Herewith three items of pandemic news you may have missed recently: testing a thyroid hormone for Covid-ARDS; grocery store clerks at high risk; and a simulator for rapid testing scenarios. Plus a frippery.

Perhaps you saw the piece today in the NYTimes whose headline casts doubt on how well one particular rapid test works: A Rapid Virus Test Falters in People Without Symptoms, Study Finds. If you read the article, you learn that the outlook is not as downbeat as the headline implies. The reporter went to the effort of scaring up scientists to offer he-said, she-said quotes — an inappro­priate use of political-junkie style jour­nalism to cover a science story, in my opinion.

The subject of the article is rapid testing, or “Michael Mina-style” testing, which we explored here in July. It’s a testing framework appropriate to pubic health surveillance of a community, not focused on individual medical diagnosis. This testing strategy revolves around simple, cheap, quick tests of lesser sensitivity, administered frequently — sometimes referred to as “lick-a-stick” testing — aimed at identifying people who are shedding infectious virus.

Proponents of Mina testing have faced headwinds from fans of the current RT-PCR (clinical diagnostic) ap­proach — slow, expensive, infrequent tests of high accuracy — partly because there has not been an easy way to compare and explore outcomes and costs of the two testing phil­os­ophies. Now there is an online testing simulator that provides exactly that.

This new dashboard enables exploring Covid-19 testing strategies for large-cohort settings — school, business, nursing home, etc. It facilitates comparing outcomes and costs of cheap, frequent rapid antigen testing with less frequent, more accurate, more expensive RT-PCR.

The dashboard shows how testing frequency, technology, and methodology interact to affect cost and results. It comes in two versions: a simple calculator with six adjustable parameters, and a detailed one with 16.

The tool was developed by UnitedHealth Group Research and De­velopment with the participation of Dr. Daniel Griffin, weekly visitor to This Week in Virology. Griffin is a co-author on the paper describing the dashboard (preprint here).

I encourage you to play with this simulator. Make up a scenario — a school with 500 people, say. Compare ad­min­istering $100 RT-PCR tests in this community every 2 weeks, getting results back in 2 days, with using daily, $5 lick-a-stick tests that read out instantly. Which testing methodology gets a Covid-19 outbreak under control? What are the costs? How important is it to do a second, confirmatory test when a rapid test reads positive?

If you want to dive deeper into the role of testing in epidemiology, I highly recommend Michael Mina’s lecture, the eighth in the ongoing, free MIT course on Covid-19 and the pandemic.

In a single grocery store in Massachusetts, 104 retail workers filled out mental health ques­tion­naires and were tested for Covid-19. Twenty percent (21 workers) tested positive for SARS-CoV-2, and of those, 16 showed no symptoms. Em­ployees with direct customer exposure were five times more likely to test positive for the virus.

Twenty-nine employees tested high on an instrument for measuring anxiety, and eight for de­pression. Those em­ployees who were able to practice social distancing at work were less likely to exhibit the psychological symptoms; those who had to rely on public transportation (as op­posed to walking, biking, or taking a private car to work) were more so.

Here is the paper in The BMJ and a writeup on MSN about the study.

Two doctors in Duluth have progressed to a Phase II study of a thyroid hormone to treat Covid-19 induced acute res­pir­atory distress syndrome (ARDS). During the H1N1 pandemic of 2009, Dr. Tim Rich and Dr. David Ingbar dis­covered upon autopsy that the lungs of victims of that influenza lacked the thyroid hormone T3, which is normally present in detectable amounts. T3 reduces inflammation and causes cells in the lungs to absorb fluid.

The doctors applied to the FDA for approval to try using T3 to treat ARDS, and this was granted late last year. The Covid-19 pandemic, unfortunately, provided plenty of ARDS cases from which to choose to see if T3 could lessen the severity of the condition. The Star Tribune article linked above profiles two cases in which T3 arguably saved lives. The Phase II study will enroll 68 patients with ARDS in Duluth and the Twin Cities, of which 50 will be given T3 and 18 will receive standard of care.

Here’s a hat tip to David Parker for pointing me to this development.

Frippery: virtual choir

On this day of all days we may need the frippery more than usual. This time it’s the sixth virtual choir put to­gether by composer and conductor Eric Whitacre (pictured above). His choral piece Sing Gently features 17,572 singers from 129 countries (the credits run to 8 minutes). It is a balm in these polarized and fractious times.