COVID-19: Why smarter testing will make for a safer reopening

Earlier this week, I mentioned research showing that New York City may have a 20 percent prevalence rate of COVID-19 infection, as of the end of April—with many, many asymptomatic people among that group.

If this figure is accurate—and I realize that’s a big “if”—it means that in less-affected areas, infection rates are likely to be less than half that of New York’s. So, what does that mean?

Well, keep in mind what I said about “predictive value.” If we were to widen our nets and include asymptomatic and low-risk people in our testing efforts—already knowing that the majority are unlikely to have contracted COVID-19—we only risk degrading our data and muddying the waters further.

That’s why widespread—much less universal—testing isn’t necessarily the magic bullet it appears to be. And it’s not the only questionable exit strategy on the table, either…

Contact tracing can get messy, too

As I’m sure you’ve heard, there’s also been a hard push for widespread contact tracing before lockdown measures are lifted. And again—it makes perfect sense on the surface. But a closer look reveals some pretty serious flaws with this strategy, too.

Aggressive contact tracing has a clear purpose—to follow the vector of a disease. And it works especially well for communicable illnesses with clear lines of infection, like sexually transmitted diseases (not coronaviruses).

In medical school, I actually had a part-time job as a contact tracer. But the world is definitely a different place now.

These days, we have technology to help us identify people who should be quarantined, in the form of app-based or Bluetooth tracing from the geniuses at Apple and Google (who, let’s face it, already have more of our personal information than they ought to).

In order for this to work, though, more than half the population would need to have one of these contact tracing apps installed on their phone. And it’s not hard to see the concerns with this. (I don’t know about you, but I certainly don’t want big brother watching me any more than they already are.)

Even in Singapore—a place that, culturally, is much more likely than the U.S. to toe this kind of line—they could only convince about 20 percent of their citizens to install the TraceTogether app.

And even there, despite being a small country of only five million, they required a widespread lockdown to control their outbreak anyway.

There’s also the issue of “false positives” with this form of contact tracing. Bluetooth, for example, could incorrectly register neighbors in apartments buildings or random passers-by on the street as contacts. (Even if you’ve never interacted with these people in your life.)

The truth of the matter is, we love to throw money at technology in the hopes that it will make our lives easier. But if you ask me, the potential for disastrous bungles here is far too high to waste precious resources this way.

A final word on widespread testing

The folks in charge—or at least some of them—seem to want higher rates of testing because they think it will translate to lower rates of death. But that simply isn’t so.

I’ve written many times about the risks of mistaking correlation for causation. And it’s something we should all be wary of in the face of so many unknowns.

Sure, there’s a correlation between higher testing and lower mortality. But we wouldn’t build a recovery plan around black uniforms just because of a correlation between dark clothing and survival. And this situation really isn’t any different.

A country’s level of testing is just one factor behind their ability to control their epidemic. (And that’s assuming that their statistics are even accurate in the first place.) Other, equally important issues are also in play—size, population density, and social policies being among the most important.

So, here’s where I stand: I firmly believe in the critical importance of testing—you know that by now. Even within my own clinical practice, I like to test for everything.

But more testing isn’t going to be the key to recovery if we’re not also performing the right tests on the right people, in order to accurately track the spread of community outbreaks as we begin to ease lockdown measures.

In other words, universal testing may not lead our country of this national nightmare. But a targeted and well-coordinated testing campaign? In my opinion, that is the only way toward a truly safe reopening.

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