On Monday, House Speaker Nancy Pelosi decided to attack the Trump administration’s COVID-19 response by blathering about lack of testing for the virus again. According to the CDC, as of May 25, over 14 million tests have been conducted. Equally important, the national positive test rate is declining for the pandemic overall; the rate is 14.3%. For the week ending May 16, this had declined to 7.9% nationwide.
Testing Strategy
What Pelosi and her colleagues are criticizing is the national testing plan put forth by the Trump administration on Sunday. The strategy of the Coronavirus Task Force has always been to address the pandemic response in a locally-driven, state-managed, and federally supported way. This extends to testing.
The testing strategy has been discussed ad nauseam by Dr. Deborah Birx and Admiral Brett Giroir. Both of these individuals have decades of public health experience and have repeatedly tried to impress upon the press corps and the nation that testing needs to be data-driven. I have to guess Speaker Pelosi wasn’t listening to their comments.
Admiral Giroir went on further to explain the production and distribution of certain testing supplies would be managed through the strategic national stockpile. For example, testing swabs, something that the U.S. has not been in the business of producing until recently, will be managed this way as the team works with domestic manufacturers to ramp up supply.
Dr. BIrx has explained surveillance testing, repeatedly focusing on nursing homes, healthcare workers and vulnerable or underserved communities. This testing will be in addition to public health surveillance for flu-like illness and has already been added to the tracking on the CDC website.
I am not really sure who Speaker Pelosi wants to test. Most COVID-19 tests currently available take two days to return a result. This is a comparable turnaround time for most laboratory tests. Some settings have been given the machine for the rapid 15-minute test, but these are rare.
A Testing Surplus
Even the Washington Post has reported states have a surplus of testing supplies:
Four months into the U.S. coronavirus outbreak, tests for the virus finally are becoming widely available, a crucial step toward lifting stay-at-home orders and safely returning to normal life. But while many states no longer report crippling supply shortages, a new problem has emerged: too few people lining up to get tested.
Their survey of state health departments and governor’s offices show at least a dozen states where testing capacity outstrips the supply of patients to test. This is despite making testing easier and more available. Utah is only testing at about 1/3 of its capacity. Governors in Georgia and Oklahoma are encouraging people to get tested even if they are asymptomatic, but people aren’t showing up.
Despite the fact that Twitter polls are not scientifically accurate, I wanted to get a sense of what people thought about getting tested in the absence of symptoms or a confirmed contact. Perhaps the results explain the surplus of tests:
Quick Twitter poll for a story I am writing.
Would you get a test for COVID-19 in the absence of symptoms or contact with a confirmed case?
— Stacey – Gen X, Reagan Kid, Commies Suck (@ScotsFyre) May 25, 2020
The Value of Testing
Among the many clarifying responses I received, some said they would take a test if they had a very specific reason. A common one was they planned to visit a high-risk loved one and would test to protect that individual. Some users also shared they were required to take a test before an outpatient procedure or doctor’s office visit. This is a perfect use of testing and great method of disease surveillance.
Those who said they would not seek out a test said if they were asymptomatic thought the value of a test was minimal. Their disease status could change by the time they received a result. Randomly getting a test, just to see if you are positive at a point in time, is pretty much useless. Others expressed concerns about health data privacy and tracking.
Even Dr. Anthony Fauci has noted that the value of a negative test for COVID-19 is not very high. This differs from other diseases, such as HIV and tuberculosis, where a negative test is valuable because there is a specific set of things you can do to maintain your negative status. This is not true for contagious respiratory viruses like colds and flu—or COVID-19.
Many users indicated an interest in antibody testing. They report that they or a loved one had a respiratory illness that mirrored the symptoms of COVID-19 between December and February when testing was not widely available.
A Rational Testing Approach
Clearly anyone exhibiting signs of an upper respiratory illness needs to be tested and follow the self-quarantine guidelines until a result is received. They should not go to work or school until they receive a result and appropriate notification and tracing should take place if a positive result is obtained.
Until then, counties and states should be compiling and updating their testing plans as data is collected regarding local experience. They should work with Admiral Giroir and the members of the Task Force to ensure centralized supplies will be delivered in a timely manner.
States may want to consider the approach floated by Dr. Scott Gottlieb, former Director of the FDA. He proposed to have patients tested if they saw their regular doctor for any reason. It appears from the responses to my poll that some providers are taking this approach already. In this circumstance, Dr. Gottlieb proposed a need to do about three million tests per week.
According to the Washington Post article, we are currently doing about 330,000 per day with excess capacity existing in many places. This puts Dr. Gottlieb’s approach well within striking distance. It also puts testing in the hands of an existing doctor-patient relationship with health data privacy protections.
I am not sure if Speaker Pelosi thinks we need to pin people down and shove a swab up their nose at random before entering public places. But the testing canard really needs to be put to bed. It is just another way for Democrats to move the goalposts from slowing the spread to something else.
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