COVID-19: Is universal testing really the way back?

I’ve really been trying to stay out of the controversy over this pandemic. Yes, it’s hard to stay mum when bad decisions roll out. But the situation has been far too urgent for me to allow myself to get wrapped up in speculation and finger-pointing.

But as I sit here thinking about everything that’s happened since this whole pandemic began, I’m not so sure I can continue ignoring the many developments that simply don’t make sense—at least not to doctors, public health experts, or scientists.

So, what gives? And who’s running this show? (Not medical personnel, I can tell you that…)

Holes in our strategy

We’re several months into this pandemic now, and here’s what I’m still seeing: a society that is locked down, terrified to go out, and afraid to see their friends and family members. Not to mention an economy that has ground to a halt with almost 40 million people unemployed. (And this is just the tip of the iceberg.)

What I’m not seeing is much in the way of reasoned, sensible strategies to guide us out of this mess.

All I keep hearing is test, test, test—or vaccine, vaccine, vaccine—as the only paths to recovery. But at the time of writing this, the country has performed about 6 million tests nationally, over one million of which were in New York State.

In fact, my home state is currently testing at five times the rate South Korea is—the current gold standard. Yet, we still aren’t “open.” Because testing isn’t enough according to the so-called experts. (Some are even calling for the entire nation to be tested!)

But let me tell you this—given the limitations of the tests we have today, universal testing isn’t going to be the salvation many seem to believe it will be. Why?

 Well, there are basically two types of coronavirus tests available: “RT-PCR” and “serologic” testing. And I’ll try to explain both as simply as possible…

Shooting in the dark

RT-PCR detects the presence of the virus itself. Positive results are highly specific and straightforward—but a negative test doesn’t prove that the virus isn’t there.

Serologic testing, on the other hand, looks for antibodies. As the disease continues to move through the population, this kind of antibody testing is going to be more useful. But it also has its limitations, because false positives and negatives are still possible.

In fact, you can take weeks to develop viral antibodies—and even then, they may be too low to detect. Or, the test may pick up antibodies from other coronaviruses (a phenomenon called “cross-reactivity”).

And even if the results are accurate, we still don’t know how long these antibodies last, or whether or not it even means you’re immune.

The “predictive value” of a test also matters, quite possibly more than any other factor. That’s why we don’t just give people chest x-rays or colonoscopies willy-nilly. Because if you don’t have risk factors or symptoms that warrant testing in the first place, a positive result is less likely to be accurate.

This is all just clinical common sense.

Now, don’t get me wrong: people who need tests must have easy access to them. But while universal testing may sound like a good strategy to light the way back to “business as usual,” there are still plenty of questions as to how useful it would actually be in practice.

Obviously, there’s a lot more to say on this topic, so we’ll dive a little deeper tomorrow. So, as always, stay tuned…

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“COVID-19: Why We Can’t Test Our Way Out of This.” Medscape Medical News, 05/06/2020. (