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Molecular, cellular and developmental biology graduate student Quing Yang examines samples as part of the process of a rapid, portable saliva-based COVID-19 test able to return results in 45 minutes in the Sawyer lab at the Biofrontiers Institute at the University of Colorado Boulder. (Photo by Glenn Asakawa/University of Colorado Boulder)
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Widespread, frequent and rapid coronavirus testing would vastly reduce the spread of disease and help to reopen society, even when using tests that are less sensitive to detecting the virus, according to a newly published study by University of Colorado Boulder and Harvard University researchers.

Fast turnaround time and more frequent testing are more important factors in preventing the spread of coronavirus than using tests that meet the gold standard for virus detection, researchers wrote in the journal Science Advances on Friday.

A view of a prototype of a rapid, portable saliva-based COVID-19 test able to return results in 45 minutes in the Sawyer lab at the Biofrontiers Institute at the University of Colorado Boulder. (Photo by Glenn Asakawa/University of Colorado Boulder)

The findings were published as a preprint in May — before peer review — and already have had a significant impact around the world, said lead author Daniel Larremore and senior co-author Roy Parker. Larremore is an assistant professor in the CU Boulder’s Department of Computer Science and in the BioFrontiers Institute, and Parker is the director of the BioFrontiers Institute and a professor of biochemistry.

Larremore pointed to the rapid tests used in Slovakia this month to test the majority of the country’s 5 million residents during the course of three weeks. While that exact model — along with the fines and strictly enforced quarantines — might not work in the United States, more testing availability would help people make informed decisions, Larremore said.

“What that means in terms of policy is we really should be prioritizing getting test results back into people’s hands as soon as possible so they can start protecting the people around them,” he said.

Researchers used a simulation to look at how early and effectively contagious people could be identified and given positive test results so they could isolate themselves.

“It measures what fraction of infectiousness would a particular testing policy be able to isolate, and by comparing different turnaround times and sensitivities, it led us to the conclusion that turnaround time and frequency is what makes the difference,” Larremore said.

Perhaps most importantly, frequent and fast testing could identify people who don’t have symptoms but are still spreading the virus, Parker said. Rapid tests are able to produce results in 15 to 20 minutes.

“For the three days someone is waiting for a test result now, they could be walking around potentially infecting new people. If I can let you know the same day or the next day, that greatly reduces the chance you have to spread it to new people,” he said.

The kinds of rapid tests studied by Larremore and Parker have been a source of debate on the world stage because they are not able to detect lower levels of the virus that “gold standard” diagnostic tests can detect.

But in the infection cycle, the time span in which a rapid test would miss a positive test result that a lab-based diagnostic test would catch is about 12-24 hours, Larremore and Parker said.

Mass testing opens up the possibility of individualized stay-at-home orders while the rest of society returns to relative normalcy, Larremore said. It could mean waiting 15 minutes before going to dinner in a restaurant, but being relatively sure that people inside don’t have coronavirus.

“If you have symptoms and you’re sick, you want a top-of-the-line test because that information is very valuable for you and your doctor. We want to prioritize test sensitivity for clinical diagnostic tests,” Larremore said. “But if the goal is to break as many transmission chains as possible, these rapid tests have a much higher value.”

The hitch in implementing widespread, frequent and rapid coronavirus testing is availability. Could the United States produce millions of tests?

“I think the answer is that you could. It would not be trivial to do that, but it could be done technically,” Parker said.

Widespread testing is not currently an option for Boulder County Public Health because there aren’t enough tests available, said spokesperson Chana Goussetis. Even CU Boulder probably couldn’t obtain the thousands of rapid tests needed to screen all students, Parker said, though the university required weekly coronavirus testing for students living on campus and frontline workers this semester.

One of the study’s co-authors, Michael Mina, an assistant professor of epidemiology and immunology at Harvard, is advocating for the federal government to step in to create new authorization routes at the Food and Drug Administration and Centers for Disease Control and Prevention so at-home coronavirus tests can be rapidly approved and produced. The first rapid at-home test was approved by the FDA this week but requires a prescription.

“When pushed to try this type of program, with all the evidence laid out, our nation’s leaders have demurred, suggesting an FDA regulatory landscape that is too difficult, or have simply refrained and asked: Why hasn’t anyone else tried this yet? It appears our leaders are failing to understand that we are living history, today, and it is they who must be the leaders to try bold new agendas,” Mina wrote in a Tuesday opinion piece for Time Magazine.

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