Rapid COVID saliva test - important for cruising?

[Fouremco]

1 hour ago, UnorigionalName said:

But with widespread mask usage, and widespread saliva testing, even if the testing isn't perfect, it may decrease the R0 by a large amount, and let you "spend" that decrease somewhere else.  Like say school reopening.  Or more in person businesses. 

 

The problem with cruises is that once you let someone slip through, it becomes a HUGE problem.

I have no background in epidemiology, vaccine development or testing for a virus, so perhaps you could explain to me how with saliva testing it will be OK to reopen schools but not to restart cruises? 

[hcat]

4 hours ago, sgmn said:

Maybe the solution is for cruises only from people's home ports or where they can drive to? At least until a vacine is developed and most people have some level of immunity 

That's our eventual plan,...

[hcat]

44 minutes ago, Fouremco said:

I have no background in epidemiology, vaccine development or testing for a virus, so perhaps you could explain to me how with saliva testing it will be OK to reopen schools but not to restart cruises? 

Schools are  usually near home or a driveable distance away.

All of it is an iffy gamble...remains to be seen.

[UnorigionalName]

49 minutes ago, Fouremco said:

I have no background in epidemiology, vaccine development or testing for a virus, so perhaps you could explain to me how with saliva testing it will be OK to reopen schools but not to restart cruises? 

 

Because they are completely different scenarios.  

 

As illustration, let me make some baseless assumptions and random numbers to explain.

 

Say the tests are 70% accurate at detecting when someone is infections, and say people are conscientious and when they are tested positive they go quarantine, and only infect a few people, like half as much as usually.  So in this setting the test will prevent 35% of infections, not great, but not bad.  So let's say re-opening schools increases infections by 20%, and opening in person retail with masks increase infections by 15%.  So with the universal testing, you can balance these out and return to some form of economic activity while keeping R0 <1.  Notice these are all percentages, and the actual level of current disease doesn't matter.

 

Cruise lines are completely different.  One infected ship and it's like all over.  As the recent experience with Norway and even at the beginning of the pandemic showed, the general population will not put up with plague ships for leisure.  It doesn't matter how high of a risk people on this board are willing to put the greater community in order to enjoy their favorite pastime, but the general population will not put up with COVID on cruises so far.

 

So let's say the current infection rate in the population is 0.1%, so on a 4000 pax ship that's 4 people per ship.  Let's say the half symptomatic people are easily excluded, that's 2 per ship.  Let's say the test is 70% sensitive, that's still 0.6 people per ship, or 3 every 5 sailings.  Way too high.  Even if the prevalence gets cut down to 0.01%, 3 every 50 sailings is still way too many given that if one of those people is a superspreader, 300 people end up getting COVID.

Edited August 17, 2020 by UnorigionalName

[markeb]

11 minutes ago, Fouremco said:

I have no background in epidemiology, vaccine development or testing for a virus, so perhaps you could explain to me how with saliva testing it will be OK to reopen schools but not to restart cruises? 

 

Neither is probably simple.

 

On land, in those environments,  you theoretically can test, isolate positives, and quarantine contacts. As transmission goes down from those efforts, you should have less and less positives that require that activity. Without controls, such as social distancing, masks, testing, isolation, contact tracing, and quarantine, each positive SARS-CoV-2 test would represent 2-3 new cases with normal mixing. If you drive transmission low enough with those controls, you should be able to drive that below 2, and maybe even approach 1 (R value). Below 1 means no sustained transmission, not no transmission. Right now, a positive test in a school would probably shut the school down; they're just not set up well to cohort students and staff to be able to quarantine a smaller cohort. That will likely change going forward, so that a positive test might only result in quarantining a classroom, including the teachers and staff. That likely will be an ongoing effort over the entire school year, manageable by having an essentially fixed cohort (think of a classroom unit), and able to accept some risk of false negatives, and accept false positives if those occur. And a classroom doesn't usually involve international travel. And none of that really addresses highly susceptible individuals. That's all population based.

 

A cruise ship only has a fixed cohort for a limited period of time, and it's generally less than the incubation period of the virus. Even with other controls, mixing of potentially infectious and susceptible populations will probably stay pretty homogenous, and not at all like most social mixing on land; one infectious individual will likely mix with a lot of susceptible individuals. More like a mid-size concert venue, but with more mixing. And the same impact of activities that spread respiratory secretions (American Pie singalong, for instance). The bar was set in the spring at essentially "no positive tests", and no admission into other countries with a positive test. I would argue you're going to have to drive the prevalence of positive down to the low single digits, with that being reflected in the population boarding a ship, for a test, isolation, and quarantine strategy to work on a ship, and if you're going to isolate and quarantine, you more or less need 14 days after your last port call, and you'll need to work out a testing strategy for that as well (test 2 days after last port call, for instance, and 2 days later?). From the standpoint of getting the ship back in port, until the whole world is dirty, or the whole world is clean, or nations just change their mind, you've got to sail clean to get home.

 

And people, like it or not, are stupid. Google the story of the two Cleveland Indian pitchers, two of their five starters, who are almost certainly multi-millionaires in MLB, who decided to break curfew and protocol and go out with friends for dinner in Chicago last week. They're now packing their own bags and carrying their own toiletries in what would have been the minor leagues any other year, and if Cleveland keeps them there long enough they could revert to a minor league contract (10's of thousands of dollars per year instead of 10's to 100's of millions) and lose their qualifying service year for retirement, free agency, etc. 

 

The NBA used the saliva test in an established bubble to I believe establish the bubble, and to maintain it. If I recall correctly, they took two weeks with repeated testing to establish the bubble, and then they tested fairly constantly to maintain it. From looking at the data NCPL posted yesterday, it correlates very well with the nasal swab, and the actually test methodology is PCR. It's easier to collect, and they've worked out a cheap extraction methodology. It's still going to miss some version of the same people the swab misses who aren't yet shedding. If everything works out so that's as low as 1%, that's still potentially 40 initial cases out of 4000 passengers, and with mixing on the ship, you could easily have the 2-3 new cases per initial case, so that's 80-120 without a superspreader event.

[hcat]

Grandson's  daycare has smaller groups right now and no mixing with  children in other groups..  They take each child's temp upon arrival and escort each child  one by one to their group.  Social distancing is followed.  Hope it works.

[npcl]

4 hours ago, markeb said:

 

Neither is probably simple.

 

On land, in those environments,  you theoretically can test, isolate positives, and quarantine contacts. As transmission goes down from those efforts, you should have less and less positives that require that activity. Without controls, such as social distancing, masks, testing, isolation, contact tracing, and quarantine, each positive SARS-CoV-2 test would represent 2-3 new cases with normal mixing. If you drive transmission low enough with those controls, you should be able to drive that below 2, and maybe even approach 1 (R value). Below 1 means no sustained transmission, not no transmission. Right now, a positive test in a school would probably shut the school down; they're just not set up well to cohort students and staff to be able to quarantine a smaller cohort. That will likely change going forward, so that a positive test might only result in quarantining a classroom, including the teachers and staff. That likely will be an ongoing effort over the entire school year, manageable by having an essentially fixed cohort (think of a classroom unit), and able to accept some risk of false negatives, and accept false positives if those occur. And a classroom doesn't usually involve international travel. And none of that really addresses highly susceptible individuals. That's all population based.

 

A cruise ship only has a fixed cohort for a limited period of time, and it's generally less than the incubation period of the virus. Even with other controls, mixing of potentially infectious and susceptible populations will probably stay pretty homogenous, and not at all like most social mixing on land; one infectious individual will likely mix with a lot of susceptible individuals. More like a mid-size concert venue, but with more mixing. And the same impact of activities that spread respiratory secretions (American Pie singalong, for instance). The bar was set in the spring at essentially "no positive tests", and no admission into other countries with a positive test. I would argue you're going to have to drive the prevalence of positive down to the low single digits, with that being reflected in the population boarding a ship, for a test, isolation, and quarantine strategy to work on a ship, and if you're going to isolate and quarantine, you more or less need 14 days after your last port call, and you'll need to work out a testing strategy for that as well (test 2 days after last port call, for instance, and 2 days later?). From the standpoint of getting the ship back in port, until the whole world is dirty, or the whole world is clean, or nations just change their mind, you've got to sail clean to get home.

 

And people, like it or not, are stupid. Google the story of the two Cleveland Indian pitchers, two of their five starters, who are almost certainly multi-millionaires in MLB, who decided to break curfew and protocol and go out with friends for dinner in Chicago last week. They're now packing their own bags and carrying their own toiletries in what would have been the minor leagues any other year, and if Cleveland keeps them there long enough they could revert to a minor league contract (10's of thousands of dollars per year instead of 10's to 100's of millions) and lose their qualifying service year for retirement, free agency, etc. 

 

The NBA used the saliva test in an established bubble to I believe establish the bubble, and to maintain it. If I recall correctly, they took two weeks with repeated testing to establish the bubble, and then they tested fairly constantly to maintain it. From looking at the data NCPL posted yesterday, it correlates very well with the nasal swab, and the actually test methodology is PCR. It's easier to collect, and they've worked out a cheap extraction methodology. It's still going to miss some version of the same people the swab misses who aren't yet shedding. If everything works out so that's as low as 1%, that's still potentially 40 initial cases out of 4000 passengers, and with mixing on the ship, you could easily have the 2-3 new cases per initial case, so that's 80-120 without a superspreader event.

I would differ with you in one area concerning risk. If you detect no positive cases out of the 4000 than the risk of have 40 false positives slip through would be extremely low. 

 

When you test a group the number of positives, will tell you the potential number of false negatives.  Out of your 4000 passenger hypothetical case if 10% of the populace was actively infected and you detected 400 positives, in your scenario you are likely to have 4 false negatives slip through.  IF you looked at the US today around 2.4 million confirmed actives cases (assume up to 10X under count) would give used a range of 2.4 to 24 million active  infections that gives us a range between 7 to 70 per thousand or roughly 28 to 280 out of your 4000 passenger cruise.  Using the best PCR rate of 20% one would expect to get some where between 5 to 55 false negatives slipping on board with the number of positives 23  to 235 positive results.

 

Bottom line is if you get any number of positives when testing at the port the odds are some slipped through. But the risk is determined by the number of active cases in the population from which the passengers have self selected.

 

In Germany, Norway and the UK the risk is much lower because the actives cases are 1/10 to 1/20 that of the US per 100,000 population.

[markeb]

37 minutes ago, npcl said:

Bottom line is if you get any number of positives when testing at the port the odds are some slipped through. But the risk is determined by the number of active cases in the population from which the passengers have self selected.

 

I'll buy that. I think we both agree it's not 0, but a reflection of the prevalence in the population (or a representative population similar to those cruising) is going to be a better point estimate. And it keeps you from sailing clean, which impacts everything downrange, and may actually produce some sick passengers onboard.

[npcl]

52 minutes ago, markeb said:

 

I'll buy that. I think we both agree it's not 0, but a reflection of the prevalence in the population (or a representative population similar to those cruising) is going to be a better point estimate. And it keeps you from sailing clean, which impacts everything downrange, and may actually produce some sick passengers onboard.

I agree

[npcl]

53 minutes ago, markeb said:

 

I'll buy that. I think we both agree it's not 0, but a reflection of the prevalence in the population (or a representative population similar to those cruising) is going to be a better point estimate. And it keeps you from sailing clean, which impacts everything downrange, and may actually produce some sick passengers onboard.

Of course you can always do like the NBA, do a saliva test every day for every passenger.  In addition to the gratuity, you could have a $15 per day test fee.

[markeb]

1 minute ago, npcl said:

Of course you can always do like the NBA, do a saliva test every day for every passenger.  In addition to the gratuity, you could have a $15 per day test fee.

 

But you need the bubble for that to work! And that took time to establish. And a lot of rules. MLB doesn't  have a bubble, and see the comment above about the Indians...

[K.T.B.]

I'm ok with it.  That, along with a vaccine and having to wear masks in highly populated areas are things I'm willing to do to cruise again.

[baldilocks]

9 hours ago, TLG40 said:

https://sports.yahoo.com/the-nba-and-yale-just-landed-the-covid-testing-breakthrough-the-nfl-and-everyone-else-in-the-us-has-been-hoping-for-183335566.html?guce_referrer=aHR0cHM6Ly93d3cueWFob28uY29tLw&guce_referrer_sig=AQAAABIh6_mgLPQY3ql7xtrQI8Yo3f3x3onLSNhMECpydWEmTq3b19AQndsgjMlmrKGGrw1LrdM7es0pF4i8rz1x9yyh1-8u6w1oalDwI0t8apQHQn1sTiFaSMLEIxOrqTMH0-3TMb_JcxCRPcyuLiDrypvveeRP1neXX59LCca1TcXh

 

 

They are using this test to bring kids back on campus--Penn State sent a test to every student. I hope it is accurate!

 

I also love this: "Developed by Yale University and jointly funded by the NBA and NBA Players Association" 

 

Great work putting up the money NBA & NBA players association! 

 

A second thank you to the NBA. If this helps us get back to cruising. I'm all for it.

[Captain Rob]

Perhaps this 15 minute blood test is the answer.

 

https://www.surescreen.com/products/covid-19-coronavirus-rapid-test-cassette

[ABoatNerd]

Well,  from my perspective any test at the dock  = risk of being left behind.

 

Test positive rightly or wrongly due to inaccuracy, what happens? What happens to all your expenses?

 

Not interested. Will not cruise with this check in risk.

 

Will cruise only when a proper functioning vaccine is widely used. 

[markeb]

56 minutes ago, Captain Rob said:

Perhaps this 15 minute blood test is the answer.

 

https://www.surescreen.com/products/covid-19-coronavirus-rapid-test-cassette

 

Not an answer, but probably another tool.

 

Caveat from the company's information:

 

Do you have a confirmation lab test for Coronavirus to confirm positive samples?

This screening test is designed to be used alongside a robust screening protocol with laboratory confirmations. We would recommend you work within your healthcare institution to ensure the correct protocols are being followed when using this product.

 

There's a pre publication not yet peer reviewed paper out there reviewing several of these devices. They rate this one pretty high, but it's really high sensitivity and specificity, like the others, are from patients somewhere around 20 days post onset of symptoms. Those are people who generally should be screened out on their medical questionnaires or never should have travelled to the port.

 

Brief immunology 101: Shortly after infection with a new pathogen (variable on re-exposure once immune), you see an increase in IgM. That's a good indication of active infection. As the infection continues, IgG starts to increase and become the predominant antibody component in subacute to chronic infection, and stays for a variable period. IgM also drops and becomes undetectable on some variable time period. Finding IgG alone on a single specimen, especially a qualitative screening test, only indicates past infection. Increasing IgG on multiple quantitative tests is usually a good indication of active infection, but your PCR should be positive for SARS-CoV-2 by then as well.

 

So, helpful, maybe. Useful in the clinical and public health settings it was designed for. Screening for boarding, not so sure.

[TeeRick]

18 hours ago, UnorigionalName said:

 

No, it will allow for reopening of much of the economy but not cruising.  The issue is its poor sensitivity.

 

The epidemiological idea behind it is that lets say base R0 ~ 3.  The goal is to get R0 < 1, so that you have decreasing number of cases.  All the different policies that the governments are trying to do will decrease this base R0.  Right now the only thing that really gets R0 < 1 seems to be a massive shutdown.  But with widespread mask usage, and widespread saliva testing, even if the testing isn't perfect, it may decrease the R0 by a large amount, and let you "spend" that decrease somewhere else.  Like say school reopening.  Or more in person businesses. 

 

The problem with cruises is that once you let someone slip through, it becomes a HUGE problem.  One case on a week long cruise = 300 infected.  So if the test is only like 70% sensitive, then how low does the population incidence have to be before it's safe to cruise with 5000+ pax ships so not one person will have the virus?  I don't think it's happening without a vaccine.

 

I can see it used in conjunction with a vaccine in the early days to start up a little quicker while not everyone is vaccinated. Or if there are issues with vaccine efficacy there may be a role. 

I understand your overall point.  But where did you find that the saliva test has low sensitivity (70%) and what does that mean anyway?  I'm just trying to understand.  The authors from Yale published the study.  Test accuracy is about 94% for positives.  It is an RNA-PCR test and so it is high sensitivity.  Am I missing something?  Thanks!

[markeb]

29 minutes ago, TeeRick said:

I understand your overall point.  But where did you find that the saliva test has low sensitivity (70%) and what does that mean anyway?  I'm just trying to understand.  The authors from Yale published the study.  Test accuracy is about 94% for positives.  It is an RNA-PCR test and so it is high sensitivity.  Am I missing something?  Thanks!

 

Device sensitivity is highly sensitive. System sensitivity, including collecting a specimen with virus, is limited by early viral shedding.

 

My personal pet peeve when the laboratorians report sensitivity and specificity on the device, without accounting for whether the patient (and we're screening here, so they're not sick) is at a state of infection when the target should be present. It doesn't matter if the device finds something correctly 100% of the time if it's only there 50% of the time even if the person is infected. Those are diagnostically false negatives, even though the device correctly said no RNA, in this case, found.

/End rant.

Edited August 18, 2020 by markeb

[TeeRick]

6 minutes ago, markeb said:

 

Device sensitivity is highly sensitive. System sensitivity, including collecting a specimen with virus, is limited by early viral shedding.

 

My personal pet peeve when the laboratorians report sensitivity and specificity on the device, without accounting for whether the patient (and we're screening here, so there not sick) is at a state of infection when the target should be present. It doesn't matter if the device finds something correctly 100% of the time if it's only there 50% of the time even if the person is infected. Those are diagnostically false negatives, even though the device correctly said no RNA, in this case, found.

/End rant.

thank you!

[UnorigionalName]

5 hours ago, TeeRick said:

I understand your overall point.  But where did you find that the saliva test has low sensitivity (70%) and what does that mean anyway?  I'm just trying to understand.  The authors from Yale published the study.  Test accuracy is about 94% for positives.  It is an RNA-PCR test and so it is high sensitivity.  Am I missing something?  Thanks!

 

Yeah, mostly what @markeb said.  Just using an illustrative random %. 

 

I have no idea about the actual accuracy.  I haven't been following the new tests as they come out actually, there are way too many these days, lol.  I am a little skeptical about the real world performance of even the best laboratory tests.  I hear about a lot of presumptive COVID cases where they have a hard time showing positivity.  There's just all sorts of variables before that RNA gets into the tube, where then all the tests perform fabulously well.

[Arizona Wildcat]

The new tests are great.  The problems in no particular order are:

 

Cruisers - especially NAmerica - tend to be older and have underlying conditions. Especially obesity and diabetes.

 

Travelling from all over to board involves air and land travel, restaurants etc.  At add to risk.

 

How many cruisers would accept wearing masks and other restrictions vs. travel in their home area?

 

Last, you get to testing with false positives and the unacceptable false negatives.  A 14 day TA with 8 or 10 infected would create a disaster with disembarking.  Anyone remember last March?

 

When will travel closures go away?  Can ships make port calls?  Restricted tours only?

 

Cannot see how anything remotely normal cruising happens from the US or Canada without a vaccine.

[npcl]

4 minutes ago, Arizona Wildcat said:

The new tests are great.  The problems in no particular order are:

 

Cruisers - especially NAmerica - tend to be older and have underlying conditions. Especially obesity and diabetes.

 

Travelling from all over to board involves air and land travel, restaurants etc.  At add to risk.

 

How many cruisers would accept wearing masks and other restrictions vs. travel in their home area?

 

Last, you get to testing with false positives and the unacceptable false negatives.  A 14 day TA with 8 or 10 infected would create a disaster with disembarking.  Anyone remember last March?

 

When will travel closures go away?  Can ships make port calls?  Restricted tours only?

 

Cannot see how anything remotely normal cruising happens from the US or Canada without a vaccine.

I would differ in one aspect.  If the US were to get its case counts down to the level of Germany or Norway. Then with some combination of screening, together with proper protocols on board, including reduced capacity to the 50% level or less.  I could see cruising in the US starting back up. At that level the odds of a ill individual would be 1 per 10,000 or 10 cruises at a 1000 per cruise level.  With screening, even with the false negative rate,  you get the odds of someone getting through to 1 in 30-40,000.  If you designed a test protocol where someone provides a mail in sample 5 days before the cruise, then gets tested at the pier, then gets tested again onboard at 5 days. (3 tests at $15 per passenger = $45 )You would increase the odds even further and identify if anyone did get on board to limit damage quickly.  OF course if they did get a positive on board that ship and crew would be pretty much out of use for an extended period based upon the lines experience with COVID during the shutdown (Cases among crew 4 months after passenger departure)

 

Not perfect but doable from a risk vs benefit question.

 

I suspect the cruise lines will have more problem getting a virus free crew on board than risk from passengers if the US can get the case numbers down that low.

 

Of course the question is can the US reach that level of infection without a vaccine.

 

 

[Arizona Wildcat]

28 minutes ago, npcl said:

I would differ in one aspect.  If the US were to get its case counts down to the level of Germany or Norway. Then with some combination of screening, together with proper protocols on board, including reduced capacity to the 50% level or less.  I could see cruising in the US starting back up. At that level the odds of a ill individual would be 1 per 10,000 or 10 cruises at a 1000 per cruise level.  With screening, even with the false negative rate,  you get the odds of someone getting through to 1 in 30-40,000.  If you designed a test protocol where someone provides a mail in sample 5 days before the cruise, then gets tested at the pier, then gets tested again onboard at 5 days. (3 tests at $15 per passenger = $45 )You would increase the odds even further and identify if anyone did get on board to limit damage quickly.  OF course if they did get a positive on board that ship and crew would be pretty much out of use for an extended period based upon the lines experience with COVID during the shutdown (Cases among crew 4 months after passenger departure)

 

Not perfect but doable from a risk vs benefit question.

 

I suspect the cruise lines will have more problem getting a virus free crew on board than risk from passengers if the US can get the case numbers down that low.

 

Of course the question is can the US reach that level of infection without a vaccine.

 

 

To expand a bit more - COVID cases have shown no decrease in numbers.  Worldwide there are continued cases. Millions infected in South America and an outbreak in NZ after weeks with closed borders and no cases.  No Europe is having more outbreaks and closed borders.

Cruising is a great leisure activity.  My entire family loves to cruise, but without an effective vaccine we will wait.  Am guessing many others will do the same.  Sadly Americans in particular are not good at following directions.  Groups of several hundred in Utah campgrounds, same on Florida beaches and Arizona bars.  

The problem is a single case of COVID and a ship is shut down for weeks and we have the fiasco from March all over again.  Is zero cases possible today?  With an effective vaccine of say 60% effective?  With tests available today?

[npcl]

1 hour ago, Arizona Wildcat said:

To expand a bit more - COVID cases have shown no decrease in numbers.  Worldwide there are continued cases. Millions infected in South America and an outbreak in NZ after weeks with closed borders and no cases.  No Europe is having more outbreaks and closed borders.

Cruising is a great leisure activity.  My entire family loves to cruise, but without an effective vaccine we will wait.  Am guessing many others will do the same.  Sadly Americans in particular are not good at following directions.  Groups of several hundred in Utah campgrounds, same on Florida beaches and Arizona bars.  

The problem is a single case of COVID and a ship is shut down for weeks and we have the fiasco from March all over again.  Is zero cases possible today?  With an effective vaccine of say 60% effective?  With tests available today?

Well the issues with the cruises in Europe have so far been largely due to crew bringing the infection with them, not passengers bringing it on board.  Lets see how long the cruises out of Germany go before they have a passenger case.  The numbers indicate that even with out testing each passenger at their current passenger load the odds indicate that they sould be able to go at least 10 cruises before encountering an issue.  With 3 ships running short cruises they might already be over that number.

 

I would say even with a vaccine, tests, and every other tool you will not reach zero (when you consider a world wide passenger base) for several years, if ever.  Take polio for example, a much lower incidence, an illness that the population embraced a vaccine for it.  A illness that was considered to be a major scourge. One with only an incidence of 40,000 cases or so.  Yet once the vaccine was available there were still 3000 cases in 1960, 3 years after the introduction of the vaccine.  Was not considered to be eliminated in the US until the 70's.

 

Zero cases may not be possible for many years.  Getting the number way done to a reasonable risk/benefit range is certainly possible.

[cangelmd]

9 hours ago, markeb said:

 

Device sensitivity is highly sensitive. System sensitivity, including collecting a specimen with virus, is limited by early viral shedding.

 

My personal pet peeve when the laboratorians report sensitivity and specificity on the device, without accounting for whether the patient (and we're screening here, so they're not sick) is at a state of infection when the target should be present. It doesn't matter if the device finds something correctly 100% of the time if it's only there 50% of the time even if the person is infected. Those are diagnostically false negatives, even though the device correctly said no RNA, in this case, found.

/End rant.

I’ve been following this news since Sunday with professional interest.

As someone pointed out, this is not really a new test, it is a new collection method coupled with a treatment step that removes some of the more time consuming, cumbersome parts of the test. Also it is open source so labs can adapt to their in-house PCR platform.

I thought the Yale group was working on another, even more rapid cheap test, possibly an antigen test, for daily use at home.

 

Wouldnt frequent repeat testing  improve case finding and reduce transmission? I know cruising will be different because it isn’t as vital as going to school or work, but it seems to me that a negative PCR on embarkation, or within 48 hours, coupled with daily antigen testing, masking, social distancing and improved handwashing, would provide a fairly safe environment to restart cruising. Yes, there are still questions, especially what happens when someone tests positive, but I think it might work.

Debbie Downer statement, though, I’m not sure the CDC will let them even try until the rate is under 10%, maybe 5%.