
Ten-Minute Coronavirus Test for $1 - montalbano
https://www.bloomberg.com/news/articles/2020-03-16/ten-minute-coronavirus-test-could-be-game-changer-for-africa
======
salimmadjd
From their website [0] my guess is their test is ELISA [1] based or similar
method of detecting if the human body has had an immune reaction to the virus
in the amount that is detectable. Where as the more expensive test is PCR
based [2] that requires the heating-cooling cycles and machines to do it.

The PCR-based test basically take the RNA of the virus converts it to DNA and
then doubles the amount of DNA every heating cycle. Assuming we are talking
about real-time PCR the PCR cycle of double is what takes time.

I have not seen the data on the incubation period and the immune response, to
know if these immune detection tests will be able to provide early detection
for asymptomatic case . It's probably for symptomatic cases and wanted to
ensure it's not flu or another infection and it's COVID-19. This is not to say
the test is useless. It actually great inexpensive way of testing the
population with symptoms and using more expensive and timely test for early
detection. Reducing the overall burden.

worth mentioning are other initiatives that are focusing on cheaper and faster
PCR process (though with potential of higher false negative and positive
results) [3]

[0][https://mologic.co.uk](https://mologic.co.uk)

[1][https://en.wikipedia.org/wiki/ELISA](https://en.wikipedia.org/wiki/ELISA)

[2] [https://en.wikipedia.org/wiki/Real-
time_polymerase_chain_rea...](https://en.wikipedia.org/wiki/Real-
time_polymerase_chain_reaction)

[3]
[https://twitter.com/JMRothberg/status/1238115465467133959](https://twitter.com/JMRothberg/status/1238115465467133959)

~~~
joshuamcginnis
Five days ago, it was reported that a German biotech company had already
produced 4 million tests.[0]

"The tests use what’s called the polymerase chain reaction, a diagnostic
method recommended by the WHO that amplifies the virus’s genetic code so it
can be detected before the onset of symptoms. The kit comes with two vials: a
primer to help detect an infection, and a synthetically engineered piece of
the virus, which labs use to produce a surefire positive match to ensure their
machines are working correctly. A lab technician combines these ingredients
with a patient’s mucus sample—usually from a throat or nasal swab—and results
are usually available in a few hours."

Coincidentally, I recently discovered the burgeoning biohacking scene in which
many folks are already using affordable PCR thermocyclers in their home labs
to do DNA amplification and crispr-cas experiments. I do fungal sequencing for
phylogeny myself.

Given the simplicity of the testing process using PCR, why does it seem like
the US is moving so slowly with getting tests in peoples hands? Is it the
primer or control virus synthesis? Is it the manufacturing process? Is it red
tape? If so, which specifically? Is it poor communication? Is it a confluence
of factors?

Why isn't every local university or lab working together to at the least, copy
the Germans protocol and get to work on manufacturing ASAP? Why isn't there a
line of people outside these labs ready to drop-off their sample and get the
results online? Where is the American version of the aforementioned biotech
startup?

This epidemic and the general response has only reinforced my belief in the
future of citizen science and the widespread accessibility of indie biohacking
tools and methodologies. There are just too many misaligned incentives in
pharma research, leaving huge gaps in the ability to bring new tests and drugs
to the market. Look no further than the antibiotic resistant drug problem.

[0][https://www.msn.com/en-us/finance/companies/a-berlin-
biotech...](https://www.msn.com/en-us/finance/companies/a-berlin-biotech-
company-got-a-head-start-on-coronavirus-tests/ar-BB114rEO)

~~~
hcknwscommenter
As far as I can tell, and admittedly this is conjecture based on piecing
together a bunch of off-hand comments by official spokespersons and a few
industry insiders I talk to regularly, it's because the U.S. decided that
everyone needs to use the same exact test. There is some validity to that
approach in that it makes the data a lot better for comparison tracking. But,
they compounded that somewhat defensible decision to require that everyone
uses the same exact test kit. This turned into a disaster when the chosen
supplier couldn't produce the reagents in the required time/amount.

~~~
skat20phys
This an aside, but this seems like a textbook example of government regulation
of healthcare not only failing but getting in the way and actively causing
harm. There are literally 1000s of generally certified labs that they could
have said very early on "go to it if you have this certification" and instead
they plodded through this top-down heavy handed mess and made this pandemic
many times worse.

In the US you have this combination of heavy over-regulation and lack of
public provisioning. It's like the worst of both combined. Between this,
cannabis, ketamine, and the opioid crisis, I absolutely do not understand why
there isn't an uproar over overregulation in healthcare getting in the way.

~~~
hcknwscommenter
None of those generally certified labs have any clue how to develop a new
test. Not even a test that is exactly the same as a test they already have.
There are 1000's of them, because you need very little training to push some
buttons and enter data into forms. Those generally certified labs did what
they are supposed to do. They looked to the government for guidance on what to
test and how. The gov't made many mistakes: disbanding of the CDC pandemic
response team. Putting anti-science Pence in charge. Forming a CDC team that
was heavy on science and management but light on epidemiology. Not following
the WHO's lead on their already established and working test. Listening to
pharma's explanation about what they will be able to do in 12-18 months and
confusing that with a statement about what they can do now. These are all
mistakes that didn't have to happen and happened because morons are in charge.

------
guitarbill
> test for the virus in Nigeria, Africa’s most populous nation, with about 200
> million people.

> its saliva and finger-prick kit could be ready for sale by June for less
> than $1 apiece

> Mologic and the Institut Pasteur have joint capacity to produce 8 million
> tests a year

every little helps, and a low-cost test would obviously be a game-changer. but
let's keep things in perspective and be realistic. it sounds quite
hypothetical right now. there's no indication it works reliably yet.

~~~
Rapzid
We are royally screwed if this thing hasn't played out by June.

~~~
ohazi
I really don't see how anyone expects this to be over by June.

Exponential growth at the current rate would have it burning through the
global population by the end of June, but since exponential growth becomes
logistic growth after an appreciable fraction of the population is infected,
June is probably closer to the halfway point than the end date.

And that's assuming zero curve flattening. The entire point of flattening the
curve is to draw it out so that hospitals continue to function for longer. But
this also makes the pandemic last longer.

A vaccine isn't expected for over a year, and even then, I'd expect at least a
few months of logistical difficulties getting enough manufactured,
distributed, and administered, especially given the state that hospitals will
likely be in.

~~~
Rapzid
Yes, this was what I had in mind when I made this comment.

We would be screwed, IMHO, based on the current mitigation strategies around
curve flattening that are not being communicated realistically to the public.
The crop of shutdowns over the weekend were billed as 2-3 weeks.. Err, what?
How are we even going to know what effect that's having without massive
blanket testing? Then, nobody seems to believe anything less than 8 weeks is
enough; and that's full-blown lock-down not fractions of half measures.

But as you say, the just spreads it out. So what happens in 8 weeks when we
still can't let up the restrictions because if we did that the number of cases
would just explode again among the uninfected population? If we aren't turning
the corner by June and getting the 40% of adults who can't afford $400 in an
emergency back to work..

I'm sympathetic to the UKs strategy and hope the best for them.

~~~
ohazi
> The crop of shutdowns over the weekend were billed as 2-3 weeks.. Err, what?

Exactly. People seem to be mistaking the incubation period (~two weeks) for
the length of time the pandemic will last (months at minimum).

It's impossible to have a perfect quarantine, so if we were to all go back to
normal after a month, the pandemic growth curve will pick up where it left
off. Exiting the lockdown will need to be done super carefully to avoid this
outcome.

As far as I can tell, this is probably going to be the new normal until we
have a vaccine.

~~~
mrec
Yup. And the worst-case scenario is infections peaking next winter to coincide
with regular 'flu season.

An Imperial College paper [1] out today predicts this under its most stringent
suppression scenario; see the chart on page 10.

[1] [https://www.imperial.ac.uk/media/imperial-
college/medicine/s...](https://www.imperial.ac.uk/media/imperial-
college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-
modelling-16-03-2020.pdf)

------
baybal2
And not a single detail on what they are...

Antibody tests are more suitable for test strips, and work under 30m, but they
need blood test.

Few companies in China are already marketing 30 minute PCR systems. One from
Xiamen, another from Nansha.

~~~
kylebenzle
Agree, tried to figure out how they got an rt-pcr machine that small, then
realized the whole article is bullshit. I guess we are in for a lot of this
nonsense.

~~~
mmmrtl
It's real tech - miniaturization with microfluidics allows shorter cycles ->
faster results. But it's not clear whether any of these companies are yet
making enough machines to help, or if it's just PR. Probably the latter.

[https://www.chinadailyhk.com/article/121312](https://www.chinadailyhk.com/article/121312)

------
blueyes
I'd just like to note that, while we should be conducting many more tests, we
should also be aware of the danger of false positives, and the burden that
places on individuals and systems. Some of these tests are just not very
accurate, according to an MD I know.

~~~
fma
You may have misheard the MD. The current tests have a very low false positive
rate. That means if the test says you have Coronavirus, you have it. There's
no "burden".

Where the tests are "not very accurate" is the false negative. The false
negative rate can be as high as 50-60%, depending on tests and how it's
administered. Sometimes they will conduct the test twice to improve accuracy.

The Roche ones recently approved have a lower negative test rate (10%?)

Edit: I removed my mention of 0% false positive rate because nothing in life
is absolute.

~~~
whatshisface
A 0% false positive rate is not possible. What if they switch your sample with
someone else's while it's being handled by a human?

Edit:

> _That means if the test says you have Coronavirus, you have it._

This line implies the parent comment is talking about the false positive rate
of the entire testing process that results in you being told you're infected,
not PCR as a platonic ideal, theoretical process.

~~~
fma
From the FDA itself. Note how firm they are in regards to a positive, vs how
cautious they are in regards to a negative. If you have COVID-19 RNA in your
body...you have the virus.

What does it mean if the specimen tests positive for the virus that causes
COVID-19? A positive test result for COVID-19 indicates that RNA from SARS-
CoV-2 was detected, and the patient is infected with the virus and presumed to
be contagious

What does it mean if the specimen tests negative for the virus that causes
COVID-19? A negative test result for this test means that SARSCoV-2 RNA was
not present in the specimen above the limit of detection. However, a negative
result does not rule out COVID-19 and should not be used as the sole basis for
treatment or patient management decisions. A negative result does not exclude
the possibility of COVID-19.

[https://www.fda.gov/media/135662/download](https://www.fda.gov/media/135662/download)

~~~
rectang
> _A positive test result for COVID-19 indicates that RNA from SARS-CoV-2 was
> detected, and the patient is infected with the virus_

You still haven't addressed the possibility of a protocol error such as a
switched sample. The lab test itself may never produce false positives, but
that emphatically does not mean that if the lab test comes back positive there
is a 100% guarantee that the patient is infected.

~~~
fma
Considering the context that I replied to is "we should also be aware of the
danger of false positives", I think given the FDA source I posted (and what
I've read elsewhere) I can say that there is absolutely no need to be aware of
a danger of false positives in terms of disrupting people's lives.

If you want to argue on the fact of life that nothing in life is absolute.
Fine. you win. If administered properly, and the test kit detects a presence
of COHVID-19 RNA in your body, and the person telling you the results is not
drunk, then the results is as close as 0% as practical.

------
sdiq
Cheap and fast screening tests for a number of health conditions are commonly
available. However the sensitivy and specificity of these tests tend to be
lower than the PCR, for example. Once a person tests positive in the first
screening test, a second confirmatory tests is then ordered. This test should
thus be one such fast screening test and would certainly help in a place like
Africa.

------
leggomylibro
So, how does the PCR-based testing work? Is it just the usual gene
amplification steps?

* Get DNA out of cells and unwrapped from their histones.

* Cleave the DNA sample with restriction enzymes at boundary sites which should mark the start/end of a stretch of viral DNA.

* Amplify the sample with PCR, using primers which match stretches of viral DNA.

* Run a gel electrophoresis and look for a mass of DNA that matches the expected size of the stretch of viral DNA.

Is that how things work, or are these kinds of diagnostics done differently?

~~~
mbreese
It's an RNA virus, so you start by isolating RNA and then using a reverse
transcription reaction to make cDNA from the RNA. Then you use viral-specific
primers in a traditional PCR. Most of the tests that I've seen presented have
then be real-time qPCR tests as opposed to gels, but for the most part, you're
not far off. Also, restriction digests aren't required.

Note: I haven't seen any of the protocols, just what I've been able to learn
from press reports.

Edit: Here's a link to the CDC's panel protocol:
[https://www.fda.gov/media/134922/download](https://www.fda.gov/media/134922/download)

And to add Wikipedia's page on real-time PCR (not to be confused with RT-PCR,
which is also used here): [https://en.wikipedia.org/wiki/Real-
time_polymerase_chain_rea...](https://en.wikipedia.org/wiki/Real-
time_polymerase_chain_reaction) . However, the crux of it is that the reaction
contains a chemical that fluoresces in the presence of double-stranded DNA. As
the PCR reaction progresses, if there is a valid template in the original
mixture (i.e. if there is virus present), then there will be a detectable
amount of DNA present after a number of PCR cycles. The lower the number of
PCR cycles required to detect this fluorescence, the more viral RNA was
present in the initial sample.

~~~
leggomylibro
Neat, thanks - it's amazing how quickly sequencing technologies have evolved.

~~~
mbreese
This isn't sequencing... you'd use sequencing to identify novel mutations or
strains of the virus. This is a set of known PCR primers that amplify the
virus's RNA. You could (in theory) also use a similar approach to identify
specific strains of the virus, but this shouldn't be the priority at the
moment.

While you could have an assay that used sequencing, it wouldn't be nearly as
fast or cost efficient.

~~~
VectorLock
This CDC document was an interesting read. I found this part particularly
fascinating.

>RNA isolated and purified from upper and lower respiratory specimens is
reverse transcribed to cDNA and subsequently amplified in the Applied
Biosystems 7500 Fast Dx Real-Time PCR Instrument with SDS version 1.4
software. In the process, the probe anneals to a specific target sequence
located between the forward and reverse primers. During the extension phase of
the PCR cycle, the 5’ nuclease activity of Taq polymerase degrades the probe,
causing the reporter dye to separate from the quencher dye, generating a
fluorescent signal. With each cycle, additional reporter dye molecules are
cleaved from their respective probes, increasing the fluorescence intensity.
Fluorescence intensity is monitored at each PCR cycle by Applied Biosystems
7500 Fast Dx Real-Time PCR System with SDS version 1.4 software.

------
aliljet
These kinds of engineering/science solutions to a hard problem are the bread
and butter of a community like this. Where can engineers pool their resourcing
and work together to assist in the fight?

------
leemailll
It’s relatively easy to develop a detection method, however the most important
thing for any detection is the false negative rate, considering current
situation. If the false negative rate is high, such a test might encourage
spread of the virus. Some Chinese company already developed antibody-based
detection method a while ago, But never saw they change the detection method
in clinic. Elisa use the same basic principle as an antibody based test.

------
boomboomsubban
What is enabling them to be the only people able to develop this far better
test? Is the rest of the world unaware how home pregnancy and malaria tests
work?

If this was worth reporting on, there should be some kind of data showing how
effective and cheap the test is when compared to the competition. I wonder
what led Bloimberg and other financial news to pick this story up.

~~~
pmoriarty
_" What is enabling them to be the only people able to develop this far better
test?"_

They're far from the only ones who've developed a far better test.

Without specifically looking for them, since the outbreak began I've seen 4 or
5 reports of different companies developing far better tests.

Unfortunately, I don't know if any of them have actually been put in to use,
or what the obstacles to doing so are.

~~~
giarc
If you are a company that wants to sell a test, you will definitely say it's a
"far better test". Whether it actually is a better test is a much different
story.

------
asiachick
$1 would be nice. Some company in Japan is selling kits $250 for a 10 test kit

[https://monoist.atmarkit.co.jp/mn/articles/2003/13/news055.h...](https://monoist.atmarkit.co.jp/mn/articles/2003/13/news055.html)

Google Translate Translation

[https://translate.google.com/translate?sl=auto&tl=en&u=https...](https://translate.google.com/translate?sl=auto&tl=en&u=https%3A%2F%2Fmonoist.atmarkit.co.jp%2Fmn%2Farticles%2F2003%2F13%2Fnews055.html)

------
nlh
Someone sent me this link recently. Can anyone provide some color on what's
actually being sold here? Is this just fraud or are there cheap tests already
available in China?

[https://www.alibaba.com/trade/search?fsb=y&IndexArea=product...](https://www.alibaba.com/trade/search?fsb=y&IndexArea=product_en&CatId=&SearchText=covid-19+test)

------
pdm55
Discussion re new simpler antibody test
[https://www.sciencemag.org/news/2020/03/new-blood-tests-
anti...](https://www.sciencemag.org/news/2020/03/new-blood-tests-antibodies-
could-show-true-scale-coronavirus-pandemic)

------
uptown
Assuming tests aren't available -- is there nay prescribed care one can
provide to others or do for ones-self if they contract the virus? I realize
some conditions may worsen to the point that you'd require medical attention
--- but what's the best course of action assuming that professional care is
unavailable?

~~~
fma
I feel like a question like this is better served doing a Google search and
finding results from reputable sources...rather than asking a question on HN.

Having said that, Coronavirus is consider a repository illness...so you'd
probably perform the same home treatment as any other respiratory illness.

~~~
rory096
>you'd probably perform the same home treatment as any other respiratory
illness.

Notably, you should not take ibuprofen or other NSAIDS. Stick to
acetaminophen/paracetamol instead.

Guidance from France's health minister:

[https://www.theguardian.com/world/2020/mar/14/anti-
inflammat...](https://www.theguardian.com/world/2020/mar/14/anti-inflammatory-
drugs-may-aggravate-coronavirus-infection)

[https://twitter.com/olivierveran/status/1238776545398923264](https://twitter.com/olivierveran/status/1238776545398923264)

~~~
velosol
This is good advice generally, especially for severe infections like COVID-19
but there's little evidence _specific_ to COVID-19 and a contraindication with
NSAIDs.

The Snopes [1] article covers the general gist although there is an early
report around that the minister likely read and passed on in the form of a
tweet.

Research is changing constantly right now so evidence may or may not show
NSAIDs contraindicated with greater risk than other infections.

[1]: [https://www.snopes.com/fact-check/covid-19-nsaids-
ibuprofen/](https://www.snopes.com/fact-check/covid-19-nsaids-ibuprofen/)

------
Markoff
by June when it will be available I'll be either dead or immune, same with
most of the population

------
rhizome
A test for $1 can be a test for free.

~~~
apk-d
A test for $1 can be afforded by anyone.

~~~
pbhjpbhj
I'd say "can be afforded by the World for everyone". Sure, the average GNI
(gross nat. income) for the poorest countries is about $2 (USD) per day, but
affordability is more complex. However, if we taxed the World, and paid
according to ability of nations to pay ... I mean USA could probably pay it
for everyone and only have to not build an aircraft carrier
([https://en.wikipedia.org/wiki/Gerald_R._Ford-
class_aircraft_...](https://en.wikipedia.org/wiki/Gerald_R._Ford-
class_aircraft_carrier) says that is $12B, money to spare!).

[Yes, finance isn't that easy, the knock on effects would make the cost
possibly greater, maybe less(!)?]

~~~
apk-d
The logistics of getting goods such as food and medicine into third world
countries have hardly anything to do with their manufacturing price. Even once
you get them there, distribution is a nightmare. Obviously I'm not referring
to countries with no actual economy to speak of.

~~~
rhizome
The "$1" in a $1 test has very little to do with manufacturing costs, too.

------
montalbano
For another novel detection method which may be suitable for low-cost
implementation see this post
[https://news.ycombinator.com/item?id=22592173](https://news.ycombinator.com/item?id=22592173)

------
Amygaz
1st, SARS-CoV2 ELISA already exists. 2nd, the CDC did compare RT-PCR vs ELISA
SARS-CoV back in 2005, and ELISA performed really poorly, and that was for
acute cases. So, that is why we should stick with RT.

------
mehrdadn
What's the current best false negative rate of any coronavirus test?

------
amelius
Wouldn't a far less specific test do the trick as well?

If we had a cheap test that tells us whether we have some kind of illness,
corona-flu included, then I'd say that would be tremendously useful.

------
DennisP
This sounds like something we could really use in the U.S., too.

------
yread
Here is a list of potential diagnostic tests for COVID-19

[http://www.finddx.org/covid-19/](http://www.finddx.org/covid-19/)

------
afterburner
How many can they make?

------
baq
it's either that and containment South Korea style or total lockdown China
style. too much risk to be in between, though some were trying.

------
bugzz
Why are flu tests so much slower and more expensive?

~~~
kube-system
Probably because "the flu" is hundreds of different viruses and the entire
world is not currently dumping massive amounts of resources behind developing
them.

Then again, the rapid flu test only takes about 5 to 20 more minutes than
this, and doesn't really cost much more than any routine diagnostic.

------
the_arun
In the same lines - Apple Watch or Samsung watch sensing it through sensors
would be so cool. I'm not a doc, so don't know the practicality of it

~~~
nomel
They have some LEDs that shine light into your skin. You're not detecting a
specific pathogen by shining UR and visible lights.

