Coronavirus testing: Insane in principle, a fiasco in practice

Someone really needs to explain why we are obsessed with testing sick people, healthy people, vaccinated people, unvaccinated people, travelers, workers, and more, even if they have little to no risk for serious disease, the results come in after a person is recovered, and the tests can’t tell us whether a person is spreading the virus.

Tests, tests, and more tests has been the mantra from public health professionals since the start of the pandemic.  We test sick people, healthy people, vaccinated people, unvaccinated people, travelers, workers, and more with the underlying goal being whoever wants a test or needs a test, sometimes those needs are mandated by laws and regulations, should have a test, instantly, anywhere, at any time.  We lambasted former President Donald Trump for not producing enough tests fast enough, and criticized current President Biden in November and December when testing capacity failed to meet the Omicron surge.  The criticism was so severe, the administration reacted by launching a website where Americans can order even more tests and ultimately masks as well.  The new portal went live on Wednesday at www.covidtests.gov, promising that every household can receive up to 4 tests free of charge, a total of some 500,000 million, provided they can wait until at least late January to receive the shipment.

Amid all this mania over testing, rarely does anyone stop to ask:  Why are we doing this and what are the costs?  I think we can all agree that testing makes sense for therapeutic purposes.  Knowing a patient, especially one in a high risk category, either elderly or with comorbidities, is positive can help ensure caregivers are providing an optimal treatment plan and ensure the best possible chance of a speedy recovery.  Further, patients that can test at the earliest possible onset of symptoms will be more empowered to take action with their caregiver sooner rather than later.  There is also some obvious value in testing individuals exposed to the virus by close contact with an infected person.  This would be especially critical for healthcare and other workers that regularly deal with the high risk community, protecting their patients and other people they come into contact with that might be more susceptible to serious disease.  The utility here, however, starts to fade when the contact with an infected person isn’t that close and the person that was exposed has limited contact with the vulnerable.  Regardless, it strikes me as a reasonable enough precaution to ensure exposed individuals can easily determine whether or not they are infected.  There might even be some value in randomized testing to determine levels of community spread, the equivalent of polling the virus to see how much is out there and where.

Unfortunately, the goals and mandates of our current testing regime have gone far afield from anything resembling those basic needs and benefits, straight into the realm of the unrealistic and counter productive.  Instead, we’re actively encouraging testing for the sake of testing, regardless of symptoms or exposure in many if not most cases.  There are colleges across the country, for example, that require the weekly testing of healthy, fully vaccinated students for purposes that are completely unspecified and objectives that are entirely unclear.  According to The Philadelphia Inquirer, Temple University plans to conduct 20,000 tests per week this semester.  Likewise, the University of Pennsylvania plans 40,000.  Penn State is all in as well, and the same story is playing out across the country.  How crazy has it gotten?  The University of Utah is actually offering tests through vending machines.  “Our public health leaders started planning for the return to campus, and the spread of the omicron variant, at the end of fall semester,” Rebecca Walsh, a spokesperson for the school, told McClatchy News.  Currently, they offer nine of these self-service sites.  “A self-serve testing program became a pivotal part of our efforts to preserve the health and safety of our campus with omicron’s rapid spread and the potential prevalence of asymptomatic infections,” she added without mentioning the tests themselves are almost useless for those types of infections, more on that in a moment.

These colleges are mandating this rigorous and intrusive testing even though college students in general are one of the least susceptible groups to serious disease.  Since the start of the pandemic, the CDC reports that 5,241 people aged 18-29 years old have died from and with coronavirus, compared to 124,575 that have died from other causes, meaning students almost 25 times more likely to die from something other than the virus.  In total, people aged 18-29 account for less than 1% of total coronavirus deaths, numbers that barely register compared to older, much more at risk Americans, and yet colleges are busy replacing soda and snacks with test kits to slow the spread or something. Contrary to the parlance in the media, these tests aren’t “free” either.  In most cases, they might cost nothing for the individual taking the test, but the schools cited by the Inquirer are spending millions of dollars on their respective testing initiatives.  Temple expects it to total some $9.8 million; U-Penn $20 million. There is another, hidden, far more insidious cost as well:  There isn’t an unlimited supply of tests.  They don’t appear from the ether when needed, nor can they be reused.  Every test a student takes on a college campus is one that can’t be used for a healthcare worker or an elderly patient.

In other words, we’re proudly reporting that we’re squandering our capacity on people that don’t benefit in any measurable way, for reasons that are entirely unclear.  Nor are colleges alone on the endless testing bandwagon.  Many private companies and government institutions are also mandating similar regimes, requiring both vaccinated and unvaccinated employees to provide the results of their testing on a regular basis, further depleting much needed capacity. In addition, taking the actual test is just one half of the capacity required to produce the results.  Many tests, including those of the highest quality like PCR, need to be processed in a lab, another limiting factor.  Recently, the wait time to receive these results has skyrocketed to 5-7 days and people are frequently learning they were definitively positive for the virus only after they’ve already recovered from the infection and any chance to improve the treatment plan has been lost. Even worse, there are serious questions about the effectiveness and accuracy of these tests in general.  Many were surprised to learn last December that the popular, much-touted PCR tests can show positive results for up to 3 months after a person has fully recovered. In addition, these tests appear to have no value in determining whether or not a person can infect others, making them unsuitable for any attempt to slow or stop the spread.

If you don’t believe me, CDC Director Dr. Rochelle Walensky recently confirmed both points herself, telling Good Morning America that using PCR tests to determine a patient is no longer positive for the virus wasn’t “viable” because it will pick up mere traces.  “So we would have people in isolation for a very long time if we were relying on PCRs,” she explained.  Later, she told CBS Mornings, “We know it performs really well during that period where you’re initially infected, but the FDA has not at all looked at whether … your positive antigen really does correlate with whether you’re transmissible or not,” meaning we’ve been turning up millions of positive tests, assuming it meant the person could become a “super spreader” without any actual evidence that’s the case.  Further, Dr. Walensky seemed surprised that people were confused by these developments, claiming “This really had nothing to do with supply. It had everything to do with knowing what we would do with the information when we got it,” but “What we do know is about 85 percent to 90 percent of viral transmission happens in those first five days, which is why we really want people to stay home during that period of time.”  That may well be true, but what good is a result 6-7 days later in that case?

Incredibly, the rapid tests the Biden Administration is pushing through their new online portal are even less reliable.  “A single rapid test isn’t really useful unless you test positive. If you test positive, yes, indeed you are truly positive,” explained Dr. Thomas Unnasch, global health and infection disease researcher at USF Health. “But if it comes up negative, there’s a two-in-ten chance that was a false negative and you were actually positive.”  Two in ten is 20%, meaning these tests are missing huge numbers of infected people, wandering around, potentially spreading the virus, thinking they’re negative.  Still, Dr. Unnasch claimed he would rely on these tests for some reason, even as he recommends equating a sniffle with a positive result and says that you should act as if you are infected even with a negative result.  “No. I would rely on the rapid tests. Even if you can’t get the rapid test, if you’re symptomatic with any sort of cold symptoms, I would just assume at this point that you’ve got the omicron variant and just stay home for five days then mask for five more.”  It gets worse:  These rapid tests are apparently next to useless for asymptomatic people, working barely 60% of the time.  “If you’re not symptomatic and you have no reason to think you were exposed getting tested is just as good as flipping a quarter so you might as well not even do it,” explained Dr. Unnasch.  If you aren’t confused already, Fox13 News summarized the approach, “If you’re worried about an exposure, Unnasch says get yourself tested three days after the exposure to a confirmed case, then, if a rapid test comes back negative, test again on the fifth day from exposure.”  Got it?

I understand that I’m not a public health professional or expert, but I consider myself a fairly rational thinker and reasonable individual.  Yet, I can make no sense of this:  If rapid tests aren’t going to show positive results for up to 5 days after exposure and two separate tests, what is the benefit to slowing the spread?  Presumably, you should be quarantined for that entire period.  If rapid tests are no more effective than flipping a coin for asymptomatic people, why would anyone take one ever?  If the more accurate PCR tests can show positive results for three months, why would we ever have recommended waiting on a negative result?  If you should assume you are positive, why bother testing at all?  If neither test really has anything to do with spreading the virus, why do they want to test so many people in the first place?  This is especially strange considering that positive test results are published on a daily basis as if they were completely reliable, spreading panic as cases ebb and flow.  It’s almost as if that’s the point, but that would be a conspiracy theory, wouldn’t it?

All this, and yet President Biden’s big plan is to ship some 500,000 more unreliable rapid tests to Americans by sometime in February, even as cases appear to be plateauing or even going down.  To be fair, the administration plan, as useless as it will likely prove to be, is merely a response to the long-running obsession with tests.  President Biden didn’t start this fetish, but given the above, he should certainly end it. Alas, he is unlikely to: An obsession with vaccines, models, and an unrealistic belief in our ability control nature has been a hallmark of our entire pandemic response, to all of our detriment.

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