very helpful although I struggle to understand all of it!

I don't understand the immunity thing at all.  

Sun 29 Mar 2020, 17:08

We also had this experience with Ebola, where are soon as the outbreak took off in West Africa, lots of companies pushed antibody ELISA kits onto the market. I tried several. We ended up producing protein in house and making our own kits to use for the clinical trials in the end. Obviously this time, it's not quite as straight forward.

In terms of viral mutation, this is much less of an issue for coronaviruses than flu and there may be some cross-reactivity between commonly circulating cold-inducing coronaviruses and SARS-CoV 2.

I agree that this may evolve into a seasonal type of infection, which makes a vaccine even more relevant. The thing about persistence of antibody is that you need quality (ie neutralising activity), not just titre and I think a cellular immune response will be helpful too.

https://www.jenner.ac.uk/about/news/press-release-oxford-covid-19-vaccine-programme-opens-for-clinical-trial-recruitment

This is where I work, hence my nerdy knowledge of the details.

Sun 29 Mar 2020, 16:58

Thanks Steve. Very informative.

Sun 29 Mar 2020, 14:51 (last edited on Sun 29 Mar 2020, 18:01)

The great majority of people who recover from COVID-19 will have some immunity in at least the short term. If that wasn't the case, then people would me immediately prone to being infected again, and that clearly isn't happening; there are just a few isolated instances reported, and those aren't…

Long post - click to read full text

Sun 29 Mar 2020, 11:13

I can assure you that getting reliable antibody tests up and running at scale is a priority and many, many people are working on this. But the tests have to be reliable otherwise they will actually make the situation worse. 

Sat 28 Mar 2020, 17:23

Nick, I think the intention is to do both. Unfortunately it is as yet unclear if once infected you become immune, and also the antibody test may detect antibodies of other corona viruses such as the common cold. I believe they are trying to figure that out as we speak.

The antibody test if it works will be a gamechanger I am quoting the CMO.

Sat 28 Mar 2020, 16:42

Am I missing something here? Isn't the proper time to consider a testing strategy for the virus at the beginning of an epidemic rather than in the middle? Isn't the more important issue to devise a strategy for testing for (at least partial) immunity from the virus to determine who has already had it? 

If you test health workers for the virus, then even if they test negative they could get it tomorrow. If you test for immunity then you can identify an important group of key workers who can be deployed in relative safety for themselves and others.

Sat 28 Mar 2020, 11:32

Seems front line health workers will now be tested Philip. We hope you and Gail are safe. Kind regards Hans and Patricia.

Sat 28 Mar 2020, 08:36

Charlie, I'm not saying that prisoners should NOT be tested, but that front line health workers should have been the first ones to be offered such tests.

Sat 28 Mar 2020, 06:07 (last edited on Sat 28 Mar 2020, 06:10)

The testing of prisoners is entirely sensible, given that there are many instances of more than one to a cell, rendering it impossible for them to keep the 2m recommended distance apart. It is not a case of "sense of priorities", Philip; what happens when their "overseers" go off duty and return home to the wife and kids?

What *is* scandalous is the government's slowness in starting to procure the manufacture of ventilators and other requirements. (Although the cynic in me expects this to change now that so-called "important" members of society such as Johnson, the Health Secretary and Prince Charles have Covid-19!)

Fri 27 Mar 2020, 18:51

Oh and to rub salt in the wound (so to speak), the Ministry of Justice has already been testing prisoners in UK jails. Strange sense of priorities in this country!

Fri 27 Mar 2020, 14:02

Useful post.....

Fri 27 Mar 2020, 13:06

Nice to see that both the PM and heir to the throne have managed to be tested. Shame that the same courtesy has not been extended to healthcare workers in the front line of the fight against this disease.