Testing protocols

Drive-through testing

In drive-through testing, the person undergoing testing remains in a vehicle while a healthcare professional approaches the vehicle and obtains a sample, all while taking appropriate precautions such as wearing personal protective equipment (PPE). Drive-through centers helped South Korea accelerate its testing program.

Home collection

In Hong Kong test subjects can stay home and receive a specimen tube. They spit into it, return it and later get the result.

Pooled testing

In Israel, researchers at Technion and Rambam Hospital developed a method for testing samples from 64 patients simultaneously, by pooling the samples and only testing further if the combined sample was positive. Pool testing was then adopted in Israel, Germany, Ghana South Korea, Nebraska, China and the Indian states of Uttar Pradesh, West Bengal, Punjab, Chhattisgarh and Maharashtra.

Open source, multiplexed designs released by Origami Assays can test as many as 1122 patient samples using only 93 assays. These balanced designs can be run in small laboratories without robotic liquid handlers.

Multi-tiered testing

One study proposed a rapid immune response assay as a screening test, with a confirmatory nucleic acid test for diagnosis, followed by a rapid antibody test to determine course of action and assess population exposure/herd immunity.

Required volume

Required testing levels are a function of disease spread. The more the cases, the more tests are needed to manage the outbreak. COVID-19 tends to grow exponentially at the beginning of an outbreak, meaning that the number of required tests initially also grows exponentially. If properly targeted testing grows more rapidly than cases, it can be contained.

WHO recommends increasing testing until fewer than 10% are positive in any given jurisdiction.

United States

Economist Paul Romer reported that the US has the technical capacity to scale up to 20 million tests per day, which is his estimate of the scale needed to fully remobilize the economy. The Edmond J. Safra Center for Ethics estimated on 4 April that this capacity could be available by late July. Romer pointed to single-molecule real-time sequencing equipment from Pacific Biosciences and to the Ion Torrent Next-Generation Sequencing equipment from ThermoFisher Scientific. According to Romer, "Recent research papers suggest that any one of these has the potential to scale up to millions of tests per day." This plan requires removing regulatory hurdles. Romer estimated that $100 billion would cover the costs.

Romer also claimed that high test accuracy is not required if tests are administered frequently enough. He ran model simulations in which 7% of the population is tested every day using a test with a 20% false negative rate and a 1% false positive rate. The average person would be tested roughly every two weeks. Those who tested positive would go into quarantine. Romer's simulation indicated that the fraction of the population that is infected at any given time (known as the attack rate) peaks reaches roughly 8% in about thirty days before gradually declining, in most runs reaching zero at 500 days, with cumulative prevalence remaining below 20%.