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We’re working on 1M Covid-19 testing capacity per day

billiontoone.com

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Re: We’re working on 1M Covid-19 testing capacity per day

#81

Post by zepto »

dang wrote: post #65
zepto wrote: post #20

Earlier quoted context omitted.

Dismissing the value of serological testing seems like a self-serving move. Such tests are immediately of very high value because they allow us to understand immunity to Covid-19, and to actually validate the estimates of cases amongst those who haven’t sought treatment. These are both of huge value regardless of the percentage of the US population estimate to have previously contracted Covid-19. By all means market…

The parent post wasn't edited.

Weird - I could have sworn I saw two different versions, when I pressed the back button.

But I’ll accept that I am mistaken about that.

Re: We’re working on 1M Covid-19 testing capacity per day

#82

Post by yters »

buzzkillington wrote: post #60
tbenst wrote: post #10

Thanks for your efforts! Inspiring to see our broader community spring into action. I was part of a volunteer team that tested 3400 people on Friday/Saturday in Santa Clara country for COVID-19 antibodies [1]. It took a team of 100+ volunteers 10 hours / day just to collect samples. Stanford, for example, has plenty of automated testing capacity, and even reagents. IMHO, the limiting factors are not that we need new…

I find it incredible that no one has done these studies before issuing the lock down orders. Without knowing what the proportion of people who have been exposed but aren't sick any response is the wrong response. If it turns out that it's already spread to most everybody lock downs are just a way to create more homelessness. If it turns out that the only people with the antibodies are the ones in the hospitals we nee…

Yes, if you google "coronavirus iceland" you'll see they've tested almost their entire population. They found 1586 confirmed cases, of whom only 6 died, which gives a fatality rate of 0.4%.

Turning this around, if we multiply confirmed deaths by 264, that gives us an estimate of how many cases there are. So, for example, with UK's death count of 6159 this means about 2.4% of the population is infected. Furthermore, on the Diamond Princess only 20% of the people onboard caught the virus under poorly quarantined conditions. So, to extrapolate even further, this would imply that over 12% of the UK population has already been exposed to SARS-CoV-2. This means that the UK should peak at about 50k deaths, without any protective measures.

In 2018, the UK had 50k deaths due to flu in excess of normal flu deaths.

https://www.telegraph.co.uk/news/2018/11/30/winter-deaths-hi...

Re: We’re working on 1M Covid-19 testing capacity per day

#83

Post by wbl »

pjschlic wrote: post #79
billiontoone wrote: post #50

Earlier quoted context omitted.

If it is specific to COVID-19 testing, we will not seek anything, as long as the end-user is not financially benefiting from it or importantly, selling qSanger kits. If they need our bioinformatics automation & help with set-up, we would license the method for COVID-19 testing for $3-$5/sample as part of each sample that is being put through our pipeline. If they ask for 96-well plates with all reagents that are read…

When you say 'as long as the end user is not financially benefitting' - is the end user the lab conducting the test? You said in an earlier comment that the reimbursement for testing is too low to justify buying expensive equipment. You are also proposing to charge half the reimbursed rate for it to run on someone else's equipment. Are the current equipment owners expected to donate this crucial equipment, because if…

This equipment isn't something a hospital has unless they have a serious desire to do top notch genetic disorder testing, and that kind of hospital is going to use the equipment for this cause. The Abbot machine is something practices with much harder financial constraints have to seriously worry about paying for.

Re: We’re working on 1M Covid-19 testing capacity per day

#84

Post by zepto »

billiontoone wrote: post #35
zepto wrote: post #20

Earlier quoted context omitted.

Dismissing the value of serological testing seems like a self-serving move. Such tests are immediately of very high value because they allow us to understand immunity to Covid-19, and to actually validate the estimates of cases amongst those who haven’t sought treatment. These are both of huge value regardless of the percentage of the US population estimate to have previously contracted Covid-19. By all means market…

I don't think we are in any way undervaluing the serological tests. A great serological test would be very useful. However, because of the indirect measurement, they tend not to be very sensitive or specific, so it is fair to say that they become more important not at the peak of the pandemic but at the post-pandemic period. By the way, as a company, we really don't have much to gain from this test. If it does not ge…

You are downplaying the value by saying they will be useful in the future, rather than now.

This is not so. They are valuable right now.

Re: We’re working on 1M Covid-19 testing capacity per day

#85

Post by devy »

billiontoone wrote: post #72
devy wrote: post #64

Earlier quoted context omitted.

Hi David, what about Rosche Cobas 6600/8800 high-throughput diagnostics machines? Are they using the traditional RT-qPCR assay? How can they are able to test 400k samples per week? https://diagnostics.roche.com/us/en/news-listing/2020/roche-...

Roche 6600/8800 instruments are state-of-the-art automated RT-qPCR machines. We need them as well as other COVID-19 testing instruments. That said, it is easier to ship the test kits than scale the instrumentation. Both Roche and Abbott still need to build hundreds of their instruments before the kits that they are shipping out this week can be used on the daily rate that they are trying to get to. I am not sure with…

> We try to avoid both issues by utilizing a currently unused Sanger install base and low-cost reagents.

Good thought! Thank you.

Additional question: are Sanger instruments also very sophisticated and manufactured by those limited few pharmaceutical companies/medical equipment manufacturers? Or is there a need or necessary to scale up the production for Sanger instruments too? I am asking that is because lack of testing is a global issue, not only in the U.S. Africa/India together has 2 billion people are the testing hurdles there are even more challenging.

Re: We’re working on 1M Covid-19 testing capacity per day

#86

Post by billiontoone »

pjschlic wrote: post #79
billiontoone wrote: post #50

Earlier quoted context omitted.

If it is specific to COVID-19 testing, we will not seek anything, as long as the end-user is not financially benefiting from it or importantly, selling qSanger kits. If they need our bioinformatics automation & help with set-up, we would license the method for COVID-19 testing for $3-$5/sample as part of each sample that is being put through our pipeline. If they ask for 96-well plates with all reagents that are read…

When you say 'as long as the end user is not financially benefitting' - is the end user the lab conducting the test? You said in an earlier comment that the reimbursement for testing is too low to justify buying expensive equipment. You are also proposing to charge half the reimbursed rate for it to run on someone else's equipment. Are the current equipment owners expected to donate this crucial equipment, because if…

$15 is half the price of even the bare minimum qPCR kits (e.g., TaqPath). We need to buy the reagents from NEB, IDT, and others and work with a contract manufacturer to mix it into a reaction. Reagent, manufacturing, quality control, and fulfillment cost already add up to ~$11/reaction. That does not take into account any costs associated with developing the assay, supporting the assay, getting it through EUA, customer service, bioinformatics help. And we have to pre-pay for all of the reagent costs in the anticipation of the volume. I anticipate that we will likely end up net negative with this work, and even if it ends up being slightly net positive, it will not impact our valuation in a positive way.

The current equipment owners are already the clinical laboratories. It is unused capacity for them. Other owners are sequencing service providers. The full cost of running an end-to-end Sanger reaction as a provided service is $2-$6, so at the $50 reimbursement price, the laboratories will still be incentivized.

Re: We’re working on 1M Covid-19 testing capacity per day

#87

Post by mike_d »

dvdt wrote: post #75
sgw928 wrote: post #56

Earlier quoted context omitted.

A self-swab surveillance program has been launched in Seattle: https://publichealthinsider.com/2020/03/23/introducing-scan-... . Is self-swabbing allowed there because it's for research purpose, not clinical purpose? The program does tell users whether they test positive though.

My guess is that self-swabbing is allowed in the Seattle SCAN study because it is a research study. The SCAN study is super fascinating because it would be crazy unusual under normal times for a research study to return results back to patients; I'm very happy they are able to do that, and it speaks to the severity of this pandemic. The FDA has recently made clear that no at-home self-collection tests are allowed (fo…

> The FDA has recently made clear that no at-home self-collection tests are allowed

I think rightfully so. I was on a government video conference where a doctor showed the current CDC testing procedure, which involves stick a swab in the nose all the way to the back of the throat. They explained that the further the sample is taken from the lungs the less accurate it is.

Re: We’re working on 1M Covid-19 testing capacity per day

#88

Post by mike_d »

buzzkillington wrote: post #60
tbenst wrote: post #10

Thanks for your efforts! Inspiring to see our broader community spring into action. I was part of a volunteer team that tested 3400 people on Friday/Saturday in Santa Clara country for COVID-19 antibodies [1]. It took a team of 100+ volunteers 10 hours / day just to collect samples. Stanford, for example, has plenty of automated testing capacity, and even reagents. IMHO, the limiting factors are not that we need new…

I find it incredible that no one has done these studies before issuing the lock down orders. Without knowing what the proportion of people who have been exposed but aren't sick any response is the wrong response. If it turns out that it's already spread to most everybody lock downs are just a way to create more homelessness. If it turns out that the only people with the antibodies are the ones in the hospitals we nee…

These studies were done well in advance. Every bit of research we have about the 1918 Influenza points to social isolation being the only effective way to combat a pandemic.

Re: We’re working on 1M Covid-19 testing capacity per day

#89

Post by treis »

dvdt wrote: post #71
abhisuri97 wrote: post #53

Earlier quoted context omitted.

Hey, lowly Bio undergrad here, but how are you able to skip the RNA extraction step? I read the paper and you use the viral transport medium, but wouldn't you have to also purify RNA from that (or is it just much easier to extract RNA from that medium)? I also dived into the paper behind the "skip the RNA extraction step" methodology and it basically seems to swap out one RNA extraction kit for another (Qiagen RNeasy…

Thanks for the question! The goal of skipping RNA extraction is to decrease the amount of labor necessary for processing samples and also to eliminate a dependency on RNA extraction reagents that have recently become difficult to find. The FDA is very strict about the specific brand and model of kit you use, so showing that you can swap out one RNA kit for another is actually very useful because you will have allevia…

>the amount of viral RNA in a patient sample is too low to detect directly,

How many tests have you run on patient samples?

Re: We’re working on 1M Covid-19 testing capacity per day

#90

Post by 55555 »

dvdt wrote: post #2

I'm the co-founder and CTO at BillionToOne. I'm happy to answer any questions here. I've also posted a slightly more technical explanation of how the test works and why it can scale here: https://twitter.com/dtsao/status/1247642005510873088?s=21 Edit: Since our site seems to be overwhelmed at the moment, here's a recap: We’ve been working hard at BillionToOne on a new COVID-19 test that scales testing to everyone in…

Is answering questions on HN really a good use of your time right now?

Thank you for doing something about the pandemic. It's quite heroic.

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