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With push to reopen the economy, Duke professors cite need for improved testing

As debate swirls around reopening the economy, three Duke professors addressed the need to remedy testing shortages in a Tuesday media briefing.

They explained that two types of coronavirus tests currently exist. One screens for active infection by detecting the virus itself, and the other determines the presence of COVID-specific antibodies, which indicates if someone has ever been infected. Although these tests are ostensibly useful, Professor of Medicine Michael Dee Gunn cautioned about their dubious reliability. 

“If both of those tests work as they are supposed to, you can get a pretty good idea of where someone stands at any time in the course of infection,” Gunn said. “Currently, we are early in this so we don’t know exactly how to interpret all of these tests. The test for the virus, which is the genetic test, we’ve seen a lot of cases where those stay positive for a long time and we’re still trying to figure out exactly what that means.” 

With so many new companies racing to develop testing, the creation of a common form of validation is the most pressing issue. Standardizing aspects of testing across companies could be crucial to understand who actually has protective immunity. 

“What you want to be able to do is to have a number of different testing platforms and be able to have it well-curated—so you can run the samples on all the platforms and look at your results and start to understand, ‘Are they all picking up the same measurement?’” said Thomas Denny, chief operating officer of the Duke Human Vaccine Institute. 

Current hurdles to adequate testing stem from shortages in the supply chain, which extend beyond just the physical kits and necessary reagents. 

Shortages in the materials necessary to collect test samples and a diminished workforce to provide more resources factor heavily into this shortage, said Christopher Woods, co-director of the Hubert-Yeargan Center for Global Health and chief of the infectious diseases division at the VA Medical Center in Durham.

The ultimate goal of sufficient testing is to facilitate a return to economic productivity, but the degree of oversight required depends on the particular location. North Carolina ranks 20th in terms of coronavirus infections, with Durham County at about 400 cases as of April 21, so the parameters in Durham to reopen would be more lax than New York City’s. 

“It’s the same thing that happens in a forest fire,” Gunn said. “Once you get the fire under control, then it’s an issue of managing the hotspots. What we need to do very efficiently is to be able to identify people that are at risk or having been infected.”  

Federal, state and local governments must cooperate to address the testing issue, Woods added. He explained that this comprehensive effort should stem from strong, but not overbearing, leadership from the president’s team and federal organizations.

“I think we require substantial national leadership from our national public health entities, but ultimately at the state level, that’s where the data will be available to make the best decisions to invest current resources and direct new resources,” Woods said. 

Although many people seek to end social distancing in a timely manner and introduce less restrictive measures, there are risks if the transition occurs too soon. The prospect of loosening quarantine measures could arrive soon, but Gunn reminded that the process must be gradual and methodical.

“If you think of rings of containment, you can think of rings of loosening the containment. So you can start small and then you watch and be ready to contact tracing and testing in that area, and you build on it. I’m concerned we are going to find ourselves in worse shape if we go too fast,” Gunn said.  

Gunn acknowledged those who are motivated by the loss of their job and income but reminded viewers that coronavirus safety is “something we can deal with on a national level, as opposed to forgetting all the efforts we’ve been through the last six to eight weeks.”

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