We made a mistake at first with how we talked about masks. We’re making the same mistake now with tests.
The discussion on these issues highlights the different ways clinicians and public health experts think. Clinicians — doctors, like me — treat patients one at a time. Our responsibility is to that individual. This is the thinking that led many of us to focus on only the most effective N95 masks at first. We knew we didn’t have enough for health care workers, and we knew that homemade masks wouldn’t work as well in the office or hospital. So we told people not to use them. Back in February I asked people on Twitter not to “waste” masks, to “leave them for those who have a real need.”
Of course, now we know that messaging was wrong. I should have leaned more heavily on my public health training. Public health experts focus more on huge groups, not individuals. They don’t need masks to work perfectly for everyone. They’re thrilled to see a smaller benefit in a larger population. And there are models showing that if masks are about 60 percent efficient, fewer than three-quarters of people would need to wear them to keep a disease like Covid-19 in check.
Today we’re in danger of making the same mistake with tests. Many schools and colleges are hoping to test students often to keep any transmission in check, and frequent testing of big groups of people may be the only way to stop this virus, short of a vaccine. It’s clear that the gold standard for diagnosing infection is a sample obtained by a nasopharyngeal swab followed by the identification of viral RNA through a polymerase chain reaction (or P.C.R.) test. The swab is uncomfortable, the test is slow, and the supplies to perform it are in short supply.
Because of that, many clinicians are arguing we need to save these tests for the sickest. “It really is not going to be feasible in probably most areas of the U.S. to try to put together some type of testing strategy where you’re testing multiple times, especially if the results don’t come back for a while,” Dr. Tina Tan, a board member for the Infectious Diseases Society of America, told The Hill. “You’re using critical resources that could be better spent in other places.”
But this kind of test is not the only one that can identify infected people. We don’t have to collect samples by nasopharyngeal swabs. We could swab just inside the nose. We could even test saliva.
Tests that collect samples this way may be less precise. But they could be collected really quickly, in large groups, with minimal supplies. They could even be collected by individuals themselves in their homes. We could do tons of them.
We could also pool tests. In many areas of the United States where Covid-19 is not prevalent, you could mix samples and run them together. If a pooled sample tests negative, you can assume no one person in the pool is infected and move on. If the pool is positive, you have to run the component samples from each person. Because most pools are likely to be negative when you’re testing asymptomatic people, you can test many more people while saving a huge amount of resources. Brett Giroir, the assistant secretary for health at the Department of Health and Human Services, has proposed beginning such testing.
Some companies are even making rapid antigen tests that can easily be done outside a lab. These tests look for certain proteins in the virus instead of genetic material. The problem is that they can miss more infections than a P.C.R. test. But they take only about 15 minutes to get a result, and if you run them in batch mode, you could most likely do more than 50 an hour. It’s not hard to imagine settings, like schools or sports teams, where such tests might be incredibly useful.
Public health experts, though, see the benefit of such tests on the entire population. They know they won’t pick up everyone who is infected, which is why we all still need to rely on social distancing, hand washing and ubiquitous masking. But every single case we identify is better than not. We can isolate that person from the population and prevent infections. That’s how we minimize risk. That’s the goal of public health interventions.
Moreover, study after study shows that for surveillance and mitigation, what matters most is the frequency with which we test people, and the speed with which we can act on results. The P.C.R. tests in short supply that are taking a long time to return an answer will not help us in this effort.
We have to start accepting less accurate, widespread testing for groups. We have to stop muddling the messaging by focusing only on the most effective tests. With testing, just as with masks, more is sometimes better than perfect.
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July 28, 2020 at 04:00PM
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There Are More Coronavirus Tests We Could Try - The New York Times
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