Politics & Policy

Testing Can’t Solve Everything

A medical professional conducts tests for the coronavirus in Bolinas, Calif., where all residents are being tested for the coronavirus and its antibodies, one of the first such efforts since the pandemic hit the U.S. three months ago, April 20, 2020. (Kate Munsch/Reuters)
We should be grateful to those who have emphasized it, because their efforts have yielded real, positive results. But it’s only part of the puzzle.

 As the coronavirus pandemic drags on, the United States is slowly, steadily building something resembling a national testing regime — or at least 50 state testing regimes.

For months, we’ve heard that “testing, testing, testing” is the key to reopening society and the economy. The clamor for widespread testing has obscured the fact that being informed about whether someone has the coronavirus is only part of controlling the spread; sound judgment in acting on that information is critical, too.

Start with the good news: The U.S. has a lot more tests to work with than it did a month ago, and the supply of tests is continuing to expand. The country is now conducting between 300,000 and 400,000 tests per day, and hit 411,235 tests Sunday. The Food and Drug Administration has given 76 companies and institutions “emergency use authorizations” to develop and manufacture tests for the coronavirus. This has generated an enormous demand for the materials and component parts of tests.

The Bath Iron Works shipyard is manufacturing more specialized machines so that Puritan Medical Group can double its production of swabs from 20 million per month to 40 million per month. (Puritan is the only company in the U.S. that makes the kind of long, flexible swab that is ideal for coronavirus testing.) Thermo Fisher Scientific is making more than a million “viral transport media” tubes per week, and has plans to scale up production to 8 million per week. Roche is making 15 million tests per month and has already started shipping a new antibody test to leading laboratories, with plans to ramp up production of the latter dramatically. Abbott Laboratories is “currently manufacturing 50,000 tests per day, plan[s] to increase ID NOW manufacturing capacity to 2 million tests a month by June and [is] working to expand beyond that.” Quidel unveiled its own ten-minute test Monday, and has been making 150,000 per day.

The supply of tests has grown to the point where places such as Virginia, South Carolina, and Colorado are offering free tests to just about anyone who wants one, although Colorado asks that only those showing symptoms get tested. In fact, we now have unused testing capacity in some places. New York governor Andrew Cuomo said Sunday that some testing sites with a capacity to conduct 15,000 tests per day are only testing 5,000 per day.

All of these numbers sound large, until one remembers that there are roughly 253 million American adults. Thankfully, we won’t need to get everyone tested all at once. Our priority will be sufficient regular testing for those at the highest risk of exposure: medical doctors and hospital staff, emergency medical technicians and ambulance crews, policemen, firemen, and just about anyone else whose job requires them to interact with the public a great deal. Considering the terrible toll of the virus on nursing and assisted-living homes, their residents and staff should also rank among the highest-priority groups.

Once the highest-priority personnel are covered, we will probably want to move on to all of the essential workers in supermarkets, pharmacies, agribusinesses, warehouses, and other companies operating through the pandemic. (Two easily overlooked categories: sanitation workers and those who work in wastewater or sewer systems. The virus has been found in untreated wastewater, though the CDC doesn’t know of anyone who has caught it that way.)

So far, so good: Our testing capacity continues to increase, and we have a general idea of who should be tested regularly once it’s feasible. But big questions still remain.

Abbott’s ID NOW COVID-19 test is designed to give results in five minutes. Quidel’s, as noted above, is meant to give results in ten. Some studies have argued that the error rate on the quick tests is higher. Abbott contends that those conducting the studies waited an hour or two between collecting each sample and testing it, and insists that when its quick tests are used properly and as directed, they have a consistently high rate of accuracy. If a person is tested using the slower methods, the sample has to be shipped to a lab and processed with reagents, which usually takes a few days but can take considerably longer if there’s a backlog. Right now in Los Angeles, the average turnaround time at county-operated testing sites is about three days. The Cleveland Clinic says it can get test results for those in hospitals within 24 hours, and for those using its drive-through facilities “within a few days.”

What’s more, even assuming that the new, quicker tests are reasonably accurate and enough of them can be produced to go around, a test can only tell you whether or not someone had the virus at the time the sample was taken. If a test conducted on Monday comes back negative on Thursday, the patient could still have caught the virus on Tuesday or Wednesday. Ideally, we would be testing regularly or even frequently, but members of the public are likely to lose patience with the process of having a swab jabbed far up their noses on a regular basis. One of the concerns about the potential for self-administered coronavirus tests is that people won’t collect good samples, because they don’t like the discomfort of keeping a swab deep in their nasal cavity for several seconds.

Then there’s the question of how well people will self-quarantine after being informed of a positive test result. The good news is that most people mean well, don’t want to spread the disease, and will generally follow a doctor’s instructions. But even well-informed individuals can conclude that they know best and make reckless decisions. Back in 2014, NBC News’ chief medical correspondent, Nancy Snyderman, traveled to Liberia to cover the Ebola outbreak, and a photographer on her team caught Ebola. Snyderman was supposed to remain in her home for 21 days upon return. She left her house and went out for soup after about a week.

Early on in the outbreak, a Missouri father took one of his daughters to a dance . . . and while there, he got confirmation that his other daughter, who had stayed home, was positive for the virus. A Kentucky woman who tested positive for the coronavirus was arrested after she violated an order to self-quarantine. In Hornell, N.Y., a person who tested positive broke mandatory quarantine to visit a pizzeria. This doesn’t mean that testing isn’t worthwhile, but it means we should recognize that good actions do not automatically follow from good information. We’re going to have some people who test positive and decide to go out anyway.

Picture an America where, by the end of summer, those in high-exposure jobs are being tested twice a week, and those less likely to be exposed are tested once every two weeks. The vast majority of those who test positive agree to self-quarantine for two weeks and then actually do it. The average number of people who catch the virus from each infected individual, already below one in almost every state and at or just above it in two, would drop even further. We would be still living with risk, even as we largely went “back to work.”

This would be a significant improvement, but we wouldn’t be out of the woods! We’d still have to practice social distancing as needed, minimize our time spent in enclosed spaces with lots of strangers, probably wear masks, and remain concerned about the elderly and the immunocompromised. Sporting events, concerts, conferences, campaign rallies, and other events involving large crowds would still be discouraged. The harshest restrictions of the quarantine would be gone, but we wouldn’t be back to “normal,” if by “normal” one means “where we were before the virus hit our shores.”

None of this is meant to dash hopes or rain on optimists’ parade. We should be thankful to those who’ve spent the last few months hammering home the “testing, testing, testing” mantra, because their efforts have yielded real, positive results. But testing was always going to be only part of the puzzle. At the end of the day, it’s likely that there remains a long road ahead of us.

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