In an op-ed in the New York Times economist Laurence Kotlikoff and epidemiologist Michael Mina propose what they characterize as a “cheap, simple way to control the coronavirus”:
Simple at-home tests for the coronavirus, some that involve spitting into a small tube of solution, could be the key to expanding testing and impeding the spread of the pandemic. The Food and Drug Administration should encourage their development and then fast track approval.
One variety, paper-strip tests, are inexpensive and easy enough to make that Americans could test themselves every day. You’ would simply spit into a tube of saline solution and insert a small piece of paper embedded with a strip of protein. If you are infected with enough of the virus, the strip will change color within 15 minutes.
Your next step would be to self-quarantine, notify your doctor and confirm the result with a standard swab test — the polymerase chain reaction nasal swab. Confirmation would give public health officials key information on the virus’s spread and confirm that you should remain in quarantine until your daily test turned negative.
Perhaps we should acquaint the learned gentlemen with Von Moltke’s famous dictum: “No plan of operations extends with any certainty beyond the first contact with the main hostile force”. We can’t even get people to obey laws against drunk driving or illegal drug use. We can’t get people to wear facemasks or observe social distancing voluntarily. The key word in “cost effective” is “effective” and such a plan requires 100% compliance to be effective.
Accepting their estimate of $1/day the cost of such a plan would cost $120 billion per year. That’s $120 billion that wouldn’t be spent on education, highways, or other health care and in the absence of 100% compliance it would be useless.
I could come up with plans to improve compliance but every single one would be so costly whether in money or time as to be impractical.
That’s why I have been perseverating on the need for rigorous epidemiological testing. Regular mandatory testing of a sample of people rather than testing everybody every day. We should apply resources where they are needed rather than dreaming about 100% compliance.