Can We Have a Word About Insisting on 5M Test Per Day Before We Can Reopen?

Now that many COVID-19 hotspots have a declining number of hospital and ICU admissions, attention is turning to how we lift the restrictions that were put in place to slow the spread. Note, I said slow the spread. Nothing about the last six to eight weeks is going to stop the spread of the virus. No one ever said it would.

Yet we see state and local leaders continuing to extend restrictions and double down on stupid programs like snitch lines so you can tattle on your neighbors. Many are citing a lack of testing for COVID-19 as reason to delay. Governor Gavin Newsome has said a capacity for California to conduct 25,000 tests per day is the minimum to begin considering reopening. Many governors have gleaned on to a Harvard study funded by the left-leaning Rockefeller Foundation. This says the United States must ramp up to five million tests per day and increase to 20 million tests per day to safely reopen. This is patently ridiculous for a number of reasons.

According to an interview with former FDA Director Dr. Scott Gottlieb, adequate testing is probably about 3 million tests per week. He shared that the nation has about 3.8 million primary care visits per week. He posited that for a period of time testing a significant number of these patients could be a good form of sentinel surveillance. These visits occur nationwide and include people without symptoms. Broad-based testing in the physician’s office would identify asymptomatic carriers as well.

This type of monitoring is what the health experts on the Coronavirus Task Force have been referencing. The purpose is to identify outbreaks early so that case-based interventions can be implemented. According to Dr. Gottlieb, contact tracing and quarantine can be done for 100s of cases in an affected community through the public health system.

To date nationwide, 18.1% of people seeking a test have tested positive. So even those with symptoms or an exposure actually have COVID-19 less than 20% or the time. To put it in perspective, 0.2% of Americans have been diagnosed with COVID-19. To date, the U.S. has conducted just over 5 million tests.

Yet some are using a benchmark of 5 million tests a day to reopen safely? And that that number needs to increase to 20 million? Who exactly are they going to test if only about 3.8 million a week have contact with their primary doctor? Will we have to pass through testing zones at public places? Be forced to get a fingerstick to enter work?

Dr. Fauci gave a great explainer during one of the press briefings about the value of COVID-19 testing. On an individual level it is almost nothing if you test negative. He compared it to HIV testing. With HIV, if you test negative for the virus there are a specific set of behavior you can avoid and be confident you will remain negative because of how the virus is transmitted. There is actual value in knowing your status in that case.

In the case of a highly contagious respiratory virus, the test is only good at the point in time it was collected. An individual’s status could change almost immediately if they encounter the virus in their environment. And as asserted by California physician Dr. Dan Erickson, due to the presence of fomites that come into our homes, it is highly likely COVID-19 is present just about everywhere.

If I walked into my physician’s office where they were doing bloodwork for annual check-ups or I had the symptoms for an upper respiratory infection, I would expect to be tested for COVID-19 or the antibodies. I strongly reject the notion of mandatory testing for what amounts to 6% of the U.S. population daily. These kinds of requirements are near police-state tactics that will be exceptionally costly to a national economy under distress.

They are especially ridiculous when there are systems and methods in place to monitor for respiratory illness. This happens every year for influenza and other flu-like illnesses. That system can be enhanced and expanded to monitor for COVID-19 and use case-based interventions that Dr. Gottlieb calls the bread and butter of the public health system.

There is simply no reality where 20 million tests a day meet the cost-benefit hurdle. Even if you take the highest assumption for asymptomatic cases at 50%, that would mean 0.4% of Americans have had COVID-19 today. Also, repeated testing of the asymptomatic population for COVID-19 is an exercise in futility.  A better strategy would be to get widespread antibody testing so we know how far the virus has actually spread in the population.

We also know what the disease experience looks like. Undoubtedly, the strategy presented by Dr. Birx, Dr. Redfield, Dr. Hahn and Dr. Gottlieb to monitor high-risk populations like nursing homes and inner cities while testing those who see their doctor for other reasons is both effective and meets the cost-benefit standard. Five million tests a week, not a day, should be more than enough.