As the COVID-19 pandemic continues to disproportionately impact our community, AACI’s Health Center remains committed to providing much needed resources during this time.
At AACI’s Story Road location will be providing No-Charge COVID-19 Testing for members of the community. Feel share this resource with your own networks and those in need.
No doctor’s note is required and we will serve everyone regardless of insurance or immigration status. Testing is only available to individuals without symptoms at this community testing event. We recommend that anyone experiencing symptoms see their own doctors.
If someone does not already have a doctor, AACI’s Health Center is accepting new patients. Please call (408) 975-2763 for more information.
To be sure of the safety and efficacy of Covid-19 screening technology that he was considering for his employees, Tech Mahindra CEO CP Gurnani, suggested testing it on himself and his household members. That decision may have saved him and his family from having to be admitted to hospital —as actors Amitabh and Abhishek Bachchan were last week. As it turned out, everyone in the house received a clean bill of health, except the two sons of his cook who were diagnosed as high risk.
As the Bachchans too must have done, Gurnani had had his domestic staff take all necessary precautions, remaining distant and wearing masks. His cook’s sons did not show any visible sign of infection, yet were potential Covid-19 carriers.
The fact is that the testing techniques in common use are inadequate, and social distancing isn’t always possible. RT-PCR (reverse transcription polymerase chain reaction) tests have ‘false negative’ rates of 20-67%, depending on when they are taken. Also, temperature screening and contact tracing fail to identify the presymptomatic spreaders who, according to mathematical modeling, could be responsible for half of the infections. When Delhi health minister Satyendar Jain showed symptoms, his first RT-PCR results came back negative. But they were positive the very next day.
The technology and techniques I had persuaded Gurnani and Tech Mahindra to pilot — and that I had a hand in developing — are based on understanding an individual’s risk and performing monthly testing. The reality is that even though Covid-19 can be devastating for a few, not everyone who gets infected will have serious symptoms. We can identify the people at high risk with reasonable accuracy based on studies from around the world and data from India. And we can give them special treatment.
For example, it is well established that men above 65, whose health is chronically compromised by diabetes, cardiovascular disease, or obesity, are at higher risk of severe outcomes. Further, severity can be predicted by a number of tests, including those for hypertension, diabetes, and obesity, and measures of lactate dehydrogenase (LDH) and D-dimer.
Businesses in the US have considered offering these types of tests. But the costs and logistics of doing so are usually prohibitive, with the most basic tests costing more than $100 apiece, and requiring the shipment of samples to labs. A single comprehensive screening for an individual could cost over $1,000, and is usually not covered by insurance plans. It can take days to get basic test results.
This is where India has an advantage over the West: it has developed screening devices, such as HealthCube, which can conduct a range of biochemical and physiological tests for a tiny fraction of the US cost. These include 12-lead electrocardiograms (ECG), tests for blood pressure, oxygen saturation, blood glucose, hemoglobin and cholesterol, and rapid diagnostic tests for infectious diseases.
With HealthCube, an entire regimen of tests, including a test for Covid-19 antibodies and severity markers, can be performed for less than Rs1,000 within minutes. The technology has received Europe’s CE certification.
The Covid-19 risk screening program underway at Tech Mahindra on the HealthCube platform uses patient risk factors — age, gender, medical conditions, potential exposure, recent travel or being in a crowded place, public health data, aggregations from previous screenings, patient symptoms, etc — to compute a risk score for patients. Those at high risk are checked for markers, such as D-dimer and troponin, which are elevated in those who develop the severe disease (which indicate heart ailments). These tests are followed up by teleconsultations and further testing, as appropriate.
With more data and testing, the artificial intelligence (AI) algorithms become increasingly accurate, and people are given an individualized screening and testing protocol based on their risk factors, rather than being treated like machines that need temperature checks.
Antibody tests have been controversial largely because the first generation of tests performed worldwide were mostly from China and were low quality and defective. There have also been doubts about whether all Covid-19 patients develop antibodies and, even if they do, how long the immunity lasts.
The newer generations of tests, made outside China, are highly accurate. Swiss pharma giant Roche, for example, claims that 14 days after infection, its test can detect antibodies with 99.8% specificity and 100% sensitivity. HealthCube claims that its India-made tests have 98% specificity and 96% sensitivity. These are both a huge leap from the 5.4% accuracy of the tests that China first sold to India.
There is substantial evidence that within 19 days after symptom onset, 100% of patients test positive for Covid-19 antibodies. And as Harvard epidemiologist Marc Lipsitch explained in the New York Times, ‘After being infected with SARS-CoV-2, most individuals will have an immune response, some better than others. That response, it may be assumed, will offer some protection over the medium term — at least a year — and then its effectiveness might decline.’ Even half a year will buy us time to understand and develop better approaches to prevention and treatment — and administer vaccines to those at high risk.
Gurnani told me that his personal experience, and the testing Tech Mahindra has conducted on a few hundred employees, have convinced him to offer the full health screening to the entire India Tech Mahindra employee base — including third-party employees, who typically can’t afford the test and are the most vulnerable because they stay in crowded places. He says that he puts his employees’ health above any business needs and cannot allow even one person to be at unnecessary risk.
Gurnani’s ambition is to show India — and the world — how to safely and sensibly open businesses and economies.
Vivek Wadhwa is a distinguished fellow and professor, Carnegie Mellon University’s College of Engineering, Silicon Valley.
This article was republished with permission from the author and can be originally found here.
We are weeks into widespread social distancing in many parts of the world, though it feels like months. Cases of COVID19 continue to mount, as expected, and we watch Italy and Spain for signs of when our society might be cast into crisis and chaos. Health care workers, the heroes of our time (and of all times, really), gird themselves for a flood of respiratory distress cases, projected to peak sometime in April. Physicians and nurses of all specialties are being asked to update their ventilator training in anticipation of being called to the front lines for service. Yet many fear that they will not have sufficient weapons for this fight, such as masks and ventilators.
At this time, it’s important to remember that COVID19 has a global case-fatality rate of about 2 to 3%, lower in the USA, meaning that most people will survive this. In the words of Larry Brilliant, “this is not a zombie apocalypse. It’s not a mass extinction event.” What is it, then? This is, and always has been, a health systems crisis more than simply a health crisis.
In a health crisis, we await salvation from a lucky mutation, a change in seasons (that will likely have no effect on this virus), a vaccine, or a cure. But in a health systems crisis, we can manufacture our own salvation through proper preparation, investment, leadership, and resource management.
In the early phase of a pandemic, it is possible to identify infected individuals, trace their contacts and quarantine them. Once there is community spread, the focus shifts to isolating populations and hardening the hospitals against the onslaught. We are clearly in this second half now.
At present, America’s one million hospital beds are not completely saturated by the number of serious COVID cases, except in overwhelmed places like New York. But in anticipation, health systems managers in many states are struggling to procure PPE (personal protective equipment), ventilators, and even sufficient front-line staff. But there is another way, and both Singapore and South Korea have shown us the first steps on that path.
With an extreme national lockdown that only permits movement of emergency personnel and essential services, lasting a couple of months or more, the number of new cases can be kept to a slow simmer. This is because it would take longer for new infections to occur, while allowing time for existing infections to resolve. The more severe the isolation, the longer it would take for a new case to emerge. The epidemic then recedes to a small number of active cases and a non-newsworthy number of hospitalizations.
The more lax these restrictions, and the slower governments are to enact them, the higher the peak of cases and deaths, and the longer it takes to push the rate of new infections down to a manageable number. But once that is achieved, we can all breathe a little easier.
The Institute for Health Metrics and Evaluation (IHME) predicts that proper social distancing would see the end of the first wave of the epidemic by early June. The timing of the arrival of a second or even third wave depends on the public health interventions made when the first wave abates.
Cases in the US as of March 27, 2020. Image provided by Pharexia.
This post-lockdown, post-first wave scenario resembles the early phase of the pandemic, with a few cases and contacts. That, then, is the time to apply the force of a newly resourced awesome preventative public health system. The secret weapon is something that exists now, that we can manufacture or purchase: tests, and lots of them.
The deployment of rapid, frequent, public testing at a national scale would allow society to return to productive normalcy while keeping the disease to a simmering annoyance.
A Herculean investment in the flotilla of new testing options now becoming available, including rapid 15-minute in situ and at-home testing would give us the epidemiological data to control the outbreak. With sufficient human resources support, every case could be quickly identified and isolated, their contacts immediately traced and tested, as well.
This would require a commitment to a strong and well-maintained public health infrastructure. But such an investment would be a pittance compared to the costs of either the expansion of our hospitals to accommodate throngs of dying patients or the economic cost of many more months of isolation.
In particular, the serology or antibody test would be critical for managing our staged return to society. Such a test would detect the products of the body’s immunological response to the virus, and would therefore tell us if a person were currently or previously infected. If the latter, then they would presumably be immune, and would be granted a free pass to return fully to normal life.
While several serology tests are now on the global market, some jurisdictions do not yet licence them. The challenges are largely scientific. First, the test cannot distinguish between past and present infection, so it would have to be followed up with another test to detect the presence of the virus and therefore determine if the person was still infectious. Second, the potential for false positives is high as it might detect antibodies to other coronaviruses, such as the common cold. And third, it is not yet known how much antibody needs to be present to confer immunity.
On the other hand, the more common nasal swab test, employed on a wide scale in almost every city, relies upon a well equipped laboratory to render a result. But a global shortage of the crucial reagents has resulted in a backlog of pending tests in several places. In many cases, university research labs are being raided to help supply the public health laboratories.
Given that expanded testing, absent a cure or vaccine, is our best path out of the pandemic morass, a natural question is whether the shortages and backlogs could have been avoided. The answer, unfortunately and unsurprisingly, is yes.
The politics of this failure are tied up in the ideological and personal conflicts between the present and former administration, as well as in the unending tension between private and public sector solutions, pertaining to the question of which sector is best equipped to order, manage, validate, apply and monitor the deployment of tests on a national scale.
Health care system crises like the COVID19 pandemic are not elemental disasters delivered by the gods, but rather are manageable aspects of 21st century globalized life. They can be overcome with good leadership, investment, and planning. Thus far, the leadership has been disappointing, the investment late, and the planning ignored. But there is time yet for these problems to be solved, not by the rare and precious front line clinicians risking their lives, but by the administrators and policymakers, of whom we have no short supply.
Raywat Deonandan, PhD, is an Epidemiologist, Associate Professor and Assistant Director of the Interdisciplinary School of Health Sciences at the University of Ottawa in Canada. www.deonandan.com
The recommendations of the Committee of Secretaries chaired by Chairpersonship of Dr. Harsh Vardhan, Union Minister of Health &Family Welfare. Sh. Hardeep S. Puri, Minister of Civil Aviation, Dr. S. Jaishankar, Minister of External Affairs, Sh. Nityananda Rai, Minister of State for Home, Shri Mansukh Mandaviya, Minister of State (I/c), Ministry of Shipping, Chemicals and Fertilisers and Sh. Ashwini Kumar Choubey, Minister of State, Health &Family Welfare were placed before Group of Ministers. After detailed deliberations on preventive measures, actions taken and preparedness for Novel Coronavirus Disease (COVID-19), the GoM took the following decisions:
All existing visas, except diplomatic, official, UN/International Organizations, employment, project
visas, stand suspended till 15th April 2020. This will come into effect from 1200 GMT on 13th March 2020 at the port of departure.
Visa free travel facility granted to OCI card holders is kept in abeyance till April 15th 2020. This will come into effect from 1200 GMT on 13th March 2020 at the port of departure.
Any foreign national who intends to travel to India for compelling reason may contact the nearest Indian Mission.
All incoming travellers, including Indian nationals, arriving from or having visited China, Italy, Iran, Republic of Korea, France, Spain and Germany after 15th February, 2020 shall be quarantined for a minimum period of 14 days. This will come into effect from 1200 GMT on 13th March 2020 at the port of departure.
Incoming travellers, including Indian nationals, are advised to avoid non-essential travel and are informed that they can be quarantined for a minimum of 14 days on their arrival in India.
Indian nationals are strongly advised to avoid all non-essential travel abroad. On their return, they can be subjected to quarantine for a minimum of 14 days.
International traffic through land borders will be restricted to Designated check posts with robust screening facilities. These will be notified separately by M/o Home Affairs.
Provision for testing primarily for students/compassionate cases in Italy to be made and collection for samples to be organized accordingly. Those tested negative will be allowed to travel and will be quarantined on arrival in India for 14 days.
Originally Posted On: 11 MAR 2020 10:18PM by PIB Delhi
