Call to action: Let’s integrate innovative and highly effective screening workflows nationwide to significantly enhance our H5N1 surveillance capabilities.
Note: I‘m not a public health expert, nor do I have an extensive list of credentials that make me an authority on these matters. I’m simply a volunteer who listened to smart physicians striving to respond effectively to COVID-19. To support them, I developed software tailored to their needs and direction and it became a successful company, Primary.Health.
The ideas presented below are compiled from numerous conversations with experts within public health, government, and the private sector—individuals whose positions often restrict their ability to advance their organizations with public discourse. I am trying to represent their insights and aspirations to a larger audience, in hopes of catalyzing the changes they deem necessary.
The CDC’s call for expanded testing for bird flu after blood tests reveal more farmworker infections is not just a wake-up call — it’s a call to action. We applaud the tireless efforts of federal agencies diligently monitoring the outbreak and tracking H5N1 activity in animals and people. However, with 46 confirmed total U.S. reported human cases of H5N1 and the detection of the virus in pigs, now is the time to elevate our response. By integrating innovative and highly effective screening workflows nationwide, we can significantly enhance our surveillance capabilities against H5N1.
Imagine the possibilities when cutting-edge technology converges with collaborative efforts:
1. Modernize Public Health Labs
Improving digital ordering systems and enabling digital sample diversion are critical steps toward real-time scaling of laboratory capacity. Securing political support to strengthen collaborations with providers, labs and vendors is essential. Currently, many laboratories still rely on outdated paper forms, fax machines, and spreadsheets, which hinder efficiency and responsiveness. Progress toward full digital integration has been slower than anticipated, highlighting the need for renewed commitment.
Modernization means equipping laboratories with the software tools they need and desire, rather than insisting on a one-size-fits-all standard. For example, laboratories that have adopted electronic laboratory reporting (ELR) systems have significantly improved data accuracy and turnaround times. By investing in technologies such as digital diversion support, bulk import tools, patient portals, modern ETOR, and optical character recognition (OCR), we can more smoothly transition to digital operations that meet labs where they are.
2. Develop Lab-Agnostic Self-Collection Kits
Envision self-collection kits available nationwide, not tied to specific laboratories, and usable without professional staff, but designed by public health. This transformative approach overcomes current limitations within the CDC and local public health infrastructures, allowing us to gather more samples swiftly and dramatically bolster our surveillance efforts.
Implementation strategies could include partnerships with employers, pharmacies for distribution, mail-order systems, and placement in community centers. By ensuring that kits are user-friendly and come with clear, multilingual instructions, we can address potential challenges related to the accuracy of self-collected samples. Integrating telehealth support can further assist users, enhancing the reliability of the collected data and speeding access to timely treatment.
3. Pilot UCLA’s SwabSeq Technology
We propose harnessing the power of self-collected metagenomic frontline surveillance screenings using University of California, Los Angeles SwabSeq technology. SwabSeq is a high-throughput sequencing platform capable of detecting over 20 viruses—including H5N1—from a single sample. Its advantages include scalability, rapid results, and the ability to process thousands of samples simultaneously.
By deploying this technology in provider waiting rooms and community sites, we can significantly enhance our surveillance testing capacity and speed. Pilot studies at UCLA have demonstrated SwabSeq’s effectiveness and reliability, making it a strong candidate for nationwide implementation. Deploying SwabSeq would give us a front-line capability for any emerging virus, avoiding the need for costly, high-complexity, and virus-specific test development. And yes, an inexpensive, sensitive test that can be programmed for any virus target is a very disruptive idea that the CDC, FDA, and established lab industry struggle to support.
4. Refine Rapid Testing Self-Collection Workflows
To expand testing access, we should distribute self-collection kits through hospital waiting rooms, local health jurisdictions, farmworker support groups, and community centers in affected areas. The public acclimated to self-specimen collection during the COVID-19 pandemic and self-collection provides a solid foundation for community-based H5N1 screening.
Additionally, by equipping community groups with validated H5N1 rapid antigen and molecular kits designed for non-clinical settings, we can make screening both accessible and affordable. Companies like Scout Health have successfully produced sensitive, cost-effective, and durable self-testing equipment suitable for real-world conditions. Their success stories reinforce the practicality of our proposed approach.
5. Pre-Register Vulnerable Populations
By creating a prioritized vaccine waitlist for at-risk groups such as farmworkers, we can streamline immunization efforts the moment targeted H5N1 vaccines become available. This initiative would involve collaborating with local organizations, farmworker associations, and community leaders to effectively reach and register vulnerable populations. Utilizing existing public health databases and secure digital platforms can facilitate efficient management of the waitlist.
6. Improve Procurement with Target Product Profiles (TPPs)
The CDC’s recent procurement solicitation for a Nucleic Acid Amplification Test (NAAT) reflects a promising recognition of the need for advanced testing but lacks crucial specifications for real-world deployment. During the COVID-19 pandemic, inadequate attention to real-world conditions led to widespread test failures—from NAAT tests degrading in uncontrolled transport temperatures to rapid antigen tests damaged by heat in storage facilities.
We recommend the CDC enhance its solicitation to include TPP concepts such as:
- Include clear requirements for operating conditions.
- Specify requirements for transport stability.
- Set a target cost per test to ensure affordability.
- Define specifications for ease of administration in various settings.
- Allow for a range of sample types to increase flexibility.
- Establish temperature stability parameters for storage and operation.
- Remove the requirement for existing high-throughput automated NAAT testing equipment in U.S. laboratories, opening opportunities for innovative methods.
- Shift focus from high-complexity laboratory testing to point-of-care solutions to enhance accessibility and response times during outbreaks.
Such adjustments would prevent limitations that could significantly hinder preparedness efforts, especially when investing up to $148 million in taxpayer dollars as specified in the CDC solicitation.
By embracing these strategies, we can realize:
- Enhanced Surveillance: Unparalleled case detection for all respiratory viruses and earlier identification of H5N1 cases.
- Cost-Effective Solutions: Lowering testing costs to potentially $5 per test through innovative workflows and expansive screening programs.
- Data-Driven Responses: Centralized screening sample collection enables rapid prioritization and deeper sequencing analysis, allowing us to monitor viral changes that could signal a pandemic threat.
A Call to Collaboration
I want to share that I’m not a public health expert, nor do I have an extensive list of credentials that make me an authority on these matters. I’m simply a volunteer who listened to smart physicians striving to respond effectively to COVID-19. To support them, I developed software tailored to their needs and direction and it became a successful company.
The ideas presented below are compiled from numerous conversations with experts within public health, government, and the private sector—individuals whose positions often restrict their ability to advance their organizations with public discourse. I am trying to represent their insights and aspirations to a larger audience, in hopes of catalyzing the changes they deem necessary.
Primary.Health has been at the forefront of technology, pandemic response, and public health innovation. We invite like-minded organizations and individuals to join us in galvanizing the surveillance effort through public-private collaboration. Together, we can build on our collective experiences and modernize response capabilities for H5N1.
If these ideas resonate with you or if you are involved in related efforts, I encourage you to connect with us. Email sales@primary.health, call 1-855-970-3223, or contact us.
Let’s collaborate to make a significant impact and safeguard our communities against H5N1.
