Dr. Michael Mina’s rapid test theory

The US could have prevented the surge of COVID-19 cases this winter that killed hundreds of thousands of people if only the FDA had approved methods for at-home rapid testing and made the tests widely available. That is the argument made by Dr. Michael Mina, assistant professor of epidemiology at Harvard’s T.H. Chan School of Public Health, one of the country’s strongest proponents for the use of at-home rapid COVID-19 tests.

“Had the regulatory barriers been broken down in the summer last year, and the companies that could produce these were actually allowed to produce them at scale…we could have seen the surges of the fall and winter that happened and killed hundreds of thousands of Americans, those could have largely been prevented,” Mina said on The Codcast.

Mina explained that if government gave every household a supply of at-home tests in September, and people were testing themselves twice weekly, that could have vastly reduced the rate of virus transmission. It’s the thing about epidemics: They either grow exponentially or they fall exponentially, and it’s a razor thin line between the two,” Mina said.

Rapid tests are technology that Mina describes as similar to an at-home pregnancy test. While the exact methodology varies based on the test, the general idea is you take saliva or a nasal swab, put it into a tube, dip a paper strip into the tube, and the strip reveals whether someone is positive or negative in about 10 minutes.

Some countries, like Slovakia, have experimented with widespread use of rapid antigen testing, with generally positive results. But it has been controversial. As the United Kingdom prepared to roll out rapid antigen testing, for example, some scientists worried that the tests would miss a large portion of infections, and those people would be falsely reassured and spread the virus.

Unlike a PCR test, which is the current gold standard for COVID testing, a rapid test generally cannot tell if someone has only a small amount of the virus – for example, if they were sick several days ago. But if someone is at the infectious stage of the disease, rapid tests will detect it at least 90 to 95 percent of the time, Mina said.

In the US, a handful of rapid tests have been approved. But under FDA regulations, they still require a doctor’s prescription. That policy, Mina said, makes the tests more expensive and adds a layer of unnecessary complexity and barriers to access.

“There is absolutely no reason in the United States right now why a COVID test should require a physician’s prescription,” Mina said. “The FDA is not helping public health here.”

A state can potentially get around that by ordering a “standing prescription” allowing anyone to get one. But Mina called that an “abuse of the purpose of a medical prescription.” He added: “I should not be forced to write a prescription for 100,000 people who I don’t know, just so that they can have a test.”

In Massachusetts, the state has purchased a stock of Abbott BinaxNOW rapid tests from the federal government and sent them to schools. They can be used, for example, to aid in pooled testing. If a PCR test of pooled samples turns up positive, rapid tests can be given to every student whose sample was in the pool to determine who is positive. Rapid tests have also been deployed in nursing homes, where the facility can operate under a blanket prescription.

Even as more people are getting vaccines, Mina said rapid tests could remain important if variants circulate, if cases rise in the fall, or if people – particularly the elderly – lose immunity.

Mina estimates that deploying rapid tests nationwide would cost $20 billion. “Twenty billion dollars is essentially what this country has purged every single day as a result of this virus since last year,” he said.

SHIRA SCHOENBERG

FROM COMMONWEALTH

A study examining the effect of declining to prosecute lower-level nonviolent offenses — a signature policy adopted by Suffolk District Attorney Rachael Rollins that has drawn both praise and scorn — suggests the approach leads to significantly less future involvement by those defendants in the criminal justice system.The new study, which looked at cases handled by the Suffolk County DA’s office going back to 2004, found that those defendants not prosecuted for lower-level misdemeanor cases were 58 percent less likely to face a criminal complaint over the following two years than those who faced prosecution for similar charges. Read more.

With a state commission concluding the film tax credit is not the best use of the state’s money, backers of the tax break say they have the votes on Beacon Hill to make it permanent. The Massachusetts Production Coalition, which represents film and TV workers and businesses in the state, said legislation it is backing that would eliminate the law’s sunset has majority support in both branches of the Legislature – 102 members of the House and 23 in the Senate are cosponsors. Read more

Republican power couple Ryan and Stephanie Fattman are challenging the fairness of an investigation by the Office of Campaign and Political Finance, which apparently focuses on money the senator donated to the Sutton Republican Town Committee, which passed it along to Stephanie, the register of probate in Worcester County. Read more.

Gov. Charlie Baker signs climate change legislation into law. Read more. Baker and House Speaker Ron Mariano begin a discussion about how to build an onshore industry to support offshore wind, and differences quickly appear. Read more

Opinion:

Sen. Barry Finegold talks to the Duxbury High School football team about its use of “Auschwitz” when calling audibles at the line of scrimmage. “Why does it matter to talk about the Holocaust?” he asks. Read more.

Hubert Murray says the passage of climate change legislation doesn’t change the reality that climate change is coming and we need to start adapting to that change. Read more

Essential workers are taking care of our state and of our nation: healthcare workers, grocery clerks, bank tellers, first responders, domestic workers, restaurant workers, janitors, and so many more. Yet many of us are fighting to keep ourselves afloat, especially as we struggle to find care for our children while we go to work. Read more from Eunicia Gomes and Marie Menard. 

Louis Kruger, a professor emeritus at Northeastern University, says it’s time to rein in the authoritarianism of state Education Commissioner Jeff Riley. Read more

Massachusetts has a lot of work to do on immigration, says Eva Millona of the Massachusetts Immigrant and Advocacy Coalition. … Ed Powell, executive director of STRIVE Boston, offers some lessons that he has learned helping those hardest hit by the pandemic. … Larry Spence of Tempus Unlimited praises personal care attendants, who are often unseen and forgotten but play a vital role.

 

FROM AROUND THE WEB

 

BEACON HILL

Salem Mayor Kim Driscoll, in an op-ed, says it’s time to end the Legislature’s exemption from the state Open Meeting Law. (Boston Globe

MUNICIPAL MATTERS  

Fall River plans to launch a body camera pilot study in its police department. (Herald News

Gloucester city councilors call for an outside expert to oversee harassment complaints because city officials who would otherwise be in charge, including Mayor Sefatia Romeo Theken, are the subject of some of them. (Gloucester Daily Times

The attorney general’s office ruled that there was no evidence to support an allegation raised by a resident that the Beverly school committee violated the state’s Open Meeting Law last August. (Salem News

HEALTH/HEALTH CARE

Has the state’s $130 million expenditure on nonprofit Partners in Health to conduct contact tracing of COVID cases been worth it? (Boston Globe

WASHINGTON/NATIONAL/INTERNATIONAL

Sen. Ed Markey says the Biden administration infrastructure plan to be unveiled on Wednesday will include a lot of the ambitious plans of the Green New Deal. (Boston Globe

Former Trump administration officials on the frontlines of coronavirus policy are speaking out against the administration’s handling of the crisis, moves some see as efforts to restore their own tainted credibility going forward. (Washington Post)

The murder trial of former Minneapolis police officer Derek Chauvin begins today. (New York Times)

ELECTIONS

Democrats, led by Attorney General Maura Healey, sense a chance to take back the governor’s office, but don’t underestimate Charlie Baker, says Joe Battenfeld. (Boston Herald

EDUCATION

A Globe editorial says the state should consider making admission to oversubscribed vocational technical schools based on a lottery. 

Boston school superintendent Brenda Cassellius outlines her vision, which includes expanded early education programming. (Boston Globe)

TRANSPORTATION

With the help of a $3.5 million grant from the state Department of Transportation, the MetroWest Regional Transit Authority is launching on-demand bus service on Sundays. (MetroWest Daily News)

Transit advocates, including regular T rider Acting Mayor Kim Janey, plan to rally outside the state Transportation Building this morning to call for full restoration of pre-pandemic T service. (Boston Herald