This week we learned that Abbott Laboratories received an FDA Emergency Use Authorization for a faster and cheaper Covid-19 test than anything currently on the market. Technically it’s an antigen test, but detecting the nucleocapsid protein of SARS-CoV-2 will detect actively replicating infection because it’s a key part of the virus’ structure.
Fast and cheap testing is one of the ways to bring travel back to normal. It would allow customers to travel with confidence, knowing that those around them are virus-free. And it would allow destinations to open up, knowing that people shedding the virus weren’t entering.
While some destinations today will allow people to enter or skip quarantine with a recent test, receiving a negative result within three days of travel is no guarantee that the person is negative when they travel. That’s why many destinations won’t take a negative result (which can also be faked), or require quarantine and additional testing on top of a negative result.
Rapid tests at the airport could be used to screen passengers and give confidence that trips aren’t spreading the virus, bringing them into a destination. And yet this breakthrough probably isn’t going to help air travel at all any time soon.
Here’s how the test works:
In this case, a nasal swab is taken, and several drops of solvent are used to put that sample onto the beginning of the absorbing strip inside the card. As it soaks up along the length of the strip, the sample will encounter a zone of antibodies that recognize the Np antigen, and these antibodies are also attached to nanoparticles of gold. This gold-antibody-Np complex is carried along in solution further along the strip until it runs into another antibody zone, one that’s immobilized on the solid support and which will bind the gold-antibody-Np complex molecules tightly. That stops them in their tracks and allows the gold nanoparticles to pile up enough to be visible as a pink or purple line. Along the way, the sample has also crossed a zone containing another soluble gold conjugate species as a control, which gets carried along until it runs into another separate zone of immobilized antibodies specific to it. The presence of a pink control line means that the test has been performed correctly; absence of such a control line means that the whole test has been messed up somehow and needs to be run again.
The federal government announced a deal on Thursday to buy 150 million tests – that’s three months’ capacity – for $750 million. Priorities for testing include school re-opening over air travel.
The manufacturer will begin shipping in September and reach 50 million tests a month in October. It’ll be late December before the government’s monopoly on initial supply ends.
As for accuracy of the test:
- 97.1% sensitivity (2.9% false positives)
- 98.5% specificity (1.5% false negatives)
Nearly 3% of tests could yield a false positive, so in an air travel context that could mean perhaps 20,000 people per day denied boarding despite not having the virus even with current low levels of trael. And by the time this is available we could be close to Covid-19 being manageable in the U.S.
There’s a real chance that Covid-19 could become manageable in the U.S. by the end of the first qurter of 2021, and a great chance it’s manageable in the second quarter. In a few months we should have monoclonal antibodies, though in limited supply and at a high cost, but for many people this could be tantamount to a cure – making as much of a difference or more than a vaccine.
And much of the U.S. will have seen enough infection by then that the virus won’t spread as quickly as it did in the Northeast, and then the Sun Belt, before it becomes more manageable via treatments and vaccines even if the first generation of vaccines is hard to distribute (mRNA vaccines requiring extremely cold temperatures to store, vaccines requiring two doses) and having only limited effectiveness. We may still see another wave in rural areas that haven’t yet seen big spikes in the virus before that though.
My hope – and I’m really optimistic – is that bioscience will make this controllable before people can be reinfected in large numbers and with severity. We won’t be through the crisis worldwide in the first half of 2021 though, because it will take time and expense to scale and distribute vaccines and treatments and because poorer countries may have less access despite efforts to the contrary. And that will have a continued effect on air travel.
The question is if its responsible to be using tests that SHOULD be used for the general public for some people to take trips that aren’t necessary. Nate Silver just posted about how its not SINGLE events that cause us to get the virus, but a combination of multiple events…I know we all want to go to Hawaii/Disney/London/etc…but maybe for the good of the human race we make sure EVERYONE gets tested at HOME first, wipe out the virus, and THEN we can take trips. Using these tests FIRST at the airport isn’t a good use of them. The other thing is I don’t see the false NEGATIVE rate being reported…Lets get this right, and enjoy travel soon, instead of enjoy travel now, and get F***ED.
@Joelfreak – that’s not how viruses work though, we aren’t going to wipe out the virus avoiding it, what large non-island nation in Europe, the Mideast or Africa or the Americas has done that successfully?
And you DO see the false negative rate reported for these tests – right here, in this post.
It’s still problematic. One scenario you didn’t consider…you are cleared to fly to resort destination by passing the test but acquire the virus while at the destination…and then you’re stuck and can’t fly home. That kind of barrier is going to keep people from traveling until the virus is under control…and that kind of control isn’t going to happen for most of the developed world until late next year at the earliest…never mind the 3rd world which will take even longer.
This was questionable technology that was rushed out out in March and the WH just now bought up a ton of it. (great sales job)
Accuracy is determined by combining false negatives with the false positives meaning 2 out of 100pax will be false negative (have active virus) and 3 (+ the traveling unit) get sent home for the false positives. That means 95% accuracy at best. (It’s still better than a temp check).
This test is quick and more accurate than the Chinese strip test but each test costs a lot more than the $5 shown as it’s being subsidized by the Govt. Each cartridge that goes into the testing machine can only be used for 8-10 tests and they supposedly cost about $200 as first reported. The good news is the testing machine is cheap compared to quality hospital lab equipment. So you could buy one for each gate. Sort of like the free razor with $3 replacement blades.
Like the TSA it’s promoted to make you feel more secure knowing most everyone (except those refusing) get tested. Junk science but easy for the desperate WH to sell to the public and to hopefully float the airline industry a few more months. I bet you can buy these machines and cartridges for a dollar on the Govt salvage website in about 3 months. Who care as that will most likely be the next guy’s problem.
@Douglas Swalen – I’ve written extensively on this issue, in fact I may have been the first one to do so in the travel space
Correction only 1 test per cartridge. Our city of 200k received 5 machines and 100 test kits and have not reordered as we test about 500/day. Original WH announcement link below.
https://khn.org/news/trump-touted-abbotts-quick-covid-19-test-hhs-document-shows-only-5500-are-on-way-for-entire-u-s/
@Paul. The Abbott “$5” test that just got emergency approval does not use any machine to process the test or to read the result – it’s not the Abbott ID NOW which is a “rapid” test that requires a machine.
As I understand the approval is only for the test to be given by a “medical” person – perhaps including pharmacists.
I question the “$5” amount. Is that the cost to purchase it from Abbott? What about shipping, storage, the nasal swab, the solvent, fee to the people authorized to perform the test, disposal….seems like $5 is not going to go very far.
This is the Abbott press release detailing the “$5” test just approved:
https://abbott.mediaroom.com/2020-08-26-Abbotts-Fast-5-15-Minute-Easy-to-Use-COVID-19-Antigen-Test-Receives-FDA-Emergency-Use-Authorization-Mobile-App-Displays-Test-Results-to-Help-Our-Return-to-Daily-Life-Ramping-Production-to-50-Million-Tests-a-Month
Thank you Als for pointing out this is the new emergency use authorization test that is using a nasal swabbed card.
I just viewed the CNN interview with Dr. Grupta.
It will not indicate positive for asymptomatic carriers and unknown accuracy if the infection is less than 7 days old. Not enough to get me back on a plane at any cost. Like you I doubt anyone working for the airlines could do this and our medical staff is a little busy right now.
I be more concerned about the false negatives, meaning on a 787, you could still have three people with Covid on the plane with you.
@Gary You are right, you did note that. However, this isn’t going to do ANYTHING to get me traveling again. Nor is it going to restart business travel.
“Nearly 3% of tests could yield a false positive, so in an air travel context that could mean perhaps 20,000 people per day denied boarding despite not having the virus even with current low levels of trael.” Wouldn’t they just simply run another test then to confirm. Seems unlikely you are going to have two false positives in a row if you are indeed negative.
People not doing the maths right on false positives, say 1% of the population has Covid and they fly just as much as the rest of us rather than staying home, so I would say 1% is high. Then on a plane of say 300 people 3 people at the airport might have it, but 97% of them would be caught by the test, so it would result in 1 in c30 flights having a person on board with covid. That’s ridiculously prudent, I expect in reality it would be 1 in a few hundred or a thousand flights, which may still be too risky for you.
However, as my name sake said, I think there is an issue with those who have just got infected as I don’t think the success rate in detection is good (but equally they are less infectious as they aren’t spluttering)
This is an antigen test, NOT a PCR test.
Virtually all countries and airlines that require a covid test require a PCR test.
This does nothing for travel requirements.
@paul – “It will not indicate positive for asymptomatic carriers”
Wth is the point then? It is asymptomatic carriers that are the most important to identify.
@Patti – what’s holding even domestic travel down is confidence, and knowing that everyone else around you was likely to be virus free would help a lot. And internationally requirements are changing all the time, the introduction and availability of new tests at scale that could be administered easily on both departure and arrival could easily change what countries accept.
I recognize that this test is not perfect, but it will be so much better than no test at all for travelers.
I’ve been on two r/t’s recently…one on SWA and the other on DL. Everyone was well-behaved regarding masking, and the flights felt safe. Actually, the gate area was of more concern than the airplane, due to many different persons walking by my seat while I waited to board.
If the $5 test permits us Americans to travel internationally again, I will be so happy!
Everyone is arguing over a test that says a few percent false negatives or positives. Many tests we are relying on now have 30% or more false negatives. So how many are walking around the grocery stores (and other places) thinking they are negative when in fact they have the virus? The test plus a mask would go a long ways to make flights and traveling in general WAY more safe. I was 100% for shutting everything down and I think we didn’t go far enough, or go fast enough. I want travel to be safe again but the reality is people are not going to keep everything shut down forever, people wouldn’t even stay home and act like wearing a mask is some huge violation of their “god given” rights. We need to take whatever steps we can at airports to make travel more safe. The airlines need to band together and get this going, the government is not going to do it.
@Angela or maybe, just maybe, we don’t travel for a while, and let things settle.
It’s not a lack of confidence that’s negatively affecting air travel, it’s a lack of brainpower.
Fast – Cheap – Accurate
Pick 2
Fast and Cheap – Wont be Accurate
NO country has authorized the use of antigen tests for entry to my knowledge.
And there are antigen tests out there already with rapid results.
This isn’t going to boost any travel, foreign or domestic.
The test is intended to be used for patients within seven days of feeling COVID-19 symptoms.
Any doctor who suspects a patient may have COVID-19, based on their exposure history or symptoms, can write a prescription for the test. The test, which needs to be performed by a doctor, nurse, school nurse or occupational health professional, picks up specific proteins made by SARS-CoV-2, the virus behind COVID-19.
@Gary – I you have it backwards. On false positives & negatives.
If the tests are 97.1% sensitivity that means you get (2.9% false NEGATIVES) meaning it accurately identifies an infected person 97.1%, it misses 2.9%.
The specificity talks about identifying those that are NOT infected, so there’s a 1.5% false positive rate. Meaning 1.5% of the time someone getting a POSITIVE is NOT actually infected.
Please look it up if you don’t believe me. This means that this test will 2.9% of the time MISS a positive infection, and falsely return a positive of 1.5% of the time for someone that is Negative.
Gary, excellent article! Your conclusions are correct, but I think Dave is also correct, 97.1% sensitivity means 2.9% False Negatives. That is plenty good enough to make for very safe flights, as long as the test works for asymptotic cases.
The reduction in air travel is more about confidence for leisure travelers but the big gap now is in business travel. Many companies restricted travel and are learning that their businesses are doing just fine without it. Like the commercial real estate business, in particular office buildings, but also apartments and associates businesses in urban areas are learning, people don’t have to commute to work or live in town or the city anymore. These shutdowns, which so many people supported out of excessive fear now have produced the greatest awakening and sea change I’ve seen in quite a while. What people don’t realize is that it’s now no longer about the virus, but an issue of efficient spending or use of our resources.
Air travel will always be here and some downtown offices and apartments too, but the volume will be forever changed or at least until a new generation starts questioning why do we have meetings virtually when we can spend a couple thousand $$ to meet in person….and employees start clamouring for their daily hour long commutes because they are sick of the kids and the dog curled up by their feet!
Testing will only serve to damage the fragile gains airlines are making now. Viruses and mutations will be with us forever and sadly this concept of hiding from the virus has resonated with some. However, as many have come to know staying healthy is more about good nutrition, supplements, consuming anti inflammatory foods and drinks versus inflammatory and common sense practices to ensure hygiene. We realize there is risk and life is not a certainty, but freedom is far more valuable than half baked solutions that introduce new risks to freedom and the businesses that depend upon it.
The title of your post is politically charged…can be keep ideologies OUT please? Lets traveling, or the dream of going back to travel, be an oasis on these polarized political times, shall we?
Now onto this “but the government has other priorities”. I’m childless by choice and while I understand the struggle for many working parents to juggle virtual schooling with their full time jobs, ultimately is their responsibility how they manage since they made a choice to have offspring. Now, having said that, I agree on having these test available first for school attendants. It’s important for the normalization of life in this country to have the kids back to school, their parents fully back to the work force, and a resemblance of normalcy starting to be built from this ground up.
Yes, It bugs me not to be able to travel, Italy and Spain are as much my home as the US, and my time used to be spent between these three countries; I feel uprooted by being root to just one place and I manifest what could very well be diagnosed as withdrawal symptoms, and yet, I think that school testing should go first. The “because I deserve it” is a more insidious virus than COVID-19.