My nerdy self was beyond delighted mid-June when news broke of the University of Illinois' fucking amazing transformation of the COVID-19 PCR test. No nose swab, no RNA purification. You drool into a tube, cook the saliva for 30 minutes, shake it up, add sauce, and then it's straight to the PCR machines, baby. I was blown away.
And it works. Knowing where the virus is allowed the U of I to clamp down quickly and effectively on an enormous outbreak. It sucked that a couple of super spreader parties and students trying to escape isolation were all that it took to spike a whole campus, but it was also awesome to watch those numbers come right back down when the campus pulled together.
So, why don't we have this more widely in our community? Or more in our public schools, which could really, really use it? I guess a lot of it is about the money.
Running this test is not resource free. The U of I has stated that they are fronting $6 million for two semesters' worth of tests on campus. My back-of-the-envelope calculations set that to mean $10-$15 per test, which jives with their $10 per test original estimate. That is not "tax payer" money by the way. Due to decades of budget cuts (with a large serving of state level budget incompetence), the vast majority of the U of I's monetary resources do not come from taxes (I didn't know that before pandemic). That $6 million is a pure loss leader that the University can't make up, and if I were them, I would be terrified that it will be an ongoing operational problem for at least four years.
Now the issue is that U of I's SHIELD team wishes to pull a Broad Institute move and set the price point at $20-$30 per test to recoup a bit of those costs, which, if you a profit-seeking capitalist, seems broadly magnanimous compared to the ridiculous price of $130 per test that Labcorp and Quest have been charging both tax payers (via the CARES act) and those of us held hostage by health insurance.
Yet we all know that $20-$30 per test sounds laughably insulting to public school districts that often have to feed kids on less than $5 per day. The feeding of small humans is not a respected workflow, but it's just as complicated as this very lab test and actually quite similar.
Can we rise above emotions and get creative about working together for mutual benefit? We can control costs together. We know that the U of I needs to recoup/minimize losses while our public schools need to remain intact and safe for the most traditionally underserved parts of our community. Here are some initial strategies to consider:
- Start pooling tests. If Rwanda can do it, so can we. Pooling drives costs down — possibly to the $3-$5 per test level. This is more MacGyvering, and I know there are people who are totally up for it, not just at the U of I, but across multiple state labs. We can even talk about "pooling" by testing wastewater, so that the more expensive saliva testing resources can be redirected elsewhere.
- Consider piloting limited event testing, for example, starting with non-negotiable state-mandated events such as the SAT, a requirement for high school graduation. A bunch of kids crammed in together sweating it out for three hours could be really safe, or a total superspreader event. You pick. Event testing would a good starting point for working out the unique public schools logistics, and making the logistics go is infinitely important in public health.
- Increase the market share of the Safer Illinois app throughout the community. Testing alone does not work — it needs to be part of an ecosystem of information and action — meaning contact tracing and quarantine support. The best way we have to support contact tracing right now is the Safer Illinois app developed by UIUC. It's free, it's mobile. Download it, people! Safer Illinois is duking it out right now for market share. If it gets an early dominant market share throughout Illinois, with proven success (you need strong contact tracing backup for this), the U of I will gain not only academic kudos, but also potential revenue from other interested state governments, so maybe it won't need to charge the poor public schools so much. Market share goes to first movers, and the longer you mess around with price discussions, the less market share potential you're going to have. If public schools can publicize Safer Illinois, quickly, widely, it's a win-win for all involved.
- Legislation. Work together on a state law to forbid payment for any infectious disease test needed for contact tracing unless the results are entered into the public health system within 16 hours of sampling. Empowering insurance companies to withhold payment unless there is a fast turnaround time would level the playing field for labs like the U of I that offer fast turnaround time, high quality, and lower priced testing. Bloated centralized giants like Labcorp and Quest would be better incentivized to return results in a timely manner and/or to switch to a better workflow, like saliva testing. That could involve paying the U of I consulting fees to help set it up.
- Growing the "green zone" of health around our immediate community, then our county, and then our state is in the best long-term economic interest of the U of I. The University is porous to its surrounding community. It thrives when the community thrives, especially during a pandemic. We have to keep reminding them of this, while they are desperately trying to stay solvent in the short run, like everyone else. Humans are bad at balancing both short and long term goals.
So let's keep talking, my friends.
Anita Ung has an MD and Masters in Public Health from Johns Hopkins University, and worked as an internal medicine physician in Baltimore and Boston in hospitals that served structurally disadvantaged populations. She was the Quality Chief at Atrius, a physician-led organization with about 400 thousand primary care patients, and was an adjunct professor with the UIC College of Medicine.