On Coronacast with Dr Norman Swan
The longer this pandemic drags on, the more likely it is that people will get fed up with taking themselves off for a coronavirus test every time they get sick.
It might sound counterintuitive, but the solution might be to test everyone more.
Regular, targeted but rapid testing of people, regardless of whether they have symptoms or not, could allow us all to return to a somewhat normal life.
On today’s Coronacast, Tegan Taylor and Dr Norman Swan discuss the possibilities and challenges of a mass testing scheme.
Tegan Taylor: Hello, this is Coronacast, a podcast all about the coronavirus. I’m health reporter Tegan Taylor.
Norman Swan: And I’m physician and journalist Dr Norman Swan. It’s Thursday, 17 September.
Tegan Taylor: So Norman, I don’t know if you’ve noticed, but this pandemic is taking a while to run its course.
Norman Swan: I hadn’t noticed, I’m glad you told me.
Tegan Taylor: Newsflash: pandemic goes on forever. Or it feels like it does at least. And we are getting fatigued about a lot of things, but one of those things seems to be testing. And we keep saying on this show and elsewhere that if you’ve got symptoms you should get tested, it’s the way to know how much of the virus is out there. But, my gosh, it’s winter, runny noses. What happens if everyone just gets fatigued with this and just doesn’t bother coming forward for testing anymore?
Norman Swan: Well, I think it’s already happening. The Chief Health Officer in New South Wales, Kerry Chant, yesterday or the day before was saying that the testing rates in New South Wales have dropped off, and I think she was quite alarmed about it because the Chief Health Officer doesn’t know whether there are only a few cases each day in New South Wales because there are only a few cases each day in New South Wales or it’s because people are not coming forward for testing.
Tegan Taylor: Well, like we were saying yesterday, there was a stage where there was probably six or seven times as many cases as was actually being picked up by testing.
Norman Swan: Yes, according to that study. It’s probably less than that and we’ll find that out next week, but there are more people out there with the infection than are coming forward. And the real problem is how much it’s spreading in the community.
So here we’ve got a situation where people are getting fatigued, they’re not coming forward, if you’re in lockdown in Melbourne you don’t want to go out. So there’s all sorts of reasons why you don’t come forward, and there’s probably fewer viruses around of other kinds and you’re not getting the symptoms to make you come out, but there are plenty of people who would be asymptomatic. And it’s going to take a while before a vaccine comes on-stream, so we’ve got come backwards and forwards, and lockdown, not lockdown, having those arguments, running the risk of outbreaks.
And actually an ex-patriot Australian who is a very eminent epidemiologist and has got the chair of epidemiology at Oxford University, David Hunter, and another very experienced epidemiologist Julian Peto, have come up with a suggestion which is…at least in the UK context but it could work here as well, which is that instead of people coming forward for testing, you actually go out and test everybody. You test as much of the community as you can on a regular basis. Now, they are saying twice a week, which just doesn’t sound feasible at all.
Tegan Taylor: That’s a huge burden, yeah.
Norman Swan: Yes, so that’s like 120 million tests a week, that’s extraordinary. And the UK’s testing regime is not working at the moment. But let’s just talk about how it might work in the Australian context. So you’ve got a situation, for example where in Victoria you might have 30 cases a day, you’re still not sure how much virus is going around. You know that south-eastern Melbourne and the north-west corridor, maybe a few other areas are getting a few cases but you don’t know how much virus is around, and you could actually go in and mass test, and mass test on a regular basis so that you can pick up whether or not there are changes in the community and how many people are walking around with infection who don’t know it.
One of the necessary developments here probably to make this happen would be much more widespread adoption of rapid testing, which we talked a bit about yesterday, but the technology is getting better because one of the disincentives to being tested is that you’ve got to self-isolate until you get the result, but if you get the result in 15 minutes, effectively you don’t have to self-isolate until you get the result and then you would have to isolate if you are positive. But there wouldn’t be that many positive people, although there would be a few false positives out there in the community.
That way you could track infection in the community and pounce on it early and deal with it that way. You wouldn’t have to do it in Western Australia, South Australia, Tasmania, and probably not Queensland, but maybe parts of New South Wales and Victoria, and it could be a way of getting out of this and then maintaining a much more normal way of life apart from that testing.
Tegan Taylor: So, 15 minutes until results is super-fast. So you’re saying that this technology already exists. Why aren’t we using it now? Why are we still waiting two or three days for test results?
Norman Swan: It’s more expensive. The accuracy in some of these tests is a bit lower, and the technology is not necessarily available in the sort of bulk that’s needed, although the Americans have got some of these technologies up in bulk. I know that we are developing some of our own, but we could move to a more rapid testing regime.
So it’s probably not the whole of Australia. It could be the whole of metropolitan Melbourne and Mitchell Shire, and it could be parts of New South Wales, to supplement the fact that people are not necessarily coming forward, so that it stays under control. And the incentive for everybody is, yes, some people would be inconvenienced by having to be isolated if they came up positive but they wouldn’t have to wait too long before getting the result.
And if we accelerated this, it could be a way of getting under control in a much more normal way of life, and the economy coming back to life, with borders down, prior to a vaccine.
Tegan Taylor: They did do some mass testing in Melbourne though, didn’t they, and that didn’t really seem to pay off in the way they thought it would.
Norman Swan: Are you talking about the asymptomatic testing they did a while ago?
Tegan Taylor: Yes, they went door to door and tested people in their homes.
Norman Swan: Yes, you’d have to bring the community with you. I think what happened with the asymptomatic testing was that people got confused, they got confused about whether or not they should isolate and so on and there were mixed messages. But communication would have to be crystal clear. Here is a way of us…it’s a preventive measure rather than, if you like, a panic measure because it’s starting to break out. This is not an easy option but it is an option worth considering, but the community would have to be on side and understand what’s going on.
Tegan Taylor: Well, let’s take a couple of questions from the audience, because you legends just keep sending them in and thank you for doing that. Greg is asking; after seemingly endless colds and sniffles last year, his two young children have not had any cold symptoms since March, which has been wonderful, so what is the impact of that going to be on the development of their immune systems as young kids? Greg thought the theory is that the exposure to colds and flus going around helped children to build up a resistance to them for later life.
Norman Swan: The important time for the development of the immune system is the first year of life and that tends to be a time where kids don’t get a lot of coughs and colds, they tend to get them when they start preschool, kindy, family day care and so on when they are mixing with other kids. And there is no question that you do build up some immunity to cold viruses, like the coronavirus, the same family as COVID-19.
I think nobody knows the answer to that question. They are beyond that critical first year where the immune system is developing. My guess about what will happen, and it is just a guess, is that they will catch up, is that as kids start mixing again, as we go out and about, after a vaccine emerges or after lockdown finishes, then kids will just catch up, and they will have a period, maybe it’s a year later, when they have these coughs and colds, but they will get them.
Tegan Taylor: What about these kids in the first year of life who have been in lockdown this year?
Norman Swan: Well, as I say, kids in the first year of life do not tend to get a lot of coughs and colds unless they are in family day-care. So most kids are not exposed to a lot of other kids in that first year of life, so it really is in toddlerhood and the preschool age group that they get this maximal number of infections.
Tegan Taylor: And we’ve got a question from Malcolm saying; any chance you could talk a bit about the long-term effects we are starting to see from Covid?
Norman Swan: Yes, it’s still relatively uncharted territory. There is a study going on in Australia led by St Vincent’s Hospital in Sydney, looking at these long-term effects. And what some people are getting…and it seems to be a recognisable syndrome which partly involves fatigue, it can also involve the heart, that some people get infection of the heart tissue, even though they might not have had a severe bout of COVID-19.
And what this means is that there is probably going to be a longer tail of COVID-19 in the community, and also people emerging with problems who never knew they had COVID-19 and subsequent testing for antibodies will discover that they have. So it is another reason for really keeping a lid on this pandemic, so a lot of people are talking about opening up and ‘let’s not worry too much, what are we worried about, the mortality rate’s going down’, but what we are discovering is that people who get mild illness, this could go on for a long time and they can be quite sick.
Tegan Taylor: And a lot of this evidence is anecdotal but I have seen some of the studies saying that it doesn’t have to be people who are hospitalised to be seeing these long-term symptoms continuing.
Norman Swan: That’s right, and sometimes it’s quite young people.
And we’ve got some feedback for our clarification corner team.
Tegan Taylor: Yes, Helena is saying; on today’s Coronacast (as in yesterday) Dr Swan mentioned that the AstraZeneca vaccine is being tested on people already infected with coronavirus, but isn’t a vaccine supposed to be used on healthy people to prevent catching coronavirus or prevent the disease? I think maybe she has misinterpreted or…would you like to clarify, Norman?
Norman Swan: Well, it could be that I just was pretty crap about explaining myself. Sorry about that Helena. No…I’ll tell you what I was talking about in a minute, but no, these people are not infected with the coronavirus, and the hope is that they do get infected with the coronavirus after they’ve been immunised so that you can see whether or not they’ve been protected. So you’ve got one group with the active vaccine and the other group…in the case of the Astra trial they are getting a meningococcal vaccine as a placebo. So that’s the idea, they are not infected to start with but hopefully they are infected going down the track.
Where I probably confused you was that in this case where this woman who caused the trial to stop had a problem, one of the things they would have wanted to know is had she been infected with the coronavirus after her vaccine? Because it’s that situation which they are worried might cause an overreaction of the immune system. So not before she’s had the vaccine but after. One of the safety issues is that when you are infected with the real virus you might get an overreaction of your immune system. But no, people that go on a trial are not supposed to have had the coronavirus first.
Tegan Taylor: Thanks for clarifying, Norman. And that’s all we’ve got time for on Coronacast today.
Norman Swan: We love your questions and they are what prompt the discussion, so go to our website, abc.net.au/coronacast, and click ‘Ask a Question’.
Tegan Taylor: You can also leave a comment if you’d like to tell Norman what you think about his rapid testing scheme, another Norman scheme, and also don’t forget to leave us a review on Apple Podcasts if you can, because we truly do love reading them.
Norman Swan: And I’ll try not to be too confusing tomorrow. See you then.
Tegan Taylor: See you then.
2 thoughts on “The ambitious mass testing plan that might be as good as a vaccine”
I just joined a group of NZ doctors, researchers, epidemiologists and lawyers who are having severe reservations about the way the NZ government is managing COVID 19. They try to have a webinar every Monday where they present the latest research. Last Monday they talked about the massive expense of mass testing – NZ, which is a very small country, has already spent $86 billion on mass testing. This has raised a lot of concern among doctors, as the NZ health system is already severely underfunded.
Lay people are allowed to join and watch the webinars (in addition to lots of good info on the website);
If someone could find a simple inexpensive way to do the testing with more or less immediate results, maybe this would help to outsmart the covid 19.