COVID-19 can be a deadly disease, especially for higher-risk populations like the elderly. Making matters worse, it’s hard to tell when someone has COVID-19 and is infectious. When infection is suspected, being able to quickly and accurately determine whether or not someone is infected is crucial to making informed decisions about whether to self-quarantine or go about your life using other risk-mitigation measures.
Unfortunately, confusion remains over basic questions like who to test, when to test, and what to do when you get a result.
Indeed, the Centers for Disease Control and Prevention have issued conflicting guidance on testing, and have not kept up with evolving test technologies that allow for better, faster screenings of sick individuals.
Last week, the Trump administration embraced rapid tests, which provide results in 15 minutes for $5. That’s a major improvement over prior tests, which take a while to produce results.
It’s also a major advancement because it allows us to use tests as screening tools to help people know when to stay home. Screening tests serve a different public health purpose than diagnostic tests, because screening tests are intended to identify who is potentially contagious as opposed to establishing a diagnosis.
To date, we’ve essentially been using diagnostic tests for screening purposes—a very inefficient use of these tests. But these new rapid tests are suited perfectly for a large variety of situations and scenarios.
These developments make it all the more critical for public health officials to provide concrete guidance on testing.
Without concrete guidance, every institution, every organization, every place of business and congregation will be left to develop protocols based on their best interpretation of often contradictory information using expertise they lack.
Here’s what we need to know:
Who should get tested, and when?
Here, the CDC’s guidance falls short. They advise people to seek a test if they have symptoms of COVID-19, or have spent 15 minutes or more within 6 feet of someone who is confirmed to have COVID-19. The problem with this guidance is it doesn’t take into consideration the environment this contact took place in, nor the people involved.
After nine difficult months, we know that not everyone faces the same risks from COVID-19, and some need greater care and protection. To provide more clarity, former CDC director, Dr. Brenda Fitzgerald, recently suggested the following guidelines:
- “Americans in long-term care or nursing homes must get regular, frequent testing.
- “Before a high-contact situation (e.g., on an airplane or in a theater), Americans should get a rapid screening test first to increase safety and reduce fear.”
- “For routine situations of possible contact (at grocery stores, for example), Americans don’t need a screening test if they feel well, but they should wear a mask or face covering, and wash hands or use hand sanitizer.”
What do we do with when we get a negative or positive result?
There’s little question as to what to do with a positive COVID-19 test result—immediately isolate and seek medical advice. But what about a negative test result?
Here, too, the CDC’s current guidance leaves much to be desired. The CDC’s website gives at least two different answers. On one CDC webpage, testing negative for COVID-19 means that “you probably were not infected at the time your sample was collected. This does not mean you will not get sick,” and “if you have symptoms later, you may need another test.”
However, a different CDC webpage takes a much more cautious approach, stating “even if you test negative for COVID-19 or feel healthy, you should stay home (quarantine) since symptoms may appear 2 to 14 days after exposure to the virus.”
It’s not incorrect to be extra cautious with self-quarantining after a known exposure to the virus, but the reason given by the CDC does not make sense. The purpose of testing for COVID-19 is to inform personal health decisions. If an otherwise healthy person should quarantine for two weeks regardless of test result, why obtain the test?
It would make more sense to allow persons with suspected exposures, but with negative test results, to “test out” of quarantine. In the months since the pandemic hit America, we have built an enormous testing infrastructure that can run over a million per day. We should not ignore those results but let them inform our decision making, who should test and when, and what to do with the results afterward.
Ultimately, we need clarity from the nation’s top public health officials. President Donald Trump rightly focused his administration recently on leveraging rapid testing. He needs to take the next step—now—and immediately directly his team to come up with better answers, so the full power of our testing capabilities can be leveraged.