Group testing all Americans every day is our surefire secret weapon
to save potentially millions of lives and immediately restart the
economy. Group testing is a super efficient way of finding out who’s
infected and who’s not. Iceland’s doing it. Israel’s doing it. Even
Nebraska’s doing it. The President needs to implement this policy
immediately with the help of the military. It’s that simple.
We are doing the unimaginable to escape coronavirus, from shuttering
stores and restaurants, to mandating quarantines, to stopping
international travel. Now some states are demanding that out-of-state
visitors quarantine for two weeks. And President Trump Saturday tweeted
he was considering quarantining New Jersey, New York, and Connecticut,
before backing off that idea. My wife and I took a drive today to
Crane’s Beach, which is an hour north of Boston. We found the beach
closed to all but locals. Soon the small towns will use their police to
keep big city “foreigners” out. Then we might see different parts of
cities seal themselves off. For example, Queens, Brooklyn, and the Bronx
could close the bridges and tunnels from and to Manhattan.
If you woke up a year ago to today’s reality, you’d think you were
somehow transported into a dystopian movie. Not yet Mad Max, but heading
that way.
Fortunately, there is a foolproof way to defeat coronavirus. The
president simply needs to make it happen. Here’s the secret weapon.
Group Test Every American Every Day.
As
I’ve written and as
Iceland is showing,
testing every American every day and giving those who test negative a
badge for the day to work, shop, frequent restaurants, etc. will let us
separate those who are healthy from those that are sick and let those
who are healthy go back to work, shop, reopen their businesses, and,
most important, rehire the workers they have just fired. Equally
important, it will give workers and employers the confidence they need
that participating in the economy and reopening their business is fully
safe.
I’ve received three sets of negative responses to this proposal.
The first: “Testing everyone every day is impossible. We can just
test people who have symptoms and if they are positive, trace their
contacts.”
This approach is fraught with problems. We’re not China, South Korea,
Hong Kong, Taiwan, or Singapore. We don’t have an electronic record of
where everyone was over the past two or so weeks, let alone with whom
they interacted. And we can’t confiscate people’s cell phones and
download their contact lists. Hence, contact tracing will be poor at
best. Moreover, infected people may be asymptomatic. Hence, they’ll
never get tested in the first place and have two weeks or more to spread
the infection. To make matters even worse, the current PCR test
produces a false negative between 14 percent and 30 percent of the time
depending on which study you read. Hence, many infected people are being
told they aren’t infected when they are. When this happens, they head
off to spread the infection, which they will continue to do for days or
weeks if they don’t land in a hospital with worse symptoms.
The second objection to daily universal testing is that it’s too
costly. This can’t possibly be true compared to the cost of having so
many people become terribly sick or die, not to mention destroying the
economy.
The third concern with testing everyone every day is that there
aren’t enough testing kits, labs, testing machines, reagents, etc.
available. This is where the miracle of group testing comes in. It’s an
old idea developed by a Harvard economist named Robert Dorfman during
WWII. I’m old enough to have met Professor Dorfman when I was in grad
school. But I never knew anything about group testing until yesterday,
let alone that Dorfman was responsible for the idea.
Dorfman was tasked with figuring out how to efficiently test new
recruits for syphilis. The test, a blood test, was expensive. Dorfman
proposed drawing blood from a group of recruits, say 20, and mixing it
together. Then you’d test the batch. If syphilis wasn’t found, it meant
that one test had cleared 20 recruits. If the test came back positive,
you could split the sample into 10 and 10 and run another test using
extra blood retained from the original blood draw. If one of the two
blood groupings tested negative, you’d know the problem was in the
remaining 10 and split those 10 into two groups of 5. If both of the
tests of 10 were positive, you’d move to four tests of 5 recruits. And
so on.
The point is that if the share of recruits with syphilis was low,
group testing could dramatically reduce the number of tests needed to
separate the healthy from the sick. And it could still identify
precisely who was sick.
What worked in WWII for syphilis can work today for coronavirus. This
is the marvelous insight of three French economists — Christian
Gollier, Jean-Luc Travernier, and Olivier Gossner — from the Toulouse
School of Economics, the National Institute of Statistics and Economic
Studies, and the Ecole Polytechnique, respectively. They sent me and
other economists, including The Hoover Institute’s John Cochrane, their
papers yesterday.
John wrote about the group testing idea in his blog. But we academics are behind the curve. Governor Ricketts of Nebraska
adopted group testing several days ago.
There is now a
15-minute coronavirus test.
What we need to do is group-household test each day. The method is
simple. A testing mobile, manned by military personnel, would come to
your street early each morning. The members of your household and maybe
another 9 (the best number is yet to be determined) would be invited to
provide a swab sample. All the swabs of all the households would be
collectively used to test if any of the swabs was positive. Fifteen
minutes later your group of households would either be cleared to go to
work and frequent stores, restaurants, and other establishments for the
day or not. If you’re cleared, you’d get a green bracelet that would
automatically change to red after 24 hours. Those with green bracelets
would be returned to normal society. If your group of households tested
positive, subgroup testing would be done, on the spot, until it was
discovered which of your group’s 10 households was infected and which
weren’t. Those households that were infected (had one or more infected
members) would need to go into quarantine.
The military is the only group that can conduct this critical mission
across the country efficiently and effectively in the time required.
The military personnel doing the testing would be extensively trained,
have protective gear, and follow a protocol would be established to
limit, to the maximum extent possible, uninfected people becoming
infected in the course of the testing. The public fully trusts our women
and men in uniform and will comply with their instructions.
Yes, the testing won’t be perfect. But by limiting the number of
tests, we can better ensure that the people doing the testing are the
best qualified and that the testing is done at the highest level. And
yes, some infected people will spend the day at work, in restaurants, in
shops, etc. But workplaces, shops, and restaurants would take
temperatures before letting people enter, continually disinfect
surfaces, and implement the best social-distancing practices.
Initially, the best we may be able to do is test every household once
a week. But over time, we can get to daily testing. And, as the tests
improve, we’ll reach the point that less frequent testing is needed.
This can all be started very rapidly, maybe in time for Easter — the president’s proposed date to restart the economy!
PS, Here’s an email from an Atlanta doc that I received after writing the above.
I agree 100% with all you say about coronavirus and agree with
Paul Romer. Please be as vocal as possible about mass screening of the
population. And start today. Any positives we remove today will impact
the level of disease we see in 3-4 weeks.
STOP testing sick people at the end. The treatment is not different.
START screening the population. Remove the fuel and the fire will
go out. I am a doctor and waiting for this to crest in Atlanta. We
could have a huge impact on the crest if we started screening the
population now and isolated positives. Instead they test sick people
after the fact. I don’t want to see all of these patients and healthcare
workers die.
Israel is now using pooled testing of 60 samples to screen. If
the pool is negative all are negative. We do this to screen our blood
supply. Handsomely pay a biotech firm to work on this strategy. But with
pools of 60, you can screen a lot faster than 1 by 1.
https://www.forbes.com/sites/kotlikoff/2020/03/29/group-testing-is-our-secret-weapon-against-coronavirus/#3c73462c36a6
