EDITOR, The Tribune.

The response to the COVID-19 pandemic has created a public health and economic crisis leading to psychological suffering and economic pain for all Bahamians. The key to stopping the spread of the SARS-CoV-2 virus– the cause of the COVID-19 disease in humans – is mass testing of every Bahamian to identify those who are contagious and quarantining them until they are no longer contagious. The motto is: test for the virus, isolate infected individuals, repeat.

The problem is that the Bahamas is not doing complete population testing. We are not testing everybody, but only a select portion of a country’s population at any given time, leaving the vast majority of individuals at any given time untested. To compound matters, many of those undiagnosed individuals infected with the COVID-19 virus who are contagious show no symptoms (are asymptomatic). Unaware of their infectious state, they end up infecting other individuals. When too many individuals get infected, and hospital resources are in danger of being overwhelmed, the government’s response has been draconian social and economic lockdowns of both the unhealthy and the healthy. Both the healthy and unhealthy are locked up as without mass testing, the Bahamas government cannot distinguish between the two: everyone is presumed guilty. If only we tested all individuals, we would never need lockdowns, as we would only have to quarantine the infected.

Why don’t nations engage in systematic population testing as selective testing alternating with lockdowns doesn’t work? One reason is the test mandated by government health agencies: the Polymerase chain reaction (PCR). The Polymerase chain reaction (PCR) test is known as the “gold standard” of testing. It can detect SARS-CoV-2 particles in microscopic amounts: a PCR test can usually detect a single molecule of RNA in a microlitre of solution. Unfortunately, PCR tests fail for nation-wide testing for three reasons: PCR tests can take from a day to weeks to get test results when what is needed is a test that can give quickly. PCR tests require specialised and expensive lab equipment that requires specially trained personnel to administer and interpret the test. PCR tests cost from $100 to $300, making frequent testing prohibitively expensive; when what Bahamians need is a cheap test that people can afford to take daily.

What is needed is a COVID-19 test that is easy to administer, like a home pregnancy test. Such a test should be sensitive enough to detect when people have a high viral load — when they are most contagious. It should be affordable enough to be used frequently, i.e., daily. It needs to give immediate results that are easy to interpret, like a pregnancy test.

What I have described sounds like a miracle, doesn’t it? Except that it is not a miracle. Multiple companies – including 3M, E25Bio, Sherlock, and Abbott – have developed such COVID-19 antigen test strips, and they work perfectly for screening purposes. These firms can manufacture them quickly in the billions, and their retail cost is less than $1 per strip test. How do they work? Where the PCR tests look for viral particles and antibody tests look for antibodies in those who have recovered from the virus, antigen tests look for antigens your immune system creates when your body responds to a COVID-19 infection. They can be easily used, at home or work, and don’t require a blood test, but only require a nasal or saliva sample. These little pieces of strips of paper change colour when they detect antigens to the virus. They are an inexpensive and elegant free-market capitalist solution to the population testing problem.

Like a home pregnancy strip, $1 home antigen tests are not as sensitive as a $300 lab test, but they are more than good enough to catch the majority of cases that are being missed. They sacrifice a little sensitivity for massive scalability and are the best option as a home and work screening tool: catching people who otherwise would go untested.

So why aren’t these inexpensive test strips available to the general public for screening purposes? Because central government planners at the FDA are using the police power of the state to prevent $1 test strip producers from selling them for consumer use. Comments Michael Mina, of the Harvard T H Chan School of Public Health on this regulatory problem: “I’m usually not against regulation, but it’s just gotten so extreme here, and it’s truly been hindering every step of the way our ability to test our way out of this virus since February…We could reduce maybe by 90-95% transmission in this country in the next few weeks if everyone could have one of these tests tomorrow.”

One of the regulations stopping the use of over the counter (OTC) tests must be at least 90% sensitive (antigen tests are typically 70-90% sensitive). The government regulator’s argument against lower sensitivity tests completely misses the point. A home test with low sensitivity is better than no home test. Even if the test only catches 50% of the people not caught before, it is an improvement over no test. Right now, the best Bahamians can do at home or work is to take their temperature with a thermometer – which essentially is no test at all. In cases where greater accuracy is required, people can still opt for a PCR test: the two – antigen test strips and PCR tests – are not mutually exclusive alternatives.

Only mass-scale testing will put an end to the need for mass-scale lockdowns permanently. Such testing, in conjunction with other public health measures, will put a severe dent to the spread of the COVID-19 virus, ending the need for mass lockdowns in the Bahamas permanently. These cheap antigen strip tests are available now, and we have nothing to lose but our lockdown chains by using them. Though the US government has prohibited these cheap antigen test strips, there is no reason the Bahamas government must do so. The Bahamas government should repeal all laws banning the sale and use of $1 home COVID-19 tests, and take those measures necessary for Bahamians to get access to these test strips. Laissez-faire COVID-19 home testing!

•This article is an abbreviated version of a ten-page article that first appeared in Capitalism Magazine. If you would like the longer, referenced copy of this article, you can contact the author at mark@bahamas2000.com.

MARK DA CUNHA

Grand Bahama,

September 23, 2020.