It’s not about being sick: Why we need to test more healthy people to beat this virus

By Ashish K. Jha, HGHI

This summer opened with a Memorial Day weekend of crowded beaches, boardwalks and pools. From California to Texas, Missouri to New Jersey, people — some with masks and social distancing, others as if coronavirus had never happened – sought the sun and sand, and time with family and friends. After more than two months of staying mostly at home, it’s more than understandable.

Every second infection comes from a healthy person

But there’s a problem with this rushed return to life-as-usual: We don’t know who in these crowded places is passing the coronavirus to others. Evidence now shows that nearly half of the spread of COVID-19 is from people with no symptoms – people who feel fine, and don’t know they are infected. Finding them and controlling the disease demands drastically increasing testing of healthy people—and no state is currently doing enough of that.

To understand the gravity of this development, and where we are falling behind, let’s rewind: As the pandemic hit, an avalanche of COVID-19 cases quickly overwhelmed our national testing capacity. Unprepared to test large numbers of people, we largely focused our limited testing capacity on those that were really sick. And we told everyone else to stay home and not even bother getting tested because the tests just weren’t there.

We all know what happened next: The rapid spread of the virus killed many Americans and shut down our economy. This week, we are facing the grim reality of surpassing 100,000 COVID-19 deaths in the U.S.

What if we knew who at the beach had been in touch with an infected person?

We must not repeat this cycle. While testing still falls short in many places, efforts to ramp up production are having an impact and our testing capacity is finally improving. With greater capacity, we finally have an opportunity to use testing not just to diagnose those with serious symptoms, but also to track the virus and prevent its spread. And the only way to do that? Testing healthy people. A lot of them. And often.

What if we knew which beachgoer had recently come in contact with an infected person? Testing contacts of infected people allows us to catch follow-up infections quickly and isolate those who test positive for the virus, making it easier to control disease spread. This so-called “Test, Trace and Isolate” strategy is used by the White House to keep the President safe: everyone who comes in contact with him, no matter how briefly, is now tested for the virus every day. It is essential we do this (though not everyone needs to be tested every day) for the rest of the country.

Work in a high risk setting? Get tested. Often

Our Harvard Global Health Institute model estimates we should test at least an average of 10 contacts of every known case. That’s a lot of testing of healthy individuals.

We also need a strategy to regularly test people in high risk settings, such as residents and staff of nursing homes, grocery stores and meat plant workers, and all healthcare workers. They all need to get tested frequently, regardless of symptoms.

And reliable tests must be readily available outside of hospitals so it will become easier to get tested, and free of charge for consumers. Drive by clinics are a good example, such as CVS’s recent move to offer a quick 30 minute test for free at 50 pilot sites in five states. Apple maps now includes testing locations across the nation in its Maps App.

Got a call from a contact tracer? Get tested right away

We all must also get comfortable with the fact we may get tested soon and often.

You may have a sick family member or colleague that you’ve been in contact with – and you should get tested so you don’t infect others. You may receive a call from a contact tracer that you unknowingly came in contact with a sick person – maybe at a coffee shop, or maybe it was the plumber who fixed your leaky pipe. It’s important to take that call and take action.

Because there is no national strategy or detailed guidance from the Centers for Disease Control, states are struggling: Each state is building its own strategy to expand testing to more contacts and settings. In many ways, each state is starting from scratch.

And while they do, our nation is losing valuable time. It is clear and must be recognized: Testing remains the best weapon we have in the fight against this virus. Until there is a vaccine, our testing strategy has to include testing enough asymptomatic—healthy—people for the virus.

States need everyone’s help to stop the spread

So should you get tested? If you’ve been in contact with someone who is infected, you should. If you are visiting a high risk location, such as a nursing home, you probably should. If you have any symptoms of COVID-19, even mild ones, you should. Knowing whether you have the virus is critical to helping you – and to helping slow down the spread.

There is another type of test that will augment virus testing in the coming months: Antibody testing, which checks if a person has had the virus in the past and has developed antibodies. This test helps us better understand how much infection already has happened. The reliability of antibody testing will be getting better and it is an important supplement to the virus testing that is so essential.

Let’s remember that testing does not make people sick—the virus does that. Testing helps us stop the spread of this virus. We need robust systems across the nation to strategically and frequently test lots of healthy people. As beaches and other aspects of public life open up again, we must be smarter this time around. We can get ahead of this virus with a robust testing program. But we can’t beat it by pretending it is not there.

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