Letter from Lynne
New research, this time from Iceland, an isolated country of 365,000 individuals where widespread testing was implemented, suggests that more than 50% of the cases of the virus are asymptomatic. Our understanding of transmission has evolved rapidly over the last month from believing that it was spread by those with visible symptoms like cough and fever to an understanding that the transmission can occur up to 48 hours before symptoms set in. Soon thereafter, it was thought that 25% of transmission occurred by those who are asymptomatic. That number is now doubled. This is both an insidious and invisible foe.
There will be no real solution without a vaccine that is used globally. But that does not mean we can’t act now. Each day we learn more, it suggests new actions. Isolating sick from well remains key. Rapid testing to identify carriers is critical.
Given the stealthy transmission of the virus, testing with a turnaround time of 2-7 days makes it difficult to control spread without universal isolation or another test to determine whether an individual has antibodies to the virus. These antibody tests are being developed and together with rapid testing will give us the data we need to enable infection control practices including isolation to be more effective.
The reality however is that we do not have these tests and while isolation is helping flatten the curve, the cost remains high. Not everyone can isolate. Health care professionals and other essential workers must keep even our skeleton society functioning. And many of these people are asymptomatic carriers. And so it spreads, silently and invisibly, targeting everyone but impacting our older and frailer population more harshly.
It is clear that rapid testing to determine if someone is an active carrier of the disease and antibody testing to determine if people who have either tested positive or had symptomatic cases have immunity should be a public policy imperative. These resources are currently in limited supply. Every effort should be made to both increase supply and expand testing, first to ALL health care professionals (not only those serving the acutely ill) but to those health care professionals that care for frail older adults who are most susceptible.
This two-prong testing strategy has positive economic implications. First, the combination of rapid testing for disease and antibody testing for immunity will permit a significant part of the population to return to work and do so presumably, safely—safely for themselves and for others. Second, by testing the more vulnerable and their care givers we believe we can/expect to/hope to save money and lives by keeping people out of hospitals.
We need widespread testing, continued tracing, continued isolation for those who are sick or positive but asymptomatic to bring this insidious foe to its knees. The healthcare workers and other essential personnel on the front lines are herculean but they need new weapons to fight this war and win.
