Other than an N95 respirator mask, face coverings are unnecessary and won't provide full protection against infection.

If you can recall, this was the sentiment early on in the pandemic that was being perpetuated by public health officials and civilian skeptics alike. This advisory would soon be retracted as evidence would supply the belief that 80% protection against infection is certainly better than none at all. While it would be ideal if every member of the community could wear an N95 mask, limited supply and relatively high costs prevent this from being a feasible measure.

A mask mandate is far from a full solution to the problem of stopping community transmission, but the risks are negligible when pitted against the public health advantages. With the gravity that this pandemic brings to the health of our community, it is important that we forgo as many unnecessarily high standards as possible if we are to have any hope of returning to normalcy.

The quantitative real-time polymerase chain reaction (RT-PCR) test has been upheld as the gold standard in COVID-19 diagnostic methodology for its relatively high sensitivity and specificity. However, a paper published by Larremore et al. examined what other factors may be of greater importance when developing wide-scale testing strategies. They determined that effective surveillance, including time to first detection and outbreak control, depends largely on frequency of testing and the speed of reporting, and is only marginally improved by high test sensitivity.

While RT-PCR may be able to detect the relatively minuscule amounts of remnant SARS-CoV-2 particulate, this amount may be negligible and far outside the threshold for infectiousness. It is likely that many individuals who test positive may be inoculated with a less considerable amount of virus because they are at the tail end of their infection, when they are significantly less likely to be transmitting the virus. While the RT-PCR and other high sensitivity tests can certainly detect the high amounts that are conducive to actual infectious viral shedding, so are the less sensitive tests.

One specific method that comes to mind is the point-of-care paper antigen tests. Essentially, these are strips of paper that are lined with monoclonal antibodies that will detect antigens that are specific to SARS-CoV-2. The technique that seems to be universal among biotech developers of this test is that they have individuals spit on the paper and insert inside a portable reader that will be able to determine whether there is virus present in the individual. While it is a lot less sensitive than the RT-PCR, it is a lot cheaper. These paper tests can cost between $1 and $2 per test, compared to the $35 to $200 cost of an RT-PCR test. On top of the cost-effectiveness, paper tests allow individuals to get their results within 15 minutes compared to the 24 to 48 hours of an RT-PCR.

Dr. Michael Mina from the T.H. Chan School of Public Health at Harvard University analogously illustrates the comparison of testing to coffee. RT-PCR is like Nespresso coffee in that it is fairly more expensive, takes time to brew and requires a machine that is only compatible with pods that are proprietary to that specific brand's machine. Paper antigen tests are like instant coffee in that they are much cheaper and can be ready much more quickly. But while the paper tests certainly will not have a comparable quality taste, it still has caffeine. If there isn't enough caffeine from that cup, then there's no issue in making as many cups as one may need. If you don't detect virus in your system now, we can easily check again later with the paper antigen test.

It would be prudent to include the application of these paper tests in our island's efforts to halt community transmission of COVID-19. The low cost of the tests increases the capacity to test more frequently. Administering tests before people go to work or to school will allow them to know if they are infectious and immediately prevent them from entering large crowds in confined spaces. The relatively unobtrusive nature of the test will allow for people to test themselves every day and factor into their decisions about going into public places. Also, this method can help to protect the patrons and employees of local businesses. Results from individuals entering the respective facility can be obtained within minutes and help to keep infection out. This will prevent businesses from having to temporarily close due to cases being unexpectedly identified.

While upscaling testing is the step that will cover an enormous amount of ground in the direction of limiting the transmission of COVID-19 in our community and eradicating the virus from our island, it also has potential economic benefits. Mounting a testing campaign of the described magnitude would potentially garner the confidence of tourists. Triangulating and addressing infections must be accomplished before we can begin to market our island as a safe destination for travel. As visitors return to the island, testing will definitely be necessary to immobilize any potential imported cases. Rather than waiting hours at best for the results of an RT-PCR test, the paper test will provide results within 15 minutes at little cost to the taxpayers.

Incorporating paper antigen tests is a novel intervention that has yet to be introduced into a public health strategy in this pandemic. But rather than wait to follow the lead of our mainland counterparts, I implore the government of Guam to act proactively, rather than reactively.

For decades, Guam has predicated its marketing on being a part of the U.S. in Asia. But with political and societal stringencies complicating our ability to employ strategies that meet the standards of our visitors from Asia, likening ourselves to the rest of the nation will work to our detriment. Instead, let us take hold of our own fate.


Kai Akimoto, from Tamuning, is a pre-med student at Macalester College in Saint Paul, Minnesota, who has been doing extensive research on COVID-19. 

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