We don’t need mass testing to reopen the country. Actually, we do. Reopening depends on our ability to transition from population-wide mitigation — which is what social distancing does — to individual-level containment. That means we must identify each individual with covid-19 and then trace and quarantine their contacts. This requires mass testing. In addition, one of the White House’s guidelines for reopening the country is a downward trend in infections. We can’t know that the numbers are going down unless we have an accurate daily count, which can only be obtained through widespread testing.
Mass testing will also provide the reassurance that many need to resume normal activities. Having enough tests to regularly check employees, students and teachers would help provide confidence that we can resume work and school. And imagine if all patients receive a test before they enter the hospital, and those who test negative will then receive care in a separate ward from those who test positive. Patients would not be so frightened to seek care for ongoing medical issues such as cancer, pregnancy or heart disease, and hospital staff could also conserve needed personal protective equipment.
A person could test negative today and contract the virus tomorrow. That’s true for any infectious disease — or indeed, for any illness. We don’t stop screening people for HIV or diabetes because they could develop the disease later. At the time of testing, people can be given guidance about limitations of a negative test.
Tests are not 100 percent accurate. Again, this is true for every test. To be sure, we need to develop tests that have as high a degree of accuracy of possible, and the federal government must stop fraudulent tests from coming on the market. But perfect cannot be the enemy of the good. We don’t stop doing tests for other diseases because there is a risk of false positives or negatives.
It’s not just testing that we need to reopen society. It’s true that there are other key components, such as the public health infrastructure to conduct contact tracing and social supports to isolate those are affected. But testing is the linchpin. We must know who is testing positive before we can identify their contacts and quarantine them. Just because other components must also be present doesn’t change the necessity of testing.
We shouldn’t focus on manufacturing one test because there are other tests being developed. There are two main types of tests: the PCR swab test that identifies people who are currently infected, and a blood serology test that looks for who has been exposed and, therefore, has antibodies to covid-19. Most public health experts agree that both types of tests are needed, but that the most urgent test that must be mass-produced is the PCR test — and ideally one that can produce results within minutes. The fact that the serology test is also being manufactured doesn’t replace the need for the PCR test; indeed, both should be produced and deployed in large numbers.
In lieu of testing, there are other ways of doing surveillance by looking at the rate of influenza-like illnesses. Waiting for hospitals to register an increase in the number of visits for flu-like symptoms is acting too late. Two weeks could pass before a patient who contracts covid-19 ends up in the hospital; the key needs to be prevent the spike in illnesses through early detection. In addition, some studies suggest that most people with covid-19 may never develop symptoms but can still transmit the virus to others. The rate of flu-like illnesses is, at best, a proxy for when mass testing cannot be done, but it does not replace the need for it.
We don’t need to test every single American. Why not? If everyone is at risk for contracting covid-19, everyone should be able to get tested — and not only once, but many times if needed. We routinely screen people for high blood pressure. We encourage everyone to be tested for sexually transmitted infections. There is no limit to the number of times people receive these screenings. Why shouldn’t everyone have access to covid-19 testing, too, when they want and need it?
The bottom line is that there are many reasons for the United States to implement mass testing. The Trump administration needs to stop coming up with reasons for why we don’t need tests and instead get to work on a national strategy to secure the millions of tests needed every day. It is a daunting task, but as a country, we can rise to meet the challenge. Our health — and our economy — depends on it.