America Needs Consensus on COVID-19 Testing

Americans are understandably impatient with the continued COVID-19 restrictions on their lives and livelihoods. For weeks, they’ve been told that testing is key. Only by developing a coherent approach to testing for COVID-19 to guide decisions at the state and local level can policymakers improve public confidence.

In the early days of the pandemic, inadequate testing for the novel virus resulted in a fragmented public health response. Public officials and medical experts did not have the data needed to understand the prevalence of the disease resulting in widespread lockdowns. The testing landscape, however, has improved dramatically over the last few months.

While some strides still need to be made with logistics in certain areas of the country and with communal populations, for the most part, Americans who need a test are now able to access one, and data is now being reported that provides a clearer picture of how the virus spread.

Federal, state, and local officials are working together to ensure testing goals are met monthly. The majority of states are also meeting the WHO’s benchmark for testing adequacy. But for those states that are not, a coordinated testing program is needed that balances feasibility, scalability, manageable cost, availability and practicality. To be effective, the plan must be easily understood by the general public and widely accepted.

Until a vaccine or therapeutic is found, combatting COVID-19 will require continuous use of efficient and effective clinical testing, the use of alternative testing methods, and renewed public confidence in the testing program.

Policymakers should consider the following steps:

• Outline the types and goals of clinical testing. Clinical testing for the virus includes both diagnostic and serological testing. The goal of testing is for diagnosis and determining possible exposure. Identification of those with the disease, those who may have had it, and random test sampling are critical to guide public health decision-making and control the spread. Rapidly changing local conditions may require deployment of surge response teams with clinical testing capabilities for communities or populations in hotspots.
• Define parameters for clinical testing. Generally, the candidates for clinical testing are individuals with symptoms and those with resolved but untested COVID-19-Like-Illness or probable exposure. Frequent diagnostic testing may be warranted to prevent asymptomatic spread in high-risk locations such as nursing homes. With reports of nursing homes accounting for upwards of 60-80% of all COVID-19 fatalities in some states, rapid testing and screening of workers prior to shifts may be necessary to minimize risk.
• Meet testing benchmarks for decision-making. The World Health Organization (WHO) and other medical experts recommend using positivity rates to determine testing adequacy. Positivity rates are determined by the percentage of positive diagnostic tests in relation to the number administered. The WHO set a benchmark at under 10% to determine if a country or location’s testing capacity is adequate to contain the spread. Other metrics used include prevalence of COVID-19-Like Illness, hospitalizations, positive tests, recoveries, and deaths. If positivity rates are approaching or exceed established benchmarks, state officials should be ready to rapidly pivot mitigation strategies and raise awareness of public health measures by increasing public service announcements about local disease threat.
• Use alternatives to clinical testing to monitor community spread. Random sampling of people, populations, and surfaces can provide additional data. Public officials should consider deploying wastewater-based epidemiology. The prevalence of the SARS-CoV-2 virus in wastewater could prove a valuable resource for monitoring of communities, schools, and businesses and alert public health officials to possible hotspots.

Coordinated state testing programs guided by a national testing strategy and public understanding of the reporting system will bolster America’s comeback – safely returning American’s to their lives and livelihoods.

Dr. Amy Anderson, DNP, RN is a professor in the schools of nursing and medicine at Texas Christian University and the University of North Texas Health Science Center and a former Graduate Health Policy Fellow at The Heritage Foundation.